DEMOCRATIC PEOPLE'S REPUBLIC OF 23 October 1998 : HEALTH AND NUTRITIONAL SUPPORT

appeal no. 28/97 situation report no. 06 period covered: 14 August - 14 October 1998

The joint International Federation/Red Cross Society of the Democratic People's Republic of Korea health and nutritional programme, begun in November 1997, is now approaching completion and planning for 1999 is underway. As winter approaches, the planned winterisation programme must be given priority to ensure the needs of vulnerable people living in remote, mountainous areas.

The context

Following major flood disasters in 1995 and 1996, the drought in 1997 and the decline in the economic situation in the Democratic People's Republic of Korea, it became clear that urgent health requirements needed to be addressed at both the provincial/county levels and the ri-levels. The overall Red Cross programme in DPRK is made up of four distinct but closely interconnected components; health, food, disaster preparedness and winterisation. The programme continues to assist some 3.5 million beneficiaries in 25 counties in the Red Cross operational areas of and North . The health project supplies essential drugs to 853 health institutions as well as training to some 12,000 medical personnel.

Latest events

The DPRK has so far largely escaped the widespread flooding that has affected parts of and the Republic of Korea but has experienced severe localised flooding in the east and west of the country following torrential rain in late August. The Flood Disaster Rehabilitation Committee (FDRC) organised a three day assessment mission to the affected area for representatives from OCHA, WFP, UNDP, FAO, WHO, UNICEF and the International Federation. The team estimated that in the eastern region approximately 30,000 hectares of agricultural land had suffered varying degrees of damage,

towns and several villages had been damaged, water supply systems had been disrupted, and roads and bridges had been destroyed.

Access to Chagang province, one of the Red Cross operational provinces, was temporarily blocked to all international staff for a couple of weeks at the end of September/beginning of October. The timing was unfortunate as the fourth distribution of drugs and coal delivery to medical institutions had just appeal no. 28/97 situation report no. 6

taken place. The temporary closure of the province has meant that monitoring of these distributions by the International Federation delegates has been limited. The province has recently become accessible to International Federation staff once again.

Whilst access to certain areas varies between the different international humanitarian agencies, the principle of 'no distributions to areas that are inaccessible to international staff', is upheld by international organisations. Despite submitting monitoring plans in advance, it is not possible to predict with any degree of certainty when certain areas will or will not be accessible. This of course creates difficulties for international organisations in terms of transparency and being able to effectively monitor distributions of food and non food items.

The long awaited UNICEF/ECHO/WFP nutrition survey started at the end of September. Field visits and collection of data from households which were randomly selected by the UNICEF/ECHO/WFP teams has been completed and a full report should be available by the end of October.

Harvesting of the maize and rice crops is currently underway and in the rural areas the maize grain is sorted and laid out to dry on the sides of the road. The FAO/WFP Crop and Food Supply Assessment Mission which aims to identify the overall food availability during the next agricultural year is due to start in mid-October.

Progress is being made with regard to the signing of the Status Agreement between the government of the DPRK and the International Federation. After three years of intensive support from the International Federation to the DPRK Red Cross, there is a need to formalise such an agreement and the Federation hope to be in a position to sign the Status Agreement before the end of the year. Discussions between the Federation and the FDRC regarding the recently imposed driving restrictions for international Federation staff within continue to take place. Red Cross/Red Crescent action

Winterisation programme l A total of 3,540 pairs of shoes donated by the Canadian Red Cross were distributed predominantly to children and teenagers in 18 counties in and 7 counties in Chagang province. Positive feedback regarding the quality of the shoes was given to the Federation/DPRK Red Cross relief team during their monitoring visit.

In preparation for the winter months, 4,000 metric tons of coal dust has been purchased locally by the Federation and was distributed during September:

w 3,000 metric tons was delivered to 108 hospitals at provincial, county and ri levels in 18 counties in North Pyongan province w 1,000 metric tons was distributed to 38 hospitals at county and ri level in 7 counties in Chagang province

Due to the shortage of other sources of energy, the coal is not only used for heating but for cooking and sterilisation of medical instruments. On average, each provincial hospital received 180 metric tons of coal, each county hospital between 40-60 metric tons and each ri hospital between 10-20 metric tons to last between 2-3 months. Samples of coal have been collected by the Federation/DPRK RC relief team, at 1,000 ton intervals and sent to the China National Centre for Quality Supervision

and Test of Coal to assess the calorific value of the coal. The results received so far indicate that the coal is of a high quality.

