MSF and North Korea 1995-1998

MSF And North Korea 1995-1998

msf speakS out MSF Speaks Out

In the same collection, “MSF Speaking Out”:

- Salvadoran refugee camps in Honduras 1988 Laurence Binet - Médecins Sans Frontières [October 2003 - April 2004 - December 2013]

- Genocide of Rwandan Tutsis 1994 Laurence Binet - Médecins Sans Frontières [October 2003 - April 2004 - April 2014]

- Rwandan refugee camps Zaire and Tanzania 1994-1995 Laurence Binet - Médecins Sans Frontières [October 2003 - April 2004 - April 2014]

- The violence of the new Rwandan regime 1994-1995 Laurence Binet - Médecins Sans Frontières [October 2003 - April 2004 - April 2014]

- Hunting and killings of Rwandan Refugee in Zaire-Congo 1996-1997 Laurence Binet - Médecins Sans Frontières [August 2004 - April 2014]

- ‘Famine and forced relocations in Ethiopia 1984-1986 Laurence Binet - Médecins Sans Frontières [January 2005 - November 2013]

- Violence against Kosovar Albanians, NATO’s Intervention 1998-1999 Laurence Binet - Médecins Sans Frontières [September 2006]

- War crimes and politics of terror in Chechnya 1994-2004 Laurence Binet - Médecins Sans Frontières [June 2010-September 2014]

- Somalia 1991-1993: Civil war, famine alert and UN ‘military-humanitarian’ intervention Laurence Binet - Médecins Sans Frontières [October 2013]

Editorial Committee: Laurence Binet, Françoise Bouchet-Saulnier, Marine Buissonnière, Katharine Derderian, Rebecca Golden, Michiel Hofman, Kris Torgeson - Director of Studies (project coordination - research - interview - editing): Laurence Binet - Assistant: Bérengère Cescau - Transcription of interviews: Laurence Binet, Françoise Courteville, Pascale Donati, Jonathan Hull, Mary Sexton - Translation into English: Amanda Harvey, Imogen Forster, Caroline Lopez-Serraf, Nicolas Rainaud - Proof reading: Rebecca Golden - Jacqui Tong Design and layout: TC Graphite - Video research: Céline Zigo – Video editing: Sara Mac Leod - Website designer: Sean Brokenshire.

Thanks to MSF Australia team for their support. Thanks to Rony Brauman for his advice.

Produced by the Médecins Sans Frontières International Movement. MSF Australia is in charge of the design, running, update, and promotion strategy of the website http://speakingout.msf.org

2 © Médecins Sans Frontières. October 2014. Foreword MSF and North Korea 1995-1998 MSF and North Korea

This publication is part of the “Médecins Sans Frontières Speaking Out” case studies series prepared in response to the MSF International Council’s wish to provide the movement with literature on MSF témoignage (advocacy).

The idea was to create a reference document that would be straightforward and accessible to all and help volunteers understand and adopt the organization’s culture of speaking out.

It was not to be an ideological manual or a set of guidelines. Témoignage cannot be reduced to a mechanical applica- tion of rules and procedures as it involves an understanding of the dilemmas inherent in every instance of humanitarian action.

The International Council assigned the project to a director of studies, who in turn works with an editorial committee composed of MSF representatives chosen by the International Board for their experience and expertise. They serve in their capacity as individuals and do not represent their national sections.

Faced with the difficulty of defining the term témoignage, the editorial committee decided to focus the series on case studies in which speaking out posed a dilemma for MSF and thus meant taking a risk.

Key information sources -MSF volunteers’ written and oral recollections — are reconstructed by highlighting documents from the period concerned and interviewing the main actors.

The individuals interviewed are chosen from lists prepared by the operational sections involved in each case. Speaking in the language they choose, these individuals offer both their account of events and their assessment of MSF’s response. The interviews are recorded and transcribed.

Document searches are conducted in the operational sections’ archives and, as far as possible, press archives.

The research is constrained by practical and financial issues, including locating interviewees and securing their agreement and determining the existence, quality and quantity of archived materials.

The methodology aims at establishing the facts and setting out a chronological presentation of the positions adopted at the time. It enables the reconstruction of debates and dilemmas without pre-judging the quality of the decisions made.

The main text describes events in chronological order. It includes excerpts from documents and interviews, linked by brief introductions and transitional passages. We rely on document extracts to establish the facts as MSF described and perceived them at the time. When documentation is missing, interviews sometimes fill the gaps. These accounts also provide a human perspective on the events and insight into the key players’ analyses.

Preceding the main texts collected, the reader will find a map, a list of abbreviations and an introduction that lays out the context of MSF’s public statements and the key dilemmas they sought to address.

In addition, a detailed chronology reconstructs MSF’s actions and public statements in regional and international news reports of the period.

3 MSF Speaks Out

Each case study was written in French and translated into English and is available in both languages.1

These case studies were essentially designed as an educational tool for associative members of the organisation. With the hope of broadening their educational scope the studies are now being made available to the public for free, on the website www.speakingout.msf.org, the various English and French-language websites of individual sections of Médecins Sans Frontières, and on Google Book.

We hope you find them useful.

The Editorial Committee.

September 2013

4 1. Document excerpts and interviews have been translated into both languages. CONTENTS MSF and North Korea 1995-1998 MSF and North Korea

People interviewed and their position at the time of the events " " " " " " " " " " " " " " " " page 6

Abbreviations " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " page" " " " 7" " "

Maps " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " page 8

Introduction " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " page 9

MSF and North Korea 1995-1998 " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " page 11

Chronology of events " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " " page" " " 175

5 MSF Speaks Out

Peo ple interviewed and their position at the time of the events

Dr. Philippe Biberson President MSF France - interviewed in 2000 Marine Buissonnière Administrator, MSF France in China, December 1996 to January 1999; Director of programs, MSF Japan, April 2000 to September 2001; Coordinator MSF France in South Korea, February 2002 to November 2003; General Secretary, MSF International 2004-2007; Exploratory mission MSF Switzerland, April 2007 - interviewed in 2007 Samantha Bolton Communications coordinator, MSF International - interviewed in 2000 William Claus MSF Belgium Programme Manager - interviewed in 2000 Sophie Delaunay Research officer, Foundation MSF France, June to August 1998; Coordinator, MSF France in China, January 1999 to December 2001; co-coordinator, MSF France in South Korea, January 2002 to October 2003 - interviewed in 2007 Antoine Gérard Head of Programmes Department, MSF USA - interviewed in 2000 Dr. Eric Goemaere Executive Director MSF Belgium - interviewed in 2000 Pim De Graaf MSF Holland Executive Director - interviewed in 2000 Dr. M Physician, MSF Programme in DPRK, September to December 1995, January 1997 - interviewed in 2000, June 1997 - interviewed in 2001 Anne-Marie Huby Executive Director, MSF UK - interviewed in 2000 Dr. Dominique Lafontaine Physician, MSF Programme in DPRK, August 1997 to September 1998 - interviewed in 2007 Olivier Lesrel Manager of MSF’s Emergency Food Cell Marie-Rose Pecchio Coordinator, MSF Programme in DPRK, November 1997 to September 1998 - interviewed in 2001 Jules Pieters MSF Holland Emergency Programme Manager Pierre Salignon MSF France Programme Manager, from October 1997 on, then MSF France Executive Director from January 2004 on - interviewed in 2000 Dr. Corien Swann Physician, MSF Programme in DPRK, January to September 1998 - interviewed in 2007 Dick van der Tak Coor dinator MSF Holland in China, January 1999 to May 2000; MSF Holland HAD adviser, July 2000 to June 2003; MSF Hong Kong Executive Director from 2003 on - interviewed in 2007

6 A bBrEviations MSF and North Korea 1995-1998 MSF and North Korea

ACF Action contre la faim ICRC International Committee of the Red (Action Against Hunger) Cross AEDES Agence européenne pour le KEDO Korean Energy Development développement et la santé (European Organisation Agency for Development and Health) MDM Médecins du Monde AP Associated Press (Doctors of The World) BBC British Broadcasting Corporation MOU Memorandum of Understanding BP5 Biscuits protéinés MUAC Mid-Upper Arm Circumference (High Proteïn Biscuits) (method of assessment of malnutrition) CAD Comité d’aide au développement NBC National Broadcasting Company (Development Aid Committee) NRC Nutritional Rehabilitation Center CDC Center for Disease Control OCHA Office for the Coordination of the and Prevention Humanitarian Affairs (United Nations) CBS Columbia Broadcasting System ORS Oral Rehydratation Salt CESVI Cooperazione e sviluppo Oxfam Oxford Commitee for Famine Relief (Italian Cooperation and Developement Organisation) PDS Public Distribution System (North Korea) CIA Central Intelligence Agency DPRK Democratic People’s Republic of Korea CNN Cable News Network WHO World Health Organisation DG 8 European Union Direcorate General (United Nations) in Charge of Humanitarian Action SCF Save the Children Fund ECHO European Community Humanitarian Office TFC Therapeutic Nutrition Center EuronAid European Ngos network UDA Unité de distribution alimentaire (Food Aid Distribution Cell) FAO Food and Agriculture Organisation (United Nations) Unicef United Nations Children’s Funds FDRC Flood Damages Rehabilitation UNDP United Nations Development Committee Programme GAA Global Action on Aging Unesco United Nations Science, Education and Culture Organisation HCR-UNHCR United Nations High Commissioner for Refugees USAID United States Agency for International Development ICN Institute for Children Nutrition WTN Worldwide Television News IDA International Dispensary Association (international video press agency IFRC International Federation of Red Cross + merged with Associated Press TV Red Crescent Societies (APTV, UK) in 1998)

Click to access the reference material list. Extract from MSF archives or press clippings. Then click on the refering number to access the full document.

Extract from interviews conducted in 2000, Click to access the reference material list. 2007 people who participated and/or wit- Then click on the refering number to access nessed the events. the video. 7 MSF Speaks Out

msf programmes north korea 1995-1998

RUSSIAN FEDERATION Yanji

CHINA

North Hamgyong : 1995,1997, 1998 JILIN NORTH Chongjin HAMGYONG Hyesan

LIAONING YANGGANG

Kanggye

SOUTH Yalu River CHAGANG Dandong NORTH HAMGYONG Sinuiji PYONGYAN Ryongsong

Hamhung South Pyongyan : 1995, 1997, 1998 SOUTH PYONGYAN Tonhan JAPAN

Korea Bay Wonsan PYONGYANG SEA North Hwanghae : 1995, 1997, 1998 Bay Nampo or NORTH Kangwon : 1995, 1997, 1998 Sariwon HWANGHAE KANGWON Eastern Sea SOUTH HWANGHAE

Haeju Kaesong

YELLOW SEA SOUTH 38th parralel SEOUL K OREA

8 INTRODUCTION MSF and North Korea 1995-1998 MSF and North Korea

In August 1995, for the first time in its history, North Korea launched a call for international aid following the destruction of its harvests by flooding. Following the breakdown of the Soviet Union, its main source of support, the planned economy of this closed off country gradually collapsed. The population, completely dependent on the regime’s arbitrary resource management, experienced shortages of energy, food and medicines. The countries involved in the Korean crisis ( regional powers and the USA) were anxious to avoid a sudden collapse of North Korea, which would impact on the entire region. They were encouraging peace negotiations between the two Koreas and a freezing and dismantling process of North Korea’s nuclear arms. The United-Nations responded to this appeal with the delivery of millions of tons of aid, thereby entering into years of an on-going bargaining process linking the progress of negotiations to the allocation of aid.

From October to December 1995, an international MSF team, composed of volunteers from the Belgian, French and Dutch sections, set up a programme in North Korea providing epidemiological monitoring of diarrhoea and distributing medicines and medical material.

In January 1997, MSF again received authorisation to open up a barley seed distribution programme, and then, from June 1997 on, over several provinces, a one year programme providing support to improve nutritional therapeutic care to malnourished children, the distribution of medical material and medicines and training, and drinking water to health centres.

For one and a half years, 13 MSF expatriates from three different sections followed the example of their colleagues who had passed through the country in 1995, working under tight surveillance and being unable to evaluate needs on the basis of objective criteria or check the final destination of their aid. Nonetheless, some of them were encouraged by certain signs or events. There was the organisation of case management for a group of children totally excluded by the system, for example.

Meanwhile, the MSF France team in China, receiving information on the outcome of North Korean refugees in China, carried out two visits (in April and August 1998) to the Sino-North Korean border. The refugees provided them with descriptions of a large-scale famine, violence and the reign of the arbitrary in the country. They also reported that international aid was distributed as a priority to the army and individuals identified as “socially useful” and faithful to the regime. This situation was also reported by South Korean organisations providing assistance to refugees and the international press, which started containing echoes of famine in North Korea.

