DEMOCRATIC PEOPLE'S REPUBLIC OF 23 October 1998 KOREA: 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 Chagang Province and North Pyongan Province. 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 China 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 Pyongyang 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 North Pyongan province 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 Nampo 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.