Due to the closure of Chagang province after the coal distribution had taken place, it was only possible for the Federation's relief delegate to monitor 3 out of the 7 counties in Chagang province, the remaining 4 were monitored by the DPRK Red Cross relief team. 2 appeal no. 28/97 situation report no. 6

Monitoring of the coal distributions has shown that many of the medical institutions in the Red Cross operational areas have broken windows and doors. To ensure that the value of distributing coal is not lost by heat escaping through broken widows, there is an urgent need for the Federation/DPRK RC relief team to purchase plastic sheeting and wooden frames to mend the windows before the temperatures plummet during the winter months.

Food Aid programme P Unfortunately, the 1,500 metric tons of maize grain procured in China for the August distribution was delayed due to quality control problems, the breakdown of the ship and the arrival of the consignment in port during the celebrations of the 50th anniversary of the DPRK. This consignment was finally distributed at the beginning of September.

Similar problems relating to the quality of the second maize consignment (1,300 mts) due to be distributed at the beginning of September had to be resolved before the consignment could be distributed at the end of September.

Whilst the distribution of both consignments was mostly carried out using the public distribution system buildings with each beneficiary receiving between 135-150 grams per day, there are examples of local branches adapting the system depending on the geographical location of their beneficiaries and hence their access to food.

As the distribution of the second consignment of maize and the start of the maize harvest in the Pihyon area coincided, the local DPRK Red Cross branch in Pihyon (North Pyongan province) adopted a different but equally rational and logical approach to the distribution of maize. The Branch decided to distribute 6 kilograms of maize grain per person per month to the beneficiaries living in the town and 3.2 kilograms per person per month to those living in the rural areas who had better access to maize and other food sources.

The Provincedistribution of the twoNumber consignments of of maizeMaize grain (MT) is outlined Numberin the table of below: beneficiaries counties North Pyongan 18 2,373.15 282,102 Chagan 7 426,15 51,473 TOTAL 25 2,799.3 333,575

A donation of 5,026 cartons of canned beef from the Austrian Red Cross arrived at Nampo port at the end of August and was distributed to city and county hospitals in September. In North Pyongan province, 24 hospitals received 3,908 cartons of canned beef, and 8 hospitals in Chagang province received 1,118 cartons.

Health Programme P The International Federation/DPRK Red Cross were able to respond to the reported increase in the incidence of diarrhoea and respiratory infections as a result of the flooding in the east of the country. An appropriate selection of 'loose medicines' from the December 1997 and June 1998 re-packing of medical kits was approved by the Ministry of Health and distributed through the local Red Cross

Branches to assist those affected by the flooding in 6 counties in South Hamgyong and 3 counties in Kaesong in October 1998. Preparation for the fourth quarterly drugs distribution targeting 853 medical institutions (see breakdown in table attached - annex 1) in North Pyongan and Chagang provinces went smoothly and no problems were detected by the Ministry of Health during the routine testing of the drugs. The Federation/DPRK Red Cross health team have been able to use the newly arrived refrigerated truck , provided by the 3 appeal no. 28/97 situation report no. 6

Norwegian Red Cross and the two new Mercedes trucks to distribute the drugs to the county storage warehouses. Previously, county hospitals have had to arrange their own transportation to Pyongyang to collect the drugs.

The Federation/DPRK Red Cross health team were able to monitor the supply of drugs in the county medical warehouses in 17 out of the 18 counties in North Pyongan province. The drugs had already been distributed from the county medical warehouse in Uiju before the team arrived. Due to the closure of Chagang province the Red Cross team were only able to monitor the distribution of drugs in one out of the seven counties.

As well as monitoring, visits carried out by the health team to medical institutions have provided a good opportunity for the Red Cross health personnel to meet with local doctors to discuss any problems or questions they may have with regard to the drugs or manuals. For example, to discuss the use and storage of medicines such as Oxytocin. This feedback from the doctors is invaluable and has formed the basis of the 1999 operation which is currently being drawn up and will be finalised with the Federation health assessment team during their forthcoming visit in mid-October. Another purpose of the monitoring visits is to enable the team to check that the weekly drugs consumption reports and individual drug stock cards are correctly completed.

The importance of the traditional Koryo medicines in the treatment of minor ailments, such as the common cold and colitis cannot be underestimated and many medical institutions produce their own plants to support this. The team have also visited substitute food factories in Hyangsan, and to gain a better understanding of this additional food source as these foods are increasingly being incorporated into the daily diet. Acorns are ground together with maize to make a powder which is then mixed with water. The dough is fed through a machine to produce noodles or noodle cakes. The Federation/DPRK Red Cross health team would like to have these noodles analysed to assess their nutritional value, and if necessary, propose an appropriate vitamin or mineral additive.