In August 1998, after several months of negotiation on the renewal of the Memorandum of Understanding, the North Korean authorities made only one proposition to MSF, being the organisation of an importation programme for basic materials, allowing the regime to rehabilitate the country’s pharmaceutics industry. MSF refused, considering that this type of activity did not fall within the mandate of a medical humanitarian organisation, and withdrew from North Korea.

9 MSF Speaks Out

Throughout this period, the occasions when MSF spoke out in public, whilst conducted in the name of the entire movement, caused disagreement between sections and/or between headquarters and the field teams. As it turns out, there are contradictions in their contents.

In December 1997, during a press conference, MSF insisted publically on the necessity of providing emergency assistance to the North Korean health system. In April 1998, in the international press, MSF described the restrictions imposed on its teams during their activities carried out for the North Korean population and their doubts on the final destination of their aid, but stated that it did not have any solid proof for denying or confirming the existence of a famine. At the same time, the international press circulated witness accounts of North Korean refugees, received from the MSF team in China, reporting a famine situation.

On the 1st October 1998, during a press conference, MSF gave a public explanation of the reasons for its withdrawal from North Korea, shared its concern on the outcome of socially disadvantaged children excluded by the system and referred to the witness accounts of the North Korean refugees. It also called on the international community to stop delivering aid to North Korea whilst it was unable to check that the aid was really reaching the most vulnerable members of the population.

Throughout this whole period, MSF was confronted with the following dilemmas and questions:

- Until which limit, could we, in order to draw closer to a population in distress, accept to work without being able to apply the basic principles of humanitarian action: access to populations, free evaluation of needs and supervision of the destination of our assistance? - Should we accept to work for a population oppressed by a totalitarian regime with the risk of our assistance serving to reinforce this oppression, support this regime? - Whilst making public calls for emergency aid for the North Korean health system, was MSF not participating in reinforcing the regime?

Epilogue : In the years that followed, the French section, with the support of its internal centre for reflections, continued to document the deviations of international aid delivered to North Korea and spoke out on this subject in the press on several different occasions. At the same time, it ran a programme of little operational stature (because partly clandestine) in an attempt to bring assistance to North Korean refugees in China or in transit through different countries in Asia and South Korea. From 2001 to 2003, MSF France spoke out publically several times to denounce the repression and forced repatriation suffered by these refugees in China, despite the presence of the United Nations High Commissioner for Refugees. As time passed, all MSF’s activities concerning North Korean refugees dwindled to a standstill. Meanwhile in 2004, a visit by a delegation of MSF Holland to North Korea with the aim of preparing an exploratory mission led to nothing. In 2007, new alarms sounded on the food situation in North Korea, and a continuous influx of refugees arrived on the Sino-Korean border, inciting the Swiss section to launch an exploratory mission, then a process of re-opening a programme for North Korean refugees.

10 (DMZ), whichis along the38 are stillseparatedbytheKoreanDemilitarizedZone having neversignedapeacetreaty.Thetwoterritories thus NorthandSouthKorearemaintechnicallyatwar, no armisticeagreementhasbeenimplementedsince, was reachedon27July1953inPanmunjon.However, This was the first conflictofthe Cold War. A ceasefire ily butnotentirelycomposedofsoldiersfromtheUSA. The southwasbackedbyUnitedNationsforces,primar- and receivedsomeassistancefromtheSovietUnion. were supportedbytheChinesePeopleVolunteers’Army ‘Korean War’lasteduntil1953.TheNorthKoreantroops reunify Koreaunderitscommunistsystem.Theensuing allised into aborder. 1. Thereareover35,000 UStroopsinSouthKoreatoday. vention and which arguably, was neverachieved. enough toresistforeigninvasion andcapitalistinter- Korea economically,militarily, andculturallystrong the ideaofself-reliance,which aimedatmakingNorth based ontheJucheideology.Itscentralcomponentis ‘Great Leader’ Kim Il Sung established a dictatorship Democratic People’sRepublicofKorea(DPRK),the In NorthKorea,thefirstandsofaronlypresidentof South Korea, Most oftheUnitedStatesarmedforceswithdrewfrom governments wereestablished.The38 not implemented trusteeship of Korea, so two separate However, by1948theSovietsandAmericanshad Union andthesouthernhalfbyUnitedStates. northern partwastobeadministeredbytheSoviet respectively, todrivetheJapaneseoutofKorea.The areas whereRussiaandtheUStroopswouldoperate parallel. Thislinewaspreviouslychosentodefinethe insula wassplitintotwopartsdividedbythe38th agreement followingJapan’sdefeat,theKoreanpen- after WorldWarII,inaccordancewithaUnitedNations From 1905,KoreawasoccupiedbyJapan.In1945, M People’s Armycrossedthe38 Republic ofKorea.InJune1950,theNorthKorean established inthenewlybornDemocraticPeople’s installed. Atthesametime,acommunistregimewas SF A N 1 whereapro-USAmilitaryregimewas D N OR T th H th parallelwiththeclaimto parallel. K OREA th parallelcryst- 1995-1998 as suchnorwashetheheadofgovernment was the Head of State, though he was never appointed to becomethecountry’snewleader,astechnically,he the ‘EternalPresident’.Hisson,KimJongIlappeared On 7July,1994,KimIlSungdiedandwasdesignated were unknown to the international community. in NorthKorea.However,atthattimetheseproblems the earlyninetiesthatfirstfoodshortagesoccurred According tokeyobserversandresearchers,itwasin budgets were maintained. ground toahalt.Yetthroughoutthistime,military currency shortagesaswellmechanisedfarmingaid tance to North Korean crises including energy and hard after the collapse of the USSR, the end of Soviet assis- of theeasternblock.However,inearly1990’s, partnership withtheSovietUnionandformermembers my grewsignificantly,mainlyoweingtoitsparticular During fourdecadestheDPRKstate-controlledecono- and theSupremeCommander oftheKoreanPeoples’Army. 2. Hewasappointed asChairmanoftheNationalCommission ofDefenceDPRK breaking talks’ would be frequently replicated; the From thattime on, the sequence of ‘resuming talks/ existing reactor in North Korea. tor nuclearpowerplantinNorthKoreatoreplacethe framework, mainlybyconstructingalightwaterreac - by theUSA,SouthKorea,andJapantoimplementthis Energy DevelopmentOrganization(KEDO)wasfounded a nuclearweaponprogramme.TheKoreanPeninsula gramme thatwassuspectedofbeingasteptowards resolve the issues arising from the DPRK nuclear pro- The agreedframeworksoughttocomprehensively nuclear programme. the DPRKagreedtofreezeandultimatelydismantleits of KoreasignedtheAgreedFramework,underwhich the UnitedStatesandDemocraticPeople’sRepublic on 28September,inGeneva.Then,October1994, talks wereheldinPyongyangbutcametoadeadlock ment toresumepeacetalks.On11September1994, July 1994,theUSAandDPRKcametoanagree- 2 . On22

11 MSF and North Korea 1995-1998 MSF Speaks Out

official reason for breaking the talks were because US, goodwill and we thank your organisation in advance, in South Korean, or North Korean ‘spies’ were caught on a the name of the homeless, for being kind enough to join boat, submarine, or helicopter somewhere in or around the efforts to relieve the victims’ suffering following this the Korean peninsula. The defection of North Korean natural disaster. officials or incidents in the DMZ zone were cited as cause for breakdowns in negotiations. Each time, the main stakes to the bargain would be the resumption of the peace talks and the control of the North Korea ”North Korea Makes Rare Plea After Floods nuclear capacity in exchange for increased ‘food aid’ Devastate Country” Kevin Sullivan, The deliveries. Washington Post (Etats-Unis), 22 September 1995 (in English). D2 In July and August 1995, floods affected several regions of North Korea. For the first time in its his- Extract: tory, the DPRK Government, through the Flood Damage Kim Myong Chol, an unofficial spokesman for North Korea Rehabilitation Committee (FDRC), which was a govern- who lives in Tokyo, said the decision to “send an SOS” was ment umbrella organization created in an ad hoc man- made by Kim Jong II. “Kim II Sung was the first generation ner at the time to manage interactions with foreigners of revolutionary fighters, so he would not ask for help,” Kim operating in the country, launched an appeal for inter- Myong Chol said. Kim Jong II is university-educated. He national aid. knows much more about the world. Kim Jong II is proud, but it is not below our dignity to ask for help in the case of a natural disaster. [...] North Korea has few friends, but among them is Bernard Krisher, a former Newsweek corre- ”Call for Emergency Humanitarian Assistance” spondent in Tokyo. Krisher, who is now involved in Asian Letter from the General Delegation of the relief projects, recently sent the North Korean government Democratic People’s Republic of Korea in the a letter asking officials if they would like him to post an French Republic to MSF France, Paris, 28 Internet appeal for donations. August, 1995 (in French). D1 The North Korea’s Flood Damage Rehabilitation Committee Extract: responded by fax on Sept. 17, telling Krisher that it would The General Delegation of the DPR of Korea in the French welcome the Internet campaign. The fax said food and Republic presents its compliments to your organisa- clothing would be welcome, but outside medical personnel tion and takes this opportunity to call on its emergency would not, because North Korea had plenty of “talented humanitarian assistance for the victims of floods caused doctors and nurses.” “North Korea may not be familiar with by the unprecedented torrential rain that inundated sev- the Internet, but it does understand the acute crisis it faces eral regions in our country between 31st July and 18th ...,” says the notice Krisher plans to post this week on the August 1995. Internet. “Politics should not play a role in assisting these helpless and homeless people in need. It is nature, not a As you know, the early hailstorms of October 1994 had political system, that has caused the flooding.” already damaged our country. The havoc continued this year, this time caused by unprecedented flooding which An UN team visited North Korea this month. Based on hit more than 145 areas in 12 provinces and towns com- estimates provided by the North Korean government, the ing under the central authority. The average daily rainfall United Nations reported that the floods caused $15 bil- stood at between 110 to 362 mm, the flooding has affect- lion worth of damage affecting 5.2 million people; 96,348 ed 5.2 million inhabitants and destroyed a large number homes had been damaged, displacing 500,000 people; of homes, factories, agricultural structures and installa- and 1.9 million tons of crops had been lost. G. Faruq tions, livestock farming and facilities used for teaching, Achikzad, head of the UN Development Program office in scientific, public health, transport, [and] communication Pyongyang, the North Korean capital, said in a telephone [infrastructures], and factories, thereby causing consider- interview Wednesday that he had just toured much of the able material damage. According to initial estimates, there affected land by helicopter. He said that while the damage is about 15 billion US$ worth of damage. The priority is severe, most of the homeless are living with neighbors, needs are supplies of food, medicines and diverse articles in schools, or in other public buildings. He said he saw of common usage, as well as other material required for no one without shelter. “You don’t see misery or anything stabilising the lives of the homeless who need to rebuild like that,” Achikzad said. “The government has a very good their ravaged homes, schools, hospitals, railways, and system for dealing with this. It is very regulated and very communications installations as quickly as possible. disciplined.”

