North Korea’s healthcare system is in dire straits, says Amnesty reportBMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c3903 (Published 19 July 2010) Cite this as: BMJ 2010;341:c3903
North Korea’s state healthcare system is in a crisis, with hospitals and clinics lacking essential drugs and supplies and doctors forced to reuse hypodermic needles and to carry out operations, including amputations, without anaesthesia, says a report by Amnesty International.
Many facilities are run down and often have power cuts and no heat. At night staff members sometimes have to work by candlelight, says the report.
Because of the shortages health workers “recycled medical supplies until worn, sometimes with little regard to hygiene and safety,” it says. The report draws on interviews with more than 40 North Koreans who left the country and with aid organisations and health professionals who work there. They say that medical personnel often do not receive salaries and have little or no access to drugs.
The report says, “Even if patients receive a medical diagnosis, they must first buy the recommended medicine at a market or a private home. If it is an injection, then the drug is brought back to the hospital for the doctor to administer.”
It is “common knowledge” that health workers sell hospital drugs privately or to market vendors as a means to earn an income to survive, it says.
“As doctors have begun charging for their services, which is illegal under North Korea’s universal health care system, the poor cannot access full medical care, especially medicines and surgery,” says the report.
“During operations, patients, if lucky, are given anaesthetic but sometimes not enough to completely control the pain.”
Contrary to claims by the government that its healthcare system is free for all, North Koreans have had to pay either in kind or in cash for medical care since the 1990s, says Amnesty.
Doctors receive cigarettes, alcohol, or food for basic consultations and cash payments for surgery or treatment that entails further tests, radiography, or hospitalisation.
Catherine Baber, Amnesty’s deputy director for the Asia-Pacific region, said, “North Korea has failed to provide for the most basic health and survival needs of its people.”
The charity’s assessment is at variance with that of Margaret Chan, director general of the World Health Organization, who after a trip to North Korea in April said that its universal coverage meant that “people in the country do not have to worry about a lack of financial resources to access care.”
Dr Chan also said that with its abundance of medical personnel and elaborate health infrastructure the people of North Korea “have something which other developing countries would envy.”
Amnesty argues that “health issues cannot be separated from the food insecurity” that has gripped North Korea for almost two decades. Emilia Casella, a spokeswoman for the World Food Programme, told the BMJ that one in three children in Korea aged under 5 years are stunted, a fifth are underweight, and about a quarter of pregnant women and breastfeeding mothers are malnourished.
Amnesty says that the South Korean aid group Good Friends reported that “thousands of people starved to death in South Pyongan province between mid-January and mid-February 2010” as a result of a currency revaluation last November that triggered spiralling inflation and doubled the prices of food staples.
Cite this as: BMJ 2010;341:c3903
The Crumbling State of Health Care in North Korea is at www.amnesty.org/en/library/asset/ASA24/001/2010/en/13a097fc-4bda-4119-aae5-73e0dd446193/asa240012010en.pdf.