A new Federation Health delegate started at the beginning of September with the specific objective of planning, implementing and evaluating the training component of the health programme. Following briefings and orientation field trips an initial assessment of the ongoing training programme and future needs has started. As a result of two separate assessment missions, WHO and UNICEF have proposed using the Red Cross diarrhoea prevention training programme throughout the DPRK due to its perceived success. The joint WHO/MSF/International Federation updated drugs information manual, pending a few corrections, is almost ready for printing though funding is still to be confirmed.

Throughout September and October, the International Federation/DPRK RC health and relief teams have been able to 'share' the monitoring of both the coal distribution and the fourth drugs distributions.

The Federation have received a verbal agreement from the Ministry of Health to start collecting information on disease patterns and prescription analysis from certain institutions in the Red Cross operational areas.

Disaster Preparedness Programme P The construction of the DPP Centre in Pyongyang is proceeding as planned. Due to a shortage of funding, the proposed visit by the British Red Cross supported Construction consultant has been

postponed until later in the year. Funds are needed so that the Federation/DPRK Red Cross can begin the construction programme.

The distribution of emergency stocks to the six regional Disaster Preparedness warehouses in Kaesong, , Sinuiju, , Nampo and Huichon has started to ensure that stocks are in place before the roads in some of the more remote parts of the country become impassable in winter. 3,000 blankets have been transported to the warehouses in Sinuiju and Huichon and the plan is to ensure that there are

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5,000 blankets in Kaesong, Sinuiju and Huichon warehouses before winter. The Federation/DPRK Red Cross relief team plan to distribute the remaining 12,000 jackets currently in the warehouse before the winter months.

Federation Delegation P The International Federation now have a team of six staff in the DPRK and one member of staff based in Beijing; comprising one HoD, two health delegates, one relief delegate, one logistics delegate, one finance/reporting delegate and one logistics delegate based in Beijing to assist with procurement. Outstanding needs

The Federation is still seeking funds (CHF 450,000) to cover basic operational costs for the period November and December 1998, in addition to further contributions for the completion of the DPP centre (CHF 352,040) and the coming winterisation programme. With winter fast approaching where temperatures can plummet to below -15C, additional funds are needed to procure additional warm clothing to be distributed to beneficiaries, particularly those living in mountainous areas, and to procure plastic sheeting and wooden frames for the basic repair of windows and doors in medical institutions. External relations - Government/UN/NGOs/Media

The Federation/DPRK Red Cross Health team continue to participate in the bi-monthly health co-ordination meetings chaired by UNICEF. Discussions have taken place between UNICEF, the International Federation and the FDRC regarding the possibility of the International Federation increasing its current operational area to include two additional provinces - South Pyongan and Kaesong Province - in the 1999 operation. Since these discussions, Kaesong has been temporarily closed to international staff. Contributions

See Annex 2 for details. The coverage of the present Appeal (28/97) is 43%. However, with funds carried over from the previous appeal, the current operational budget is 76% covered. Conclusion

The International Federation needs continued support from donors to implement the well-received health, food, disaster preparedness and winterisation programmes it implements together with the Red Cross Society of the DPRK.

Peter Rees-Gildea Hiroshi Higashiura Director Director Operations, Funding & Reporting Department Asia & Pacific Department

BREAKDOWN OF MEDICAL INSTITUTIONS TARGETED FOR DISTRIBUTION ANNEX 1 PROVINCE COUNTY PROVINCIAL COUNTY RI CLINICS INDUSTRIAL HOSPITAL HOSP HOSPITAL HOSPITALS CHAGANG Huichon 2 5 40 3

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Tongsin 1 5 22 0 Kopung 1 2 17 0 Usi 1 4 22 1 Chosan 1 4 21 0 Uiwon 1 6 28 2 NORTH Sinuiju 1 3 3 48 1 PYONGAN Ryonchon 2 42 29 2 Yonmju 1 64 25 1 Cholsan 1 46 24 1 Tongrim 2 74 26 0 Souchon 1 57 31 1 Kwaksan 12 35 34 0 Jongju 2 63 48 1 Unjon 2 6 27 0 Pakchon 1 7 20 0 Kujang 1 3 28 3 Hyangsan 1 3 16 0 Unsan 1 4 26 2 Taechon 1 3 27 1 2 6 35 2 Uiji 1 6 20 1 Pihyon 2 5 29 2 Byokdong 1 4 18 0 TOTAL 25 1 35 111 681 25