Familiar as I am with the humanitarian work carried out In addition to the $1.2 million in cash donations, the by your organisation through its rapid interventions in United Nations and other international organizations similar situations of suffering, the General Delegation of have pledged $700,000 in cash and more than $1 million 12 the DPR of Korea hopes it can count on your humanitarian worth of equipment, supplies and personnel. While that for international assistancefollowingsevere floodsthat In responseto anappealfromthegovernment ofDPRK Extract: by the DPRK authorities. question theseriousnessofsituationasdescribed independent evaluation. However, theteam did not meeting totheotherandwasnotablecarryoutan The team was mainly being paraded around from one conducted anassessmentmissioninNorthKorea. teers from MSFFrance, MSF Belgiumand MSF Holland From 4-9September,1995,anMSFteamofvolun- forced to fly theNorth Korean flag. ing. AnotherSouthKoreanrice-deliveryshipwasbriefly seized ashipdeliveringriceandaccusedthecrewofspy- North Korea.ButinAugust,theKoreanstemporarily Korea is providing 150,000 tons of emergency rice to percent ofSouthKoreansopposedgivingfloodaid. than inSouthKorea,wherearecentpollshowedthat63 Nowhere arethedisasterreliefpoliticsmoretortured rice donations. reasons only. It said Japan is willing to discuss resuming understands that the rice was offered for humanitarian Foreign Ministry said Japan is satisfied that North Korea In itsstatementannouncingtheflood-reliefaid,Japan’s was sendingthericeto“atone”foritspastaggression. tions whenaNorthKorean government official said Japan this year,Japanabruptlyhalteditsemergencyricedona- aid toNorthKorea,butnotwithoutsomescolding.Earlier Japan announced this week that it will send $500,000 in Korea andhalts missile exports. its massivemilitarypresenceonborderwithSouth nuclear program,resumestalkswithSouthKorea,reduces diplomatic ties with North Korea until Pyongyang stops its House ofRepresentativesaskedClintonnottoelevate in Pyongyangasearlythismonth.Butweekthe with North Korea, is scheduled to open a liaison office United States, which has no formal diplomatic relations many criticsintheRepublican-controlledCongress.The program. Thedeal,supportedbyPresidentClinton,has for apromisetohaltitssuspectednuclearweapons deal toprovideitwithnuclearpowerreactorsinexchange still tryingtoreachanagreementwithNorthKoreaona response. The UnitedStates, Japan, and South Korea are communist NorthKoreahascertainlybluntedtherelief is significant,theworld’scomplicatedrelationshipwith (in English). Viretto, Mr Patrick Chomier ”14September 1995 Frontières –4/9/95to10/9/95 –DrGerald People’s RepublicofKorea–MédecinsSans Report onthe“ExploratoryMission–Democratic D3 -To designandproposeaprojectofemergencyassistance. in theaffected areas. -To assesstheimpactofdisasteronhealthsystem Its objectives were: MSF team arrived in Pyongyang on the 4th of September. occurred duringthemonthsofJulyandAugust1995,an their system). to thenegligence oftheirgovernmentand, evenworse, of our expats. This could expose the incredulous masses quantities ofeffectivemedicines andtheregularpresence connection betweenthesudden existenceofsufficient populations would soon work out the cause and effect opinion itisaboveallawkward forthegovernment; surface, whichwouldnotbeappreciated(infact,inour of ourexpatscouldbringthesebadmemoriestothe Japanese colonisationandNipponadvisors. The presence -Awkward: ruralKoreanshavebadmemoriesofthe generally dissatisfied with the UN’swork…). reminded themthat until nowtheyhadclaimedtobe in thefield).Thesetwooptionswereproposedtous(we inauguration ceremonies(bestinP.Y.or,lessinteresting, isfied with supervising from P.Y. or even better, holding -Unusual: other organisations (above all the UN) are sat- bother us rather than honour us). in difficult conditions and life in a luxury hotel would Korean people’snormsofhospitality(we’reusedtoliving are inadequateforwesternvisitorsanddonotmeetthe -Uncomfortable: livingconditionsinthecountryside days in certain areas. (UNICEF, WHO)haverepeatedlyspentseveralsuccessive eigners outsideP.Y.Thisisfalse;membersoftheUN -Illegal: Koreanlawdoesnotallowthepresenceoffor- II) for things tomove very fast… requires theconsentofDearLeader(a.k.a.KimJong ince, county, several ministries involved). In fact, it just obtaining thedifferentauthorisations(capital,prov- -Technically difficult:severalweeksarerequiredfor big stores in Pyongyang). ated (falsebecausewecanfindmedicinesonsaleinthe perhaps been stolen) cannot be commercialised or negoti- in theDPRK,medicines(implyingthathave -Inadequate: asthehealthsystemistotallyfreeofcharge medicines performs sufficiently well. -Superfluous: theirownsystemforsupervisingtheuseof medicines on their own. Korean doctorsaresufficientlycompetentinusingour -Pointless: there’snoneedtohaveexpatsinthefield, 1. Arguments - forthem our presenceis: tiations. This lastpointpresentedastumblingblockinthenego- manent presenceofexpatriatesinthefieldwasaccepted. Clauses 12,13,14and15couldbeacceptediftheper- Extract: Korea, 8 September1995 (in French). the ReportofMSF’sExploratoryMissioninNorth “MoU DPRK/MSF:TermsofNegotiation”Annexto D4

13 MSF and North Korea 1995-1998 MSF Speaks Out

For us, this presence is indispensable because: -It’s an integral part of the moral contract we have with our private donors, which involves guaranteeing the cor- Our first contact was when North Korea called for rect use of their money. international aid, arguing three successive years of -It’s fundamentally ‘humanitarian’, with our teams working floods and droughts, so food difficulties, etc. We alongside the suffering population. sent a first exploratory mission. Photos were circulated on -It’s the way we normally work, in more than 50 countries, its return. We could see that the team was passed around and we do not see any objective reasons (??) why this from official receptions to celebrations in stadiums. This should be different in the People’s Democratic Republic of first visit was extremely guided, respecting protocol, and Korea (long silence, loaded with the unspoken). consisted of obtaining guarantees, trying to find out if we -The contact and collaboration between Korean personnel could bring in foreign personnel, have access to health and expats are sources of mutual enrichment (here, we’re facilities, even move around outside the capital, live in the really hypocritical). field, etc. The exploratory mission focused on hunger. They hadn’t tried to evaluate the situation from the population’s 2. Concessions: health perspective; its nutritional state. -They’ve accepted the possibility of a team based in P.Y. paying periodic, regular visits to the different counties. Dr. Philippe Biberson, President MSF France -We proposed the possibility of hotel accommodation, on (in French). the condition that it’s not too far away from the intervention areas and amounts to a temporary solution only.

We left it there, but they agreed to study this final proposition carefully [...]. After difficult negotiations regarding the presence of MSF expatriates in the country, a Memorandum of General impression Understanding was signed with the DPRK authorities. They tried to deceive us […] They allowed us to think at MSF launched a drug and medical equipment distribu- the beginning of our stay that our preliminary conditions tion programme in the provinces of North Pyongyang would pose no problems (particularly expat presence in (Pakchon county), Chagang (Huichon county) and the field), then during our final meeting they pretended North Hwanghae (Unpa county). At the time, the mem- that they had not understood (oh really, you want expats bers of the MSF France Board of Directors looked upon in the field!! Well, well, and what for!!) Maybe they aimed the DPRK appeal as a move toward an opening onto the to let us get sufficiently drawn in (recruitment of staff for world. On October 3, 1995, MSF Belgium, MSF France P.Y., preparation of kits, and full charters) so we couldn’t and MSF Holland issued a press release to announce the pull out at the last minute. opening of this programme, matching their speech to the rhetoric of the government on the floods. This expatriate presence is really the key point in the negotiations, and not all their arguments are demonstrations of bad faith. It really is a source of anxiety for them, and opens up perspectives of problems. […] Does this “Briefing of Expats Leaving,” Fax from Maurits scare them more than the prospect of a winter of famine? Van Pelt, Coordinator of MSF Holland, Belgium, [...] Whatever the case, it’s not surprising that this issue and Switzerland in Cambodia, member of the is already generating conflict between the elders and the MSF exploratory mission in North Korea to Wilna more modern thinkers... van Aartzen, Programme manager MSF Holland, 28 September, 1995 (in English). D5 From our side, we should perhaps soften up our position, allowing them to get to know us, get used to us: Extract: -2 expats per county instead of 3 (1 med, 1 log) Here is some information for the people that will leave -Intermittent presence at the hotel with frequent returns to the new project. If you give this for them to read, we to P.Y. (easy at UNPA, hard elsewhere). will have something on the basis of which we can discuss. Maybe they will have some questions. [...] If this type of solution is accepted, I think it’s important to insist on its temporary nature in the MoU (the time The daily context: The state has a firm control over the required for finding acceptable accommodation) so we population. What is most striking is that the population don’t reach a point of no return. Don’t forget, the North does not seem to be very unhappy, at least not in the city Koreans have shown us that they know how to play the of Pyongyang, but also not outside. Of course, the people game. They were jubilant when they mentioned their in the affected areas that we saw, especially in Unpa, atomic negotiations with the Americans (which lasted made a really miserable impression: they have lost their 20 full days) during which they obtained undreamed-of houses, lack tools to rebuild their houses, and they did concessions…. not seem to get enough to eat. They face a cold winter 14 ahead. [relaxation of policy towardsforeigners]organized bythe that wecome intothiscountryonan‘openings move’ are withUNorganisations,and businessmen.Thismeans NGOs are and how they function. Their only experiences in JULY1995.Theydonot understandyetfullywhat in Korea,October 1995, foran emergency that started working collaboration.[...] We arethefirstNGOtowork enter hospitalsinthecountryside,letaloneestablisha Pyongyang. Probablytheyhaveneverbeenallowedto The UNwasneverallowedtolodgeorstayoutof “If the leaders say Athepeople say A.”[...] the governmentandleadershipseemstotallytaboo. Direct orsubtlecritiquewillnotbeacceptable.Critiqueof see. Theyaremadeveryconsciousofthecolonialpast. and therearequitesomethingstobeproudof,asyouwill motivated intheirtasks.Theyareproudofcountry ers. Thebestworkergetsareward.peoplearevery a ‘guiltculture’.Thereisrealcompetitionamongthework- done by social pressure. It is a ‘shame culture’ rather than aged. Criminal punishment is rare, as most corrections are The divorcerateissaidtobeverylow.Divorcediscour- visits to the disaster areas hospitalsand clinics. any western medicine available for the people during our medicines and15%iswesternmedicine.Wedidnotsee prescriptions. Officially85%ofmedicinesaretraditional so also[even]whentheyhavenotcalledhim.Hemakes their healthandgivethemadviceeverysomanydays, doctor for5families.Hecomestovisitthefamilycheck health of20families.Theplanistoextendthisone to forfreehealthcare.Onedoctorisresponsiblethe ‘health post’onthegroundfloor,wherepeoplecango Almost everyflatbuildingthatyouseehasasortof this in a subsidisedwayto the population. [...] can selltheircropstothestate(surplus).Thesells enough to keep everybody from the streets. The farmers ing. Thereisproductionandindustrybutprobablynot still youseemanypeoplejusthangingarounddoingnoth- keeps thepopulation“from thinking about their fate.”But the tunnels,constructingunnecessarypublicworks.This kept busywith futile tasks: sweeping the streets, cleaning mendous responsibilityonitsshoulders.Thepopulationis Everybody istakencareofbytheState,whohasatre- by theMinistryofFood.Thereisnobakery,butcher. only afewshops,merelyfortourists.Foodisdistributed We haveseennoprivatebusinessesinthecities.Thereare worker’s paradise; natural disastersareusedtoprovethatNorthKoreaisa *problems in other countries such as AIDS, crime, and *Japan the old enemy *the enemy USA plotting against them *provocations by theSouthKoreans at theDMZ world: interprets tothepopulationwhatishappeningin propaganda machinethatconsistentlycommunicatesand inside andtheotherwayaround.Thereisanimpressive The StatecontrolsALLtheinformationfromoutsideto translated by them. faxes thatyou sendoutofthecountrywill bereadand insult the headof state or makes jokes about him. All • You will be listened to and bugged and translated. Never the Korean counterpart instead. something and avoid asking something yourself, but use the localauthoritiesgetpermission fromPyongyangfor take, beforeintroducingitwiththeMoH.Ifpossible,let feel about a newidea oraninitiative that wewant to • Alwaysfindoutfirstwiththelocalauthoritieshowthey more about the society; out find to translators your with friendship build to Try • this issue lies indaily work? [...] Hospital Directoraquestion...”Pleaselaterfindouthow but preferablytitles,forexample,“IwouldliketoaskMr • In the beginning: don’t use people’s names all the time, questioning rather than judging and condemning); visor toexplainyouwhyMrXisdoingthis:indirect+ • Don’t criticize people directly (ask your colleague super- pull them in first); them (make legs outstretched people’s over walk Don’t • first); permission (ask heads people’s on tap Don’t • Does andDon’ts health authorities,toseehowtheyreacttheidea.[...] in thethreedistricts,whereMSFisworking,withlocal be good to choose a moment to bring it up simultaneously but afterafewweeksofsuccessfulcollaborationitwould too sensitiveanissuetostartdiscussfromthestart, veys. Wecouldteachthemhowtodothis.Itispolitically trust ofthelocaldistrictauthoritiestodonutritionalsur- ally MSF would be the organization that would gain the eigners monitorthesituation.Itwouldbegoodifgradu- government hasaproblemadmittingit,andlettingfor- There ischronicfoodshortageforthepopulation,but Opportunities which ones they preferwestern medicine. for which aliments they chose traditional medicine and for treatments andconsumption.Itwillbeinterestingtosee right tomonitorthedruguseandaskquestionsabout those withthemedicinestocounties.MSFhas lations oftheprescriptionguidelinesMSFandsends Thursdays. TheideaisthattheMoHmakesKoreantrans- and goeverywhere.Wecannotstayinthedistrictsbeyond doctors, whocanspeakEnglish,withwhomwework Health SupervisionTeam.Wewillgettranslatorsthatare and the RI-Dong clinics in collaboration with the County Our work will be to do supervision of the County Hospital have quickeraccess. country. Theycanthencallusimmediatelyandwewill and thengetoutagainuntilanewproblemarisesinthis body andhelpsthevictimsmakesagoodimpression easier forustodoan‘excellentjob’whichpleasesevery- three monthsofthisinitialprogramme.Itmightwellbe delayed. ItisnotsurethatMSFshouldstaybeyondthe the introduction of other organizations will be further fails, thefailure will bouncebackonthesereformers,and progressive peopleofthegovernment.Ifexperiment

15 MSF and North Korea 1995-1998 MSF Speaks Out

• Never shout or get angry, it will turn against you and it emergency operations outside their capital, Pyongyang. will only aggravate the situation. [...] Médecins Sans Frontières (MSF) will send 10 volunteers • Upon arrival you will be taken immediately to pay and 61 tonnes of medical and logistical supplies to North respect to a bronze statue of Kim II Sung, the deceased Korea. The MSF volunteers will work in the provinces of father of Kim Jong II. You have to put a flower there and Pakchon, Huichon and Unpa, distributing medicines and look down in respect. This will be filmed by local televi- basic medical equipment, Due to problems with access to sion. Make sure you wear decent clothing. clean water; there is a risk of diarrhoea outbreaks. MSF • Never do something yourself that they can do for you. It will work with local staff and authorities to follow the is in general not a ‘hands on’ mission. There is no way for outbreak and carry out epidemiological surveillance. them to deter goods and sell them on the black market, like in other countries. I suppose they would be in serious Torrential rains in July and August 1995 caused flooding trouble if they get caught on the offence of stealing. in 145 of 200 regions in North Korea. More than 5 million • Do not take this paper with you to Korea... people were affected and 100,000 homes were destroyed. Roads, railways, health centres, medical stocks, and water supply systems have been partially destroyed. Two char- tered planes with 21 and 40 tonnes of supplies for North ”Minutes of MSF France Board of Directors Koreans will leave from Bordeaux, France and Ostend, Meeting, 29 September, 1995,” (in French). Belgium. The international team will include members D6 from France, Belgium, Holland, and Bosnia.

Extract: It’s the first time that North Korea has called for international assistance, following serious flooding in the coun- Minutes of the International Meeting of try. It’s the latest completely closed country to manifest a Operations on North Korea - 5 October, 1995, real desire to open up. Two exploratory missions left from October 9, 1995 (in English). D8 Thailand and Burma. After visiting the sites concerned, we proposed setting up a support project for existing Extract: facilities with 3 sections in 3 different provinces. The Were present: country is in a state of economic collapse. The personnel -MSF H: Wilna Van Artzen and health facilities are good but there are no medicines. -MSF B: Mario Goethals and William Claus -MSF F: Marc Gastellu – Jean Hervé Bradol - Martine Lochin The draft agreement between MSF and the authorities Subject: Organisation of coordination for the international came unglued on the presence of expatriates in the field, intervention in North Korea and the exploratory missions left Korea because expatriates weren’t accepted. Then Korea let it be known in Decision: Cambodia that expatriates would be tolerated, but not -To have a common approach in front of the North Korean more than three nights a week in the field. This gives government for the emergency programme during the 3 them control over our work and if we leave at the week- months. end, they can arrange meeting. […] MSF has accepted -To have an international “Chef de Mission” [coordinator] and the missions should be set up without delay. 2 planes in Pyongyang (Hervé Isambert). are planned: 1 MSF Belgian and 1 MSF Bordeaux (Dutch- -Each team has a field coordinator who is under the French). We are planning on a mission of three months national coordination of Hervé Isambert. with a facilitator in the capital (representing the different -To have a coherent programme sections) transformed into a Head of Mission. It’s a real *the medical coordinator is from MSF B international section. We’ll start working in the district *the logistic coordinator is from MSF H hospital before tackling the outlying facilities. *the administrator for the common pot in Pyongyang is from MSF F -in Europe, MSF Paris will be the section, which will have the contacts with the team. “Médecins Sans Frontières Responds to North Korea’s Call for Aid,” MSF Belgium, MSF France, MSF F will have the responsibility for the daily monitoring MSF Holland, Press Release, 3 October, 1995 of the mission and will take the daily decisions. For the (in English and in French). D7 important decisions (orientation of the programme, decision to stay or to leave...) it will be discussed between Extract: Pyongyang and the different sections. If they are some Following severe summer floods, the international medi- disagreements between the different desks, the decision cal relief organization, Médecins Sans Frontières, has will be taken by the operations directors of different sec- responded to North Korea’s call for assistance. This is tions. the first time that the North Korean government has 16 given authorization for a foreign organisation to launch Dutch, for the logisticsof all threeofthe teams. After one logistics, better thanweare.Wehadone logistician,a stored inPyongyang.TheNorth Koreans are very goodin in thebiggerkits.Thedrugs came inbyplane.Theywere We startedsimple,withthesmall kitsandfinallywebrought and medical instruments. all theclinicstoseehowtheywereusingmedications we gavethemcoursesonhowtousethem.Thenwent doctors oftheclinicsincountycametoPakchonand kinds ofclasses,wetaughtthemhowtousethem.Allthe lot ofthemedicinetheydidn’tknow.Sowe[instructed]in with herbs and wewere tobring in newmedicine. But a floods. Medicinesweredestroyed.Theymainlyworking money. According to them, everything was because of the not duetofloods,justbecausetherewerenomeans, hardly functioning,theclinicswerebut clear that this country was bankrupt: the hospitals were North Koreatosay:‘Oknowweallowallhelpin.’Butitwas not allowedtogoto.Ithinkthefloods were anexcusefor the areasthatwereaffectedmostbyfloods;we that intheseareasIdidn’tseemuchflooddamage.think We werecalledin,becauseofthefloods.ButImustsay office, they were security people. Because thetranslatorswereclearlyfromStateAffairs every thingwesaidortranslatedeverythingthedoctorsaid. though wedidn’talwaysknowifthetranslatortranslated And wewereabletocommunicatewiththedoctors,even We were able to see allthe ri-clinics in thecounty. county hospitalthatwasourbasis,wherewehadanoffice. of 3months, we havebeen able tobe regularly inthe ment, and literrallystandsfor “village”]. Over that period the ri-clinics[The“ri”issmallestlevelofruralgovern- nated andsupervisedtheclinicsinsmallcommunities, ported thecountyhospital.Andhospitalcoordi- mornings usually,wewenttothecounty.First,sup- Unpa, which is south, quite close to Pyongyang. On Monday which wasabitfurther,alsonorth,andtheFrenchwerein north of Pyongyang; and the Belgians were in Huichon, km fromPyongyang.TheDutchwereinPakchon,whichis counties. Theywerequitefar.Ithinkourswasabouta150 were inPyongyangandduringtheweekwe were notworkingyetataprovinciallevel.Everyweekendwe team andaFrenchteam,weeachhadonecounty.We direct access to thepatients. unscheduled visittoanyhospitalorclinic.Theyhadno the NorthKoreanauthoritiesandcouldneverpayan guides, minders, interpreters, and drivers provided by volunteers workedunderthepermanentmonitoringof medical stafftousethedrugsprovidedbyMSF.The The volunteers’ main activity consisted of training 1995. Wehadthreeteams: a Dutchteam,Belgian October 1995,foraprojectthatwentuntilDecember The firsttimeIwenttoNorthKorea,itwasin was also a problem as there was noelectricity. more andbeds.ButIthinkthatfeedingthepatients during thetimewhenwewerethere,theystartedusing on outpatients.Thebedswereempty.AndImustsaythat they didn’tstayinthehospital.Weuseddrugsmainly coal, fuel,anything.That’swhythepatientswereathome; cold; allthemineshadbeenfloodedsotheydidn’thave no heating:itwasthemiddleofwinterandquite in Pakchon,thehospitalwaspracticallyempty.There small quantity;mostofthestuffwenttoplaces.Infact, might have disappeared but I must say, it must only be a and theyactuallydiditallbythemselves.Somethings the NorthKoreanswantedtodoeverythingbythemselves month, it was decided that he would better leave because bargaining continuously. nise everythinginawaywhichwecouldn’t…Wewere day. Theywouldneversayclearlyno,buttheyorga- a day, and that was not allowed, wecouldonly do one a a finalroundtoalltheclinicsanddothreeorfour visit clinicsmorethanonce.Intheend,wewantedtodo of, andweneverhadpermissiontodoitagain.Like had donesomethingthatintheweekendwasdisapproved the properway.Itwasclearthatsometimes,inaweek,we spontaneous changeofplans;everythinghadtobedone inside thecounty,therewashardlyanypossibilityfor we leftagain.Andtheyhaddecidedwhatcoulddo. sible andwhatwouldnotbepossible.AndthenonMonday week, andonSunday,wewouldhearwhatbepos- Saturday evening,wehadtosubmitaplanforthenext had beendoingandwhatwewereplanningnext.Andby with thestatedepartment,andreportedaboutwhatwe we camebackfromthefieldandthatwaswhentheymet pened. Sotherewerethreepeoplewatchingus.OnFriday had anopen-eyeandopen-earforeverythingthathap- down everythingthatwassaid,andIthinkthedriveralso the driverwereallfromStatedepartment.Theywrote and theotheroneaguide.Theguide,translator foreigners, adriverandtwoguides.Onewastranslator You havetoimagine the countyteamcomposedoftwo Thus theydidn’t havetimetoseehowthings wereused.In clinic, didashort course,whichwasverytime consuming. the staffthenwentbackagain. Thentheywenttoanother vise. MSFBelgiumwenttoevery clinic,didashortcoursefor the doctorsandthen,after course,distributeandsuper- decided todocoursesfirstat the countyhospital.Callinall where tostartand end.AsforMSFHollandwe ferences] onlyonthewaytodoit,sequenceofthings, gramme itself, we had nodisagreement. We hadsome[dif- finally wemanagedtofinishtheprogramme.Onpro - France, there was a different approach on how to do it, but different ways. Between MSF Belgium, MSF Holland and MSF work. Weacceptedfromeachother that wewoulddoitin when Iwastherein1995werereallynice.enjoyedthe got tooclosetotheteamreplaced.Thethreemonths a Koreanwithoutyourguideandtranslator.Translatorsthat had aguideortranslatorwithus.Youwouldnevertalkto behind thecounterwouldtryandtalkalittlebutusuallywe Sometimes, wewenttoastateshop,someofthepeople

17 MSF and North Korea 1995-1998 MSF Speaks Out

MSF Holland, we chose to centrally give courses, then distribute, then go around and see how they’re using it. Fax from Hervé Isambert, MSF coordinator in [...], Physician, MSF Programme in DPRK, September North Korea to Martine Lochin, Wilna Van to December 1995, January 1997, June 1997. Aartsen, William Claus, Programme manager, 22 November, 1995 (in French). D9