PROVINCIAL HOSPITAL - referral hospital for the province (approx 350 beds) COUNTY HOSPITAL - average 200 beds, 30,000 catchment population, referral for the ri hospitals RI- HOSPITAL - 7-10 beds. 3,000 - 5,000 catchment population CLINIC - no in patient facility, 1,000 - 3,000 catchment population

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KOREA - HEALTH AND NUTRITIONAL SUPPORT

APPEAL No. 28/97 PLEDGES 22/10/98 RECEIVED

DONOR CATEGORY QUANTITY UNIT VALUE CHF DATE

CASH APPEAL COVERAGE

REQUESTED IN APPEAL 20,011,000 43%

CANADIAN - RC 15,000 CAD 13,590 27/11/97 ECHO (DANISH RC) 2,000,000 XEU 3,192,600 27/01/98 DIRECT TO ONS FINNISH - RC 250,000 FIM 67,300 09/12/97 GERMANY - RC 500,000 DEM 404,250 15/01/98 WINTER RELIEF GERMANY - GVT 182,500 DEM 146,475 23/03/98 BLANKETS/SHEETS GERMANY - RC 250,000 DEM 205,000 21/08/98 FOOD GREAT BRITAIN - RC 110,000 GBP 275,000 25/03/98 DP CENTRE GREAT BRITAIN - RC 15,000 GBP 37,500 25/03/98 FOOD IRISH - RC 4,360 IEP 8,680 16/02/98 JAPANESE RC 24,000,000 JPY 271,464 06/02/98 MOTO/BIKES JAPANESE - RC/ROTARY 5,850,000 JPY 66,169 24/02/98 RICE INT'l CHINA/HONG KONG - RC 300,000 HKD 54,482 15/12/97 CHINA/HONG KONG - RC 319,075 HKD 62,558 31/03/98 HEALTH & NUTRITION CHINA/HONG KONG - RC 59,635 HKD 11,484 18/08/98 MAGEN DAVID 500.00 USD 718.00 12/01/98 ADOM/PRIVATE DON. NORWEGIAN - RC/GOVT 2,000,000 NOK 395,930 10/08/98 FOOD NORWEGIAN - RC 500,000 NOK 98,983 10/08/98 DP CENTER NEW ZEALAND - RC 50,000 NZD 38,565 18/06/98 DP CENTER NEW ZEALAND - RC 11,115 07/08/98 SPAIN - RC 2,307 USD 3,345 11/02/98 SWEDISH - RC/GOVT 4,500,000 SEK 864,450 05/05/98 WINTERISATION SWISS - RC 12,000 08/01/98 TRANSPORT KITS SWISS - RC 100,000 19/01/98 WINTER CLOTHE SINGAPORE - RC 887,760 SGD 792,000 13/01/98 RICE SINGAPORE - RC 104,149 14/04/98 WINTER JACKETS UNITED ARAB EMIRATES RC 5,000 USD 7,500 06/10/98 PRIVATE DONORS 3,642

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SUB/TOTAL RECEIVED IN 7,248,948 36% CASH

KIND AND SERVICES

BELGIUM - RC DELGATES 15,000 26/01/98 CANADA - RC DELEGATES 30,000 26/01/98 DENMARK - RC DELEGATES 20,000 26/01/98 SWISS DELEGATES 30,000 26/01/98 FINNISH DELEGATES 30,000 15/08/98 GREAT BRITAIN - RC DELEGATES 45,000 26/01/98 NORWAY - RC DELEGATES 25,000 26/01/98 NORWAY - RC RELIEF 904,842 04/02/98 ITEMS NORWAY - RC TRANSPORT 107,916 04/02/98 SWEDEN - RC DELEGATES 60,000 26/01/98 SWEDEN - PRIVATE DONOR MAIZE 600.00 MT 152,250 26/01/98

SUB/TOTAL RECEIVED 1,420,008 7%

NOT REQUESTED IN APPEAL

CANADIAN - RC BOOTS 70,517 CAD 73,373 15/05/98 EGYPTIAN - RC MEDICAL 72,500 28/02/98 SUPPLIES JAPANESE - RC 9.000 KG / 28,155 11/06/98 RICE SWEDEN - RC BABY SETS 4,700 SETS 177,399 23/03/98 SWISS - RC EMERGENCY 124,000 31/12/97 KITS (17) SINGAPORE - RC FIRST AID 175,840 06/03/98 KITS (8.000) AUSTRIA RC CAN BEEF 50.00 MT 28/08/98

SUB/TOTAL RECEIVED 651,266

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