Extract: Received your fax concerning the two AFP releases. On 21 November 1995, the press agency ‘Agence Here’s what I think: [...] I think that the state of affairs France Presse’ issued an article supposedly based on he presents is drawn from the conclusions of the explo an MSF alarmist ‘report’ and on an interview with an mission and not from the present mission. […] ‘MSF representative’, regarding the consequences of floods in North Korea. In fact, the ICRC had issued the 3. Concerning the communication itself, I don’t think it report, and the MSF ‘representative’ was an MSF Japan will cause too many problems: a call for international aid employee whose remarks had been misrepresented. by organisations present in the field seems increasingly necessary if we want to raise donor awareness and collect funds. Certain members of the government are starting to understand this and the WFP is working on the question. It (WFP) has asked me if I would accept to give an inter- “North Korea Devastated by Floods, Humanitarian view, I replied that I would, following authorisation from Group Reports,” Pierre-Antoine Donnet, AFP the Korean committee. But it’s too early to say anything (France), 21 November, 1995 (in French and yet: WFP needs to obtain the committee’s approbation in English). first, then, I’ll contact you about it immediately. So more on this point soon. Extract: Huge swathes of farmland have been destroyed in North 4. The contents aren’t completely false but be warned; Korea by flooding and the communist state faces a serious the number one problem remains food. We can’t say that crisis, a leading international relief group said Tuedsay. there’s a serious lack of food because we don’t see Somali ”There has been enormous material damage,” said Frank children yet! The damage really was catastrophic, the WFP Boquet of the Médecins sans Frontières group, which has has asked for a joint valuation with the FAO to get an had a team in North Korea for two months. According to objective idea of its scale. The remaining food in stock statistics released by the French-based medical group, has allowed the last few distributions to take place, which around 400,000 hectares (one million acres) of arable land prevents the global state of malnutrition becoming visible have been wiped out by the floods that struck 145 of the to the “naked eye” for the time being. We’re currently isolated state’s 200 regions during the summer. The group working on raising Korean paediatric teams’ awareness on said around five million people had been affected but that the detection of infantile malnutrition and taking adapted it was impossible to estimate the number of dead and measures, if necessary. We cannot therefore say anything injured. “Hundreds, perhaps thousands, we don’t know,” about malnutrition at the moment. said Boquet. “But a large number of villages were swept There’s an incontestable shortage of medicines and needs away in landslides,” said the Médecins sans Frontières have heightened since the floods. representative. Boquet added that in a 150-kilometre (95- The Koreans are expending considerable energy dealing mile) zone around the North Korean capital Pyongyang did with this catastrophe. A lot of rehabilitation work (recon- not seem to have been any epidemic or serious food short- struction of houses, etc.) has already been done but the ages. “The situation does not seem to have reached really country needs food and healthcare; it’s incontestable. catastrophic proportions,” he commented, while adding that there were serious shortages of medicines. In conclusion: this paper should not be a big problem but it’s always better, especially in this delicate context, North Korea has made deals with South Korea and Japan to hold precautionary consultations with the Paris head- for the grant or purchase at favourable terms of hundreds quarters. of thousands of tonnes of emergency rice. South Korean officials have said they suspect there is a serious food crisis in the North. Médecins sans Frontières have had a 10-person team in North Korea since October, an unprecedented mission in the tightly sealed-off country now ruled by Kim Jong-II, son of the country’s former “Great Leader” Kim II Sung who died last year. The North Korean authorities approached the French humanitarian assistance group for help. 18 the countryhas beengoingthroughsevere economic crisis Risk of famine in North Korea? Over the last three years, Extract: in order to obtain more international aid. DPRK wasexaggeratingtheseriousnessofsituation the SouthKoreanauthorities.Theysuspectedthat ing. The reality of the emergency was challenged by widespread famine,whiletherewasnofoodaidarriv - Korea warnedthatthecountrywasindangerofa On 11December1995,thedirectorofWFPinNorth BBC and2) a Koreanjournalist. directly tomedirectly.Atthemoment,there’sbeen1) asked allmycolleaguestopasscallsconcerningKorea replying, and kindly gave them your name instead. I’ve BBC calledmethesameevening,Itooklibertyofnot again andacceptourprofoundapologies.[...]Whenthe assured ofourcontrition,believeusthatwe’llneverdoit do [...].Inconclusion,Ithinkweweresetup.Pleasebe Le Monde, for example), which the AFP journalist didn’t before theircirculation(whichwasthecaseofP.Pons that normallyallJapanesejournalistshavetextsre-read angry exchangewiththeAFPboss.Itshouldbenoted mation. Ihadtomakedowithsharingthismorning’s outfit, itisofcourseimpossibletowithdrawthisinfor- As thefaxhasbeencirculatedandAFPisaserious ‘minor pathologies’. of medicines,andaboveallaboutshortagesconcerning for example,hedidn’ttalkaboutlandslides,orshortages Franck didn’tsay:“There’senormousmaterialdamage,” the ‘official’informationcirculatedbyNorthKoreaitself). too quicktoattributeMSF(certaininformationbeing mation containedinsitrepn°1,whichthejournalistwas on NorthKoreacomesfrom(Dr)Franck.Franckcitedinfor- style oftheAFPfaxclearlyindicatesthatallinformation we justanswerthetelephone,that’sall[…].Thegeneral I should point out that we’re not trying to contact Korea; […]. Clarifications,whichyouprobablyalreadysuspect. Thanks for the fax that we were waiting for, cringing Hi Marc, Extract: December, 1995 (inFrench). Famine” “Half aMillionNorthKoreans Threatenedwith 1995 (inFrench). Deputy DirectorofOperations,24November, Director toMarcGastellu-Etchegory,MSFFrance Dominique Leguiller,MSFJapanExecutive “Regrets andContrition” Philippe Pons,LeMonde,(France),15 D10 D11 Message from responsible for theshortage, and nottheregime. North wantits populationtobelievethat thefloodsare difficulties inprovidingmore aid.Accordingtohim,the figures producedbyPyongyang, which exacerbates the mations of damage suffered by the North just reuse the Unification inSeoul,theinternational organisations’esti- […] AccordingtoKimHyung-hi, ViceMinisterofNational 60% ofthe needs. million tonnes of cereal; this year, it can only respond to According to South Korean experts, the North need 6.7 to becopingwiththesituation,exceptintermsoffood. which seems,despitethepovertyofitsinfrastructures, lation’s relativeconfidenceinsupportfromthestate, International organisations,nonetheless,notethepopu - the situationforhomelesspopulationisalarming. per dayfixedbytheWFP.Inacountryofharshwinters, rations donotreachtheminimumof450gramsrice floods. Droppingfrom340to150kilos,theindividual The annualrationsofricehavebeencutinhalfsincethe food are largely insufficient. […] by December.”MrPageestimatesthatthese5.1tonnesof arrived onthe23rdNovember-“Therewillbeafamine gency foodcareprovidedbyWHO-thefirstdelivery has justreturnedfromNorthKorea,withouttheemer- an independentAmericanjournalistbasedinTokyo,who symptoms ofmalnutrition.AccordingtoBernardKrisher, Parisette, who has just spent a month there, observed the International Committee of the Red Cross (ICRC), Calvi 500,000 peoplehavelosttheirhomes.Arepresentativeof estimate that400,000hectareshavebeendestroyed and less, and15billionUS$worthofdamage.Mostexperts Pyongyang; 5millionoutof23peoplehome- […] It’s not easy to check the figures put forward by notes the lack ofmedicines in particular. system, andfoodwatersuppliesinthecountry;it trophe affectsthemostimportantelementsofhealth food. AccordingtoMédecinsSansFrontières,thecatas- when fermented,formsthestapleseasoningofKorean practically everywhereinthesouthofDPRKwhich, Huanghei province.Italsonotestheabsenceofcabbage areas wherethelandwascarriedawaybyfloodsin Page hasseenruralpopulationssearchingforrootsin (DPRK): “Thereisanemergencyfoodsituation;”Trevor According totheWFPrepresentativeinNorthKorea Seoul andWashington and paralyse the delivery of aid. These divergencescreateaclimateoftensionbetween South Korean authorities tend to minimise the situation. (WFP) are sounding the alarm, signalling famine, the Whilst therepresentativesofWorldFoodProgramme about the scale of the disaster, and its consequences. catastrophic floodsoflastsummer.Expertsaredivided cides, andfuel.Thesegapshavebeenaggravatedbythe collective system,isparticularlylackingfertiliser,insecti- ‘Hermit Kingdom’, fallen prey to theinefficiency of its into, amongstothersexplanations,asfoodshortages.The following thedismantlingofUSSR,whichtranslates

19 MSF and North Korea 1995-1998 MSF Speaks Out

funding. To help make up for the shortfall in government aid bequests, Washington has quietly encouraged private “A Killer Winter – The Isolated Regime Desperately organizations to step into the breach. But South Korea Needs Food Aid but Doesn’t Know How to Ask,” has dug in, refusing to encourage any aid until Pyongyang Tony Emerson, Newsweek (USA), 18 December, asks it directly. Following South Korea’s lead, Japan halted 1995 (in English). D12 government aid as well. The result: this winter threatens to bring North Korea closer than ever to the collapse both Extract: Seoul and Washington desperately hope to avoid. In some When the skies opened this summer, no one foresaw that northern provinces, says Page, there is already “acute mere rain could erode the barriers that have isolated North malnutrition” and rations of cabbage have fallen from 120 Korea for five decades. But so it has. The worst flooding of kilos to under 20 kilos per person this year. the century has forced Pyongyang to issue its first, reluctant call for international aid. Now foreign relief workers have Meanwhile, North Korea has welcomed its new private fanned out across a nation that traditionally confines guests benefactors in typically erratic style. International groups to the showcase capital. Prompted by Washington, which is like the Red Cross have been given full access to the coun- eager to forestall a collapse of the North Korean economy, tryside. […] One food shipment was greeted by a live pop about half a dozen private U.S. organizations are delivering band. Other groups, like France’s Médecins sans Frontières, everything from milk powder to dental supplies. In a country remain uncertain whether Pyongyang will even allow them still wary of foreigners, with erratic passenger and frights to stay. “The basic problem is that North Korea, as ever, has connections to the outside world, succor is a struggle. [...] no consistent policy on admitting foreigners, even at a time of need,” says Barron. Yet the picture of North Korea is still far from complete. In interviews, relief workers paint a far bleaker tableau of desperate hunger and widespread devastation. The floods destroyed up to one third of an already weak grain harvest; leaving North Korea 40 percent short of its total In late December 1995, while the three-month long grain needs this year. Trevor Page, Head of the new U.N. programme was coming to an end, the MSF team in World Food Program (WFP) office in Pyongyang, says Pyongyang, together with the Programme managers, that during a trip to north Hwanghae province in late started to think about a new program, and commenced November, he saw “old wizened elderly women, on their discussions with the DPRK authorities. The UN agen- hands and knees in newly ploughed paddy fields, trying cies, foreseeing a further deterioration in the nutrition to find roots for the family soup pot.” Earlier the same situation in North Korea, were trying hard to convince month, Peter Lee, coordinator of the private relief group MSF to remain involved in the country. MAP Asia, watched children in Hwanghae province walking in hail and freezing temperatures without coats or socks.

The relief campaign is falling short. A WFP assessment Sitrep n°8. Fax from Hervé Isambert, MSF in concluded that half a million people had been displaced Pyongyang (DPRK) to MSF B, F, H Programme in a population of 22 million. Of those, 55,000 are under managers, 24 December, 1995 (in English). the age of 5. “The children appeared wasted and stunted” D13 as even colder weather approaches, said the WFP. [...] “The offers of assistance have not exactly been overwhelm- Extract: ing,” says WFP official Michael Ross. “North Korea is not General the most popular place in the world right now.” No, it’s Everything has been going well to prepare the soon depar- not. At first, both South Korea and Japan offered major ture of the team. You got already some time schedule shipments of rice aid. But Pyongyang has proven a most information. They spent past two weeks visiting other prickly supplicant, sustaining blistering attacks on Seoul fields and finishing their current activities. and Washington even as it suffers. UN agencies meeting After its September plea for aid, North Korea seized a South Last week Marcel then this week Maarten attended the Korean ship that had delivered a load of rice, and detained UN meeting. Nothing really new except that before leav- the ship’s crew. Seoul claims North Korea sent armed infil- ing to Roma for Christmas, Trevor Page expressed again trators into South Korea. Pyongyang continued to make very strongly his concern about the food situation in the new financial demands in its negotiations with Washington country and gave some telephonic interviews. He said that on abandoning its suspected nuclear weapons program. And without any prompt response of the international commu- South Korean President Kim Young Sam recently charged nity the WFP will have to withdraw from the country which that North Korea was massing warplanes near the border. would be dramatic [...]. Marcel announced ‘officially’ our soon departure. The agencies reaction was unanimous lo Because of unresolved tensions, neither Seoul nor express their wish to see us staying as they were con- 20 Washington has given North Korea substantial relief cerned in view of the further deteriorating conditions in After discussions withMaartenandMartine (becareful urging usto take actioninhelping them. new commitmentwiththem. Ontheotherhand,WFPis tee seemstobeinglookingforward [at]whatcouldbeour randum. This is right on time to start now as the commit- I introducedourpartinthe negotiation ofanewmemo- requires aninternationalassistance. [...] departure from thecountry while the currentfoodsituation ficult forustojustify[to]theinternationalcommunityour food relief.Andthen,thefactisthat[it]willbeverydif - worthwhile to convince the donors in providing funds for such surveyisinternationallyrecognisedanditindeed in doingasurvey.TheexperienceofMSFconducting son whyweproposedtohelptheMinistryofPublicHealth and thentotakeappropriateactionontime.Itwastherea - happens to be compulsory. It is the only way to early detect a healthproblem.Themonitoringofthenutritionalstatus a lackoffoodbecomesproblemthatmeansit tablets whichcanfeedthepeople.Iexplainedthatwhen doesn’t seewhatwecouldtoaslongitisnotmedicine no foodtodistributeinspiteoftheappealsentalready,he try. HesaiditwasOKforhimbutaslongthereisstill part inthemonitoringoffoodreliefassistancecoun- (UNDP, DHA, WFP) asked him to allow us to stay and take (the diplomaticrepresentationinParis)andinternational Then, hesaidthatmanydifferentpartsbothnational international help incaseof such disasters. political mainlinesofthecountrybutdoesn’texclude reminded theprincipleofself-reliancewhichconducts we wouldbethefirstonetorequestedforhelp.He [for] a new disaster, but in case it might happen again, ment ofvolunteers.Hesaidalthoughhewasnothoping word ‘humanitarian’whichincludesthepersonalinvolve- humanitarian workandtheirbestunderstandingofthe me allthegoodimpressiongovernmenthasaboutour more onthenutritional status monitoring. [...] He told ceed straightwithanewassistanceprogrammefocusing January, anewagreementwiththeCommitteewewillpro- We insuredhimthatifwereach,[bythe]beginningof the factheneededourworktoconvincedonors. Page triedagaintopersuade us tostayandstressed Maarteen and I met WFP just before their departure, T. complementary workbetweenUNandNGOagencies. writing alettertotheGovernmentexplainingneeded UNDP proposed a common approach from their side in sign from the committee side. we didn’tgetanypositiveansweryetneither part intheinternationalreliefassistanceoperationbut of Koreanpeople.Hesaidwearereadytocontinueour concerned withthegeneralhealth-nutritionalsituation the closureofcurrentprogramme,asweremainvery willingness toresumeMSFactivitiesinDPRKjustafter He addedthatwetoldalreadytothecommitteeour is endingvery soon now. committed ourselveswithathree-monthcontract,which the country.Marcelexplainedourpresentsituation:we of itbut anyway thatis of course upto them. make thecommitteeunderstood oftheabsolutenecessity a realmonitoringofthenutritional situation.We’lltryto this canbepreviewedjustif weareabletomakeatfirst distribution atleasttoward the underfives.OKweknow if wewouldbeabletoprovide emergencyfoodforgeneral the fooddigestedinpeoplestomachscouldbeshortened the compulsorydelaybetweenafinallyheardappealand one ofthemainreasonswhytheyneedustostay.Then response canbeexpectedbeforeproofofneeds.That’s by theWFPaboutfoodreliefmakesusworried:noreal the newlybornMSFdepartment.Theinformationdelivered for anemergencyfoodreliefassistanceprogrammewith the same time it would be worthwhile to prepare ourselves community. This is of course our main reason to stay. At with undeniableargumentsandconvincetheinternational position toearlydetectit,wewillbeableraiseourvoice toward thenutritionalstatusofunderfives.Ifwearein severe, asitseemstobe,therewillbesoonrepercussions there isalmostnoresponseyet.Ifthelackoffood In spiteoftheinternationalappeallaunchedbyUN, Comments: mented on a largescale. a generalfooddistributionforunder5’sshouldbeimple- necessary andafterreliable[data]collectedbyourteam, should besetupineachpaediatricunitatbeginning.If be providedifstillneeded.Therapeuticfeedingcentres and nutritionindicator.Theessentialdrugssupplycould be includedastocontinuethefollowingupofhealth The three counties where we have been working would similar programmeastheformeroneinanewcounty. After anexploratoryassessment,wecouldproposea Location: in suchsituation. in ordertodetectthecommonoutbreaksthatmightoccur -To proposeandcollectsomebasicepidemiologicaldata food problem. [...] tional community[awareof]withthecurrentandacute international acknowledgement and make the interna- ising andmonitoringnutritionalsurveysastoprovidean -To cooperatewiththeMinistryofPublicHealthinorgan- Activities: pathologies inhealthfacilitiescoveredbytheprogramme. -To ensure the drug supply able to cure 80% of the lack of heating system). current precarious situation after the floods (lack of flood, -To earlydetectandpreventanyepidemicsduetothe 2/Health: of the lack offoodrelief to come. -To minimiseinintensityandduration,therepercussion priate food. -To feedthedetectedundernourishedchildrenwithappro- -To early detect adeterioration of the nutritional status 1/Nutrition: The objectives should focus two axes: new programme we could propose. with thetwodifferentpronunciations)hereisroughly

21 MSF and North Korea 1995-1998 MSF Speaks Out

serious enough to do more in terms of facilitating the work of international aid agencies as far as monitoring Sitrep n°9. Fax from Hervé Isambert, MSF in of the nutritional status is concerned. We are trying to Pyongyang (DPRK) to MSF B, F, H Programme convince them that it is the only way to get from the managers, 25 December, 1995 (in English). international community a proper response and beyond D14 that to be aware of the actual severity of the problem for a better monitoring in the future. Extract: New negotiations were officially started with the Chairman 2-There is a precarious health situation, which is still of the committee this morning and I prefer to keep you in need to be monitored and supported. The winter is informed as soon as we are getting new information. here, many heating systems are still not functioning and First of all, as expected before it has been clearly said the outside temperature is going down to minus 5 to 10 this morning that there should be no confusion between degrees, diarrhoea is still a problem in many places... the current project and any future plans. We assured that except for the government no one else can really say that it was also our goal to finish everything related to the the health situation is under control. current project before the 6th of January, deadline of the contract. We introduced what could be our future There is an obvious role for MSF to assist the DPRK in the objectives and activities for a new programme in DPRK, activities we are used to run. At present, we are leaving as already described in the sitrep n°8. They said that the the country because the DPRK government doesn’t see the door was not closed but they think they made a lot of necessity for our technical help at this moment. In case concessions already to allow assessments from different of need, however, they leave the door open for the future. organisations and they received little assistance only... Then, we are conducting negotiations and we are still hopeful to reach an agreement. We agreed with Martine They need more guarantees from us even if they expressed and William to give us a chance up to the 15th of January. their satisfaction with the former programme. We expressed In a new agreement we have to be seen as a real partner our wish to be seen by them from now on more as partner and not as just a convenient donor. We are now in a bet- than just donor: a partner who has indeed in his hands ter position after introducing ourselves (it was one of the even more resources than just the guarantee in term of main objectives of our former mission). This is probably his available funds. The fact is this is not clear yet. They not enough but there are also some other things which are still confusing NGO with UN and donors. In this regard will certainly be in our favour: at first the unanimous we are trying to write a paper to explain better the part opinion of other international agencies, which we would of the different partners in relief assistance. We’ll meet prefer not to be expressed in terms of pressure but more again soon. During this while it would be useful to keep in terms of a necessary partnership, and then the nega- contact with the DPRK representation office in Paris to tive impact our departure will have on the international inform them directly about what MSF is ready to do in community which is inevitable and which, as we indirectly the future. You know that we would prefer (as you would heard, has been expressed already without any request for sure!) to reach an agreement before our departure as from our side (you may have heard more about this on otherwise it will take a long time and cost more money. your side as well). In a certain way, this is a real emergency to take action in need of professional monitoring if we want to minimise the repercussion of the possible starvation to come... We will try our best. “North Korea,” Letter from Wilna Van Aartzen, MSF Holland Programme managers to Martine Lochin, MSF France Programme manager, 29 December, 1995 (in English). D16 Sitrep n°10, fax from Maarten Groot, Hervé Isambert, MSF in Pyongyang (North Korea) to Extract: MSF B, F, H Programme managers, 29 December, Herewith my reaction on Hervé’s fax. He should continue 1995 (in English). D15 pushing the government for: 1) Monitoring and surveillance of nutritional status. Extract: Indeed the only way to trigger a response (= donor assis- We feel a bit worried that with this new idea (general food tance). Without hard figures no donor response to be distribution), we could lose our main line: the part that expected. we usually have to play in this kind of situation. Maybe 2) Health situation to be monitored and health assistance some clarification is needed from our side. by MSF. 3) Our departure is the wrong signal to the international 1-There is a real need of food. Even though it is not yet community (try to make that very clear to the govern- documented in terms of repercussions it might have for ment). the population, everybody agrees on that. But at the 22 moment the government doesn’t consider the situation On general food distribution: in the given circumstances, things by themselves, or justwalk. squares, butthat’sorganised,youdon’tseepeopledoing it’s organised.Youseepeopledoinggymnasticsonthebig developed, butthere’shardlyanylifeinPyongyang,unless at you,it’sabitunreal,hugecity,big,lookswell the occasionalMercedes-Benz,peoplewhodon’tdaretolook been?’ Wewalkedalot.Youseetheemptyboulevardsand and whenwecamebacktheywereworrie:’Wherehaveyou and IescapedthehotelwhenwewalkedthroughPyongyang, that wasano-goarea.Attheend,2or3weeks,Hervé wanted to talk about it. We have repeated it many times but much. So that was a very sensitive issue; and they never county level: we were seeing too much and hearing too for them,itwasclearthatwouldnotcontinueata conversations wewerehavingwiththepeople,Ithinkthat as wewereinthecountiesandtheynoticedkindof “nutritional survey”werethelastdropforthem.Assoon three months, we will not extend it.’ I think the words point whentheNorthKoreanstoldus:‘Theprojectisonly nutrition surveywasnecessary.Thatimmediatelythe one monthinthecounties,westartedthinkingthatamal- possibilities to come back toNorth Korea. country. Nevertheless,MSF keptonmonitoringthe 20 February,1996,thelast MSFexpatriatesleftthe DPRK authorities.ThustheMoUwasnotextended.On to conductanutritionalsurveywererefusedbythe activities. However,thisproposalandanother ties, onethatwouldlinknutritionalandmedical posed furtheremergencyactiontotheDRPKauthori - In earlyJanuary1996,theMSFteaminPyongyangpro - Mauritz and one ofus(me). negotiates avisitofMSFinabout2months(March?)by do notreachanagreementbefore15.01.96,Hervéalready manipulation, whichfoodis.Iliketosuggestthatifwe but thennotwithaprogramme,whichissovulnerablefor a generalfooddistribution[is]stayingforstrategical:OK Besides, weshouldnotstayoutonstrategicreasonswhen is for me essential, and this factor therefore conclusive. They evenfearconfusionandloosingourcredibility.This of the team (Hervé, Maarteen) is in the same direction. malnourishment yet(thatmightcome).[…]Theopinion that is no data, no observation by our teams of serious [...], Physician, MSF Programme inDPRK, September tion butnotofacutemalnutrition.Andinfact,after saw amongst childrenwas signs of chronic malnutri- We had expected a bad nutritional status; what we to December 1995, January 1997, June1997. essential drugs andparticularly antibiotics remains. assures 50percentofthedrugs neededbutaneedfor only untiltheendofFebruary 1996.TheKoreanmedicine where MédecinsSansFrontières hasbeenworkingwilllast end ofApril.Thefoodavailable inthethreeprovinces principally themalnourished. Thewinterislastinguntil These pathologieshitfirstthechildrenandamongthem respiratory trackinfectionsanddiarrhoeaareincreasing. of drinkablewaterincertainplaces,pathologiessuchas to theuseofdrugs.Dueverycoldwinterandlack their activity again and to train the Korean medical staff ity wastosupplyhealthstructures,whichwerestarting lack ofessentialdrugsandmedical;material.Theprior - Médecins SansFrontièresmedicalteamshavemetthe main pathologyafterthisdisasterwasdiarrhoealdiseases. medical material have been damaged or destroyed. The During the floods, some health structures, pharmacies and Medical situation the Korean children. nine comingmonthswillbedifficulttolivethroughfor The nextcropwillbeharvestedinSeptember1996,the that thenumberofmalnourishedchildrenwillincrease. trition. If the lack of food confirms and remains we fear under fivechildrentopreventtheoccurrenceofmalnu- This actionhastobereinforcedbyafooddistribution children. nutritional statusandgoodcareofthemalnourished action isnotsufficientifthereafollowupofthe staff hasbeentrainedtorecognisemalnutritionbutthis Sans Frontièreshasbeenworking.TheKoreanmedical already beenidentifiedinthehospitalswhereMédecins festations. Nowadays, some cases ofmalnutrition have needs medicaltreatmentadaptedtoitsdifferentmani- malnutrition amongthechildrenunder5.Thispathology The consequenceofthislackistherapidlyincreasing well asinthelastreportofWorldFoodProgramme. for food.Thisneedisacknowledgedbythegovernmentas the agriculture.Thatismainlywhythereanurgentneed The floodsoflastsummer1995havemassivelydestroyed Nutritional situation proposes an action. for thecomingmonths.MédecinsSansFrontièresalso its worries about the nutritional and sanitary situation cal andhumanitarianorganisation,itneedstoexpress and Pakchon.BecauseMédecinsSansFrontièresisamedi- with themedicalstaffofprovincesUnpa,Huichon teams haveappreciatedworkingwiththeauthoritiesand From OctobertoDecember1995MédecinsSansFrontières Extract: D17 Sans Frontières,January1996(inEnglish). Democratic People’sRepublicofKorea,”Médecins ” Proposition for an Emergency Action in

23 MSF and North Korea 1995-1998 MSF Speaks Out

Propositions of action from our side about this were said to be upsetting and a To reduce mortality and morbidity caused by malnutrition threat for future cooperation. No apologies, just that we and others pathologies worsened by the winter. should appreciate their assistance. It was an anti-climax 1. Care and prevention of malnutrition and king of a humiliating experience. We decided to get it -To evaluate the malnutrition among children to obtain a over with as soon as possible and were back in Pyongyang malnutrition rate and to be able to follow its evolution. on Wednesday evening. -To detect precariously malnourished children and to take care of them by training the medical and paramedical Information we did get during our ‘discussions’ was that in staff. To supply drugs and special food. Huichon the paediatric department of the factory hospital -To prevent malnutrition by organising a food distribution was closed because of the heating problems and that they for children under five. treated until now 90 children (out of the 700 children 2. Need of essential drugs they are responsible for?) <80%. In Pakchon the number -To carry on Médecins Sans Frontières’ action in the three was 27 children. The day after finishing the distribution provinces and to widen it to other parts of the country we waited in vain for our counterpart and the car, which where needs are important too. reminded us of the time our telephone and fax line were disconnected, one day earlier than agreed, immediately Conclusion after signing the handing over of the cars to the govern- If Médecins Sans Frontières’ teams notice that the ment. Positive side of this was that we enjoyed a ‘free!’ nutritional situation is rapidly worsening Médecins Sans day on foot in Pyongyang. Frontières could be involved in a general food distribution. Since Médecins Sans Frontières’ action in emergency We were informed later that the Committee chairman had situations is appreciated by the International Institutions been trying to see us during that time (???). Our agenda, it will be able to bring awareness to donors and to the which was discussed repeatedly, was disrespected again International Community about the needs in Korea. the day before our departure. When getting ready for the Médecins Sans Frontières will work in collaboration with weekly UNDP meeting we were informed that the Chairman the Korean authorities and the Korean Ministry of Health. of the committee was on his way to meet us. The meet- In 1995, Médecins Sans Frontières has been working in 64 ing was an open discussion. The Chairman mentioned countries with 2,950 volunteers in the field and a budget the clear disapproval of the government to see food and of 300 million US dollars. health problems linked together. Their opinion is that all the funds available for DPRK should be used to respond to their food needs. They understand our rules but we need more flexibility to adapt ourselves if we want to reach an Sitrep n°14 bis. Fax from Maarten Groot, Hervé agreement. He clearly said that the voice of the develop- Isambert, MSF in Pyongyang (DPRK), sent from ing countries was not taken enough into consideration Beijing (China) to MSF B, F, H Programme man- by the rich countries and as we have the Government as agers, 29 December, 1995 (in English). D18 counterpart, we should respect it – they have their own nutrition unit, which can supply us, better than anyone Extract: else, with the necessary figures or information). As from 20-01-96, we are back in Beijing […] Our last week in Pyongyang. We left Pyongyang with strong nega- He mentioned also that in the former project, some tive feelings as far as the last week: our wishes as far as agreements he made during the discussion with the MSF the final distribution visits, as agreed upon before, were negotiator have been denied by our team and explained not respected, our position as MSF representatives for that he was talking about our presence at Ri level while the negotiations was ignored and ‘facilitation of our work’ it was agreed before that we would work at county level meant for our (new) counterpart clearly to facilitate our (according to him this was the source of the Unpa prob- early departure. lems, which surprised us, since it was never explained like that before and we did not have these problems in In some more detail: Huichon or Pakchon). He mentioned the disappointment Immediately upon our return from Beijing we discussed of the people in Huichon after they showed us their water with the (new) counterpart and the translator our wishes problems, not to see us coming with solutions. Then he and agenda for the week and the fact that we had two said again that the general conclusion of the Government mandates: finish the distribution and represent MSF in about our former program was good and that they hope further discussions about possible new MSF assistance. MSF may provide future assistance to their country. The As far as the distribution visits to the 3 countries we papers given by headquarters to the representation in can be short. We were taken around as puppets, being Paris are being studied at the moment. Their criticism is just delivery men, meeting people who had been clearly that they do not mention a total amount of US$ for a spe- instructed what to say and what not. The agreement that cific time period and the number of expats needed. They a medical translator would accompany us to discuss the prefer to negotiate further through Paris and expect that experience/use of Ketamine and possible other medical an action from our side will start soon after we get their 24 subjects, was at the last moment not honoured. Protests approval and that a report from their nutrition department whole thingwas over,itwasclear.InBeijing atthattime had inthestores, thentheywantedthekeys tothecars, During thesetwoweeks,we distributed thelastitemswe Coordinator] andme,westayed twoorthreeweekslonger. but whentheprojectisover, yougo.’HervéIsambert[the government said: ‘No, wewant the course, the medication, have likedtocontinueand expand buttheNorthKorean Bye, Maarten & Hervé. recommendation paper will follow. of interestfromourside.Astrategyhastobedrawn,a MSF, ifwecannotdoit,itshouldnotbebecauseoflack program butnotatanyprice.Thereisaspecificrolefor critical anditisourdutytoprepareforanewassistance You canguessouranswer...Certainly,thesituationis something neworcompromiseourselves(butarewe?). their suggestionsexceptifwearewillingtoproposethem DPRK governmentforthetimebeing.Wehavetowait us) havedoneenoughnowintryingtodiscusswiththe in termsofdollarsandcars.Wethinkthatwe(Paris ating team, like the previous one, which is willing to talk negotiate directly with Paris or to receive another negoti- delivered. Thismaybethereasonwhytheypreferto clearly hintedtotheUS$1,000,000,whichwasnotfully denied byMSF”and“differentopinionswithinMSF,”he population. Whenthechairmanmentioned,“agreements lars andnotintermsofactualassistancetotheaffected government thinksofassistanceonlyintermsdol- and our‘sincerity’.Butitisclear,onceagain,thatthe expressed theirappreciation,however,forour‘goodwork’ our attentionforchildrenisnotreally‘appreciated’.They objection againstMSFisthatweworkatfieldlevel.Also remarks andmeetings,itiscleartousthatthestrongest These arethecommentswecanmakerightnow.From Conclusions after this week: right now) a furtherprogramme. [...] people andthatwewillbereadytodiscussanytime(even expressed tothemagaintheMSFconcernforKorean from othersourcesthantheonesofagencies.We proposal thepricewillbecalculated.Fundsusuallycome the affectedpopulation.Afteramutuallyagreedprogram assistance isdiscussedintermsofmeetingtheneeds problem (includingfooddistribution).AsfarasMSF, ready to address a food problem when it becomes a health parties. MSFisfirstofallahealthorganisation,however, written afteropendiscussionsandsuggestionsfromboth and notasaprogrammeproposal,whichcanonlybe explanation andaspossibleoptionsforMSFassistance That thepapersreceivedthroughParisweremeantas We answered to thedifferent remarks: start (they don’tlike assessments). together withtheWFP/FAOwillbegoodenoughforusto hoped tocontinueafterthreemonths.Wewould of theexploratorymission.That’salsowhywehad In fact,thefirstprojectwaskindofacontinuation be quickly addressed. tional situationinNorthKoreawasseriousandshould though onecouldn’tyettalkaboutafamine,thenutri- Coordinator inNorthKoreastatedtothepressthat appeals forfoodassistancetofloodvictims.TheMSF Korean authoritiesaskedrelieforganisationstostop sion todeliverfoodaidNorthKorea,the Japan, andSouthKoreahadjustannouncedadeci- In earlyFebruary 1996, atatimewhentheUSA, stir [things] up. ist. Butbecausewewantedtocontinue,didn’twant ation waslikeinNorthKorea.Hervétalkedwiththisjournal- North Korea.Sotheywereveryinterestedinwhatthesitu- people inSouthKorea,favourofsendingassistanceto there wasaSouthKoreanjournalistandlotof countries. These combined contributions amount to half contribution of 1.9 million dollars supplied by European Nations’ WorldFoodProgramme (WFP),willbeaddedtothe American assistance,whichwill bedeliveredviatheUnited crises byrecognisingthegravity ofthesituation.This tination andcontroversyregarding theNorthKoreanfood allies, wasmeanttobreakopen aviciouscircleofprocras- assistance, againsttheadviceofitsKoreanandJapanese the endoflastweek.Washington’sdecisiontoprovidethis ticularly the2milliondollarsaccordedbyWashingtonat Pyongyang does accept the aid already committed, par- has no doubt played a role in this hardening attitude. Yet Korean militaryexercises,settocontinueuntilMarch, […] Last Thursday’s resumption of American and South remaining Stalinist regime in thepast. the entrenchmentwhichhascharacterisedworld’slast community forassistanceappearstoindicateareturn summer, hadturnedforthefirsttimetointernational Republic ofKorea(DPRK)which,afterseriousfloodsthis his country. The hardening of the Democratic People’s He accusedSouthKoreaandJapanofblockingaidto long astheinterferencefrom‘hostileelements’persists. request assistancefromtheinternationalcommunityas on Thursday8thFebruarythathiscountrywillnolonger Gil-yon, confirmedtotheJapanesepressagencyKyodo authorities. TheNorthKoreanambassadorfortheUN,Pak provoked stiffeningattitudesamongstthePyongyang of the serious food shortage gripping the country has The politicisationofaiddestinedtorelieveNorthKorea Extract: [...], Physician, MSFProgramme in DPRK,September (France) 11February,1996(inFrench). its FoodShortage,”PhilippePons,LeMonde “ North KoreaRenouncesAidDestinedtoRelieve to December 1995, January 1997, June1997. D19

25 MSF and North Korea 1995-1998 MSF Speaks Out

of the 8.8 million dollars emergency request by the WFP, -To continue the discussion with the government about which considers that 2.5 million women and children are possible interventions by MSF based on the MSF report suffering from malnutrition in the DPRK. after the previous mission. -To target the most vulnerable groups regarding nutri- This summer’s floods aggravated a chronic shortage. […] tional status, presumed to be the children under five, Seoul has played down the scale of the disaster. It’s especially those who are not attending nurseries. not impossible, on the contrary even, that Pyongyang -To come to a programme proposal and agreement with is trying to obtain as much foreign manna as possible the government and to start up this assistance programme by dramatising the situation. Nonetheless, humanitarian when possible. organisations that have been to the DPRK are unanimous in recognising the gravity of the situation and pointing Several meetings were held with the Committee of out the risks if it deteriorates. […] Rehabilitation after the Flood Damage (CRFD) [Flood Damage Rehabilitaiton Committee – FDRC], with differ- The testimony of Médecins Sans Frontières: ent UN departments present in the DPRK (WFP, UNDP, According to Doctor Hervé Isambert, Head of Mission UNICEF), and one visit was made to Huichon city (meeting for the French non-governmental organisation Médecins with the Vice Chairman of the county, Director of Public Sans Frontières in North Korea, who has just spent three Health of the county and the Director of Huichon City months in the country, “whilst we can’t yet talk about a Hospital). There have been no meetings with paediatri- famine – I saw no one dying of hunger - the malnutrition cians or family doctors. Also meeting the Ministry of and under-nourishment are very much in evidence: “Given Public Health in Pyongyang was not possible. the Siberian cold currently reigning in North Korea, the children - and some of them were presenting signs of malnutri- Results of explo-mission tion in November - are threatened by pulmonary infections. -From information of the government and the UN it Once we’ve reached this point, the situation will rapidly became clear that the nutritional situation in the coun- become dramatic. We shouldn’t wait until the children are try is bad, that it will get worse in the coming months in really bad shape before intervening. The situation is cer- because the government is not able to provide enough tainly not like certain countries in Africa, but it’s potentially food to the Public Distribution System, the pipeline of as serious. The big difference is that when we can actually food assistance by donors is becoming dry and the harvest see it, we’ll already be on the edge of a precipice.” is delayed because of the late spring time. The nutritional condition of the population will seriously deteriorate to an alarming level if the situation continues as it is now. -General food assistance is needed to supply the Public Distribution System. From 30 April to 22 May, 1996, under invitation by -It was not possible to do any kind of nutritional survey, the DPRK representative in Paris, an MSF International so vulnerable groups are not targeted. team of three volunteers undertook an exploratory -During the field visit to Huichon the idea came up that mission in North Korea. However, they were not free to MSF could start an assistance programme of food distribu- move around as they wished. Once again, negotiations tion to hospitalised patients, in combination with supply- about a possible MSF nutritional-medical programme ing essential drugs and giving support to the nutritional stumbled over the North Korean authorities’ strong and epidemiological surveillance System. desire to receive huge amounts of food aid without any expatriate to monitor its delivery. Some members MoU of the MSF France Board of Directors expressed their After discussions with MSF headquarters in Europe the opposition to what they described as: “Collaboration proposal was laid down in a new Memorandum of with a totalitarian regime.” Understanding (MoU) which was offered to the Chairman of CRFD, Mr. Jong Yun Hyong, being the representative of the government for negotiations with MSF.

Report “Exploratory Mission to DPRK, April 30 – Basically the programme proposal concerns: 22 May, 1996, MSF International Mission,” -Nutritional and medical assistance to health facilities in Georges Dutreix, Monique Peerden, Hervé Huichon and Pakchon counties. Isambert, (in English). D20 -Food distribution to another 8,000 hospitalised patients in different hospitals in the country, preferably in the Extract: vulnerable areas, meaning North Pyongyan and Chagang Introduction: provinces, along the Chinese border. In April 1996, the government of the DPRK (Democratic -Cooperation between local health workers and MSF expats People’s Republic of Korea) invited MSF via their represen- (1 nutritionist, 1 medical doctor and 1 logistician admin- tative in Paris, Mr Kim, to visit the DPRK again. On April istrator on capital level) to support the nutritional and 30, an international MSF mission arrived in Pyongyang. medical surveillance system and exchange knowledge with 26 The objectives were: Korean doctors. [...] week Pakchon. Ingeneraltheydiscussed and ventilated one ortwodays, visitingoneweekHuichon andtheother CRFD isthattherewouldbeone fieldvisitperweek,being access tohealthfacilities.But thefirstproposalof there couldbefurtherdiscussion abouttheextentof of discussion,thepresence of NGO/MSFinthecountry, ties: iftherewouldbeanagreement uponthefirstpoint *Access tohealthfacilities-Accessthefacili - and itwas also notlaid down in theprevious MoU. fact thatthisteamvisitedRi-clinicswithoutpermission the MSF team in Unpa. They mentioned several times the This wasaggravatedbytheproblemsinco-operationwith aches tofollow,organise,andcontrolsuchabigteam. total, asoverwhelming.lthasgiventhemalotofhead - number ofexpatsinthepreviousMSFmission,ten *Expats -Numberofexpats:theCRFDexperienced which will be launched by the endofJune. second consolidatedUNappealconcerningmanymillions, rent visitoftheDHAdelegation,whichispreparingfora much biggeramounts.Thiscouldbeinfluencedbythecur- pilot projectandmentionedthatotherNGOswereoffering the budget,it’snotbigenough.Theyaskedifthiswasa USD): they asked if there would be a possibility to extend *Budget -Theextentoftheproposedbudget(1,000,000 Other points of discussion: cannot guarantee this extension beforehand. each time,whichcouldbeextendedeverymonthbutthey They wouldconsiderthepossibilityofvisaforonemonth period ofsixmonthsisverylongtoissuevisaforexpats. higher levelinthegovernment,whichtakes more time.A is nottakenbytheCRFD[FDRC]buthastobemadeona decision aboutanNGOhavingabase/officeinPyongyang despite theirgoodexperienceswithMSF.Besidesthatthe they cannotrefusethattolessreliableorganisations, they allowMSFtostaypermanentlyinthecountrythat that thisisnotthecasewithMSF,theyareafraidif spies inthecountry.Althoughtheyunderstandverywell US onNorthKorea,sotheycannotaffordtohavemore regarding the continuous attacks by South Korea and the the countryisverysensitiveandtenseatmoment mation. AccordingtoMrJongthepoliticalsituationin past months, which collected all kinds of sensitive infor- some organisationsthatvisitedthecountryduring doing). Thisisalsobasedontheirbadexperiencewith regular visitstomonitortheprogramme(likeCaritasis somewhere else,forexampleinBeijing,andtocome regulations. ThegovernmentprefersMSFtoopenanoffice who rather refuse assistance than breaking their rules and nent base.Theyexplainedthattheyareproudpeople in the country and having many foreigners on a perma- give, theyareveryreserved to permit organisations being grateful totheofferofassistancethatMSFiswilling government recognisestheneedsofitspopulationandis in any law, this condition is unacceptable. Although the Because thepresenceofNGOsinDPRKisnotincluded MSF wants to have an office in the country, in Pyongyang. ernment has with the condition included in the MoU that The mainpointofdiscussionwasthedifficultygov- Office in the country the DPRK. It could be a very good opportunity to mobilise on adifferent level. Asthereisno[similar] NGOsofarin ferent thantheUNsystemand haspossibilitiestolobby community forfoodassistance. MSFisinthisregard,dif- mentary roletoplayinmobilisation oftheinternational experienced andrespectedNGO hasanotherandcomple- assistance tothepopulation. ItisstressedthatMSFasan no interestinespionage,andisonlyheretogiverelief not giveanyinformationtoothers(journalistsetc.),has an independent,neutral,humanitarianorganisationwill written downintheMoU.ItisalsoguaranteedthatMSFas of the DPRK and not undertake any action, which is not expats andwouldofcoursetrytokeepthegivenrules *The mission,forthisproposal,wouldconsistofthree the government of the DPRK wouldprefer as assistance. mented. MSFdoesn’tgive‘blind’donations.Thatiswhat able tovisithealthfacilitiesbeforeextensionisimple - which populationorareatotarget,soMSFwantsbe necessary butinthatcaseMSFwantstoknowbeforehand would be considered, an extension of the budget would be the otherwayaround.Ifanextensionofprogramme the costsismadefromwhichabudgetfollowsandnot Regarding allthepointsinaproposalanestimationabout programme proposalismadebeforeabudgetfixed. *It isexplainedtotheCRFDthatwithinMSFfirsta could bea start tocover this vulnerable period. from thebeginningofJune,sosixmonthsassistance is delayedandexpectedinOctober.Thatfivemonths months andevencontinueaftertheharvest.Theharvest of the population, which will deteriorate in the coming is proposedregardingthealarmingnutritionalsituation be extended? An intervention of (at least) six months when manyreliefgoodshavearrived,thevisawouldnot extension ofthevisa.Whattodoifafterfirstmonth, six months some kind of guarantee should be given about Visas couldbeissuedpermonthbutwithaprogrammefor of infrequent visits from abroad. basis. MSFisnotwillingtostartaprogrammeonthebasis accommodation but still this should be on a permanent It ispossiblenottotalkabouttheofficebut cannot be considered at all, to open an office in Beijing. is compulsorytohaveexpatspresentinthecountry.It tioning co-operationwiththehealthworkers.ForMSF,it to thefieldasoftenpossibleestablishawellfunc- able to closely monitor the ongoing programme and to go *MSF thinksanofficeinthecountryisnecessaryastobe of MSF: Basically the following answers were given from the side the collected data inthecapital. monitoring, is functioning perfectly well and MSF can use veillance system,aswellnutritionalepidemiological for MSF to collect data for surveillance because their sur- tors arenotreallywaitingforthat.Itisalsonecessary need supervision,control,orwhatsoeverandthatthedoc- They saidthattheirdoctorsarewelleducatedanddon’t their doubtsabouttheneedofexpatsbeinginfield.

27 MSF and North Korea 1995-1998 MSF Speaks Out

resources if MSF were allowed to have a programme here. the provinces in the north of the country as to decide *As MSF wants to implement their programme with and where food assistance to 8,000 patients could be directed for the population by co-operating on ‘grass roots levels’ to, has not been given. This in spite of the fact that it is very important to have unlimited access to the health we asked several times, that it was promised everyday, facilities. One or two days per week is a bit too restricted, and that we waited for more than ten days. There have but this could be discussed in a later stage and maybe also been no meetings with paediatricians, family doc- extended as soon as an MSF office is established in the tors, or any other health worker on county level except country. the director of the city hospital in Huichon. As we had been instructed not to ask for any data, we didn’t obtain Remarks information or even get an impression about the current *After having been some time in the DPRK, having heard morbidity and mortality figures in health care. As nutri- the experiences and anecdotes of other foreigners in the tion and infectious diseases are closely linked and as MSF country and having felt the atmosphere, the problems of is a medical organisation aiming also at implementing the government of accepting NGOs in the country seemed partly a medical assistance programme, it should be made quite acceptable. Although there has been a previous possible the next time to get more information on this mission of MSF, this has given constraints. The other subject. [...] organisations (WFP, UNDP, UNICEF) all operate on capital level and thus are controllable. After the floods of last Conclusions year many delegations visited the country, and though -For the moment no agreement about a MSF assistance the government doesn’t always like that, they need to programme has been reached with the government of the ask assistance, but still within their limits. The door to DPRK. the country seems to open up a little bit, but we had -The CRFD will discuss the possibility of MSF opening the impression that it is just a bit too early for NGOs to an office in Pyongyang (= a NGO being present in the establish in Pyongyang and to be seen as partners. On the country on a permanent basis) at a higher level in the other hand, there is not a definite “No” to MSF and we government. It could take longer for the government to have to wait for further reactions from the government. take such a decision. The results will be submitted to the If MSF will be invited to come again it is very important representative of the DPRK in Paris, Mr Kim and further that before leaving it is clear what MSF is going to do, contacts with MSF will follow in Paris. where they want to visit, whom they want to talk to and -Concerning the contents of the programme proposal what kind of programme will be implemented. According nothing has changed so the current MoU could function to the system of the DPRK this should be announced in as basis for further MSF activities. detail before arriving, otherwise it will not be possible to do anything. We experienced that in this explo mission Recommendations and that should not be repeated. It is advisable to send -To be prepared for a positive reaction from the govern- a detailed schedule to the government beforehand and to ment and for starting a programme. ask for approval. -To have an internal MSF discussion with the different sections to reconsider the position of MSF as an NGO in the *It is likely that the nutritional situation will deteriorate DPRK and to define the objectives of a possible assistance fast in the coming months, which is of big concern to programme. In other words, to consider if it is the right the government and the organisations present in the time for MSF to have another attempt or that maybe it country. The impression exists that maybe adults are very should be delayed, till a more favourable time regarding vulnerable because children get food first; they are well the political climate in the DPRK. looked after by the system and by the family. But still we -For a next visit: to discuss and write down in detail don’t have any idea about how the children are managing beforehand the programme-schedule of MSF and to insist that are not attending in nurseries, an estimated 25%! on approval for this schedule before leaving Europe. Malnutrition is not very obvious but it can be understood -To revise the MoU when thought necessary and to indi- that the nutritional status of the population is slowly cate in more detail, the hospitals where to distribute food deteriorating and it is just the question how much fur- besides Huichon and Pakchon. It is needed to obtain the ther this can go? There must be also some micronutrient figures about the number of hospitals and the number of deficiencies at the moment, but so far nobody has been hospitalised patients in the different counties (preferably able to record that, everybody going on field trips had in the north, being the most vulnerable areas after the ‘the impression’. floods and regarding accessibility). -To read the WFP report of Lola Nathaniel and to have *It has not been achieved to [We did not] meet the contact with Trevor Page. Ministry of Public Health in Pyongyang. All the contacts and appointments were arranged by Mr Jong, our counterpart of the CRFD, and it is not possible to take contact with anybody directly. The information we asked Mr Jong to give us about the number of hospitals and the number 28 of hospitalised patients in these hospitals, preferably of and it’sworth trying toevaluatethesituation despitethe -Those whothink thattherearepeoplebehind thisregime out anutritional survey… what we base our work on, when no one is allowed to carry already costs1millionUS$ for atrial…Christianeasked doesn’t understandwhyweare startingaprogrammethat for futuremanipulation(Frederic, Guy,etc.).Esmerelda that ifMSFisauthorisedtointerveneitcanonlybe -Those whoareextremelywaryoftheregimeandthink place between: For or against an MSF intervention? A discussion took Yet forthefirsttimegovernmentisaskingfood… talk tothemaboutmalnutritiontheydenyitsexistence… Korean medicine is the best in the world and when we complicated country.There’srealnationalprideforthem. A complexsituation:MartineexplainedthatKoreaisa dealing witha‘perfect’regimeintheOrwelliansense.[...] sponding toMSF’scharter?FredericpointedoutthatMSFis Does thismeettheconditionsofaninterventioncorre- Discussion plants found in thecountry). use ofthesemedicines(pharmacopoeiamainlybasedon -Supply inmedicinesandtrainingprogrammeonthe north. and adults)byattemptingtogetupthestatesin -Food inthehospitalsforaround1,000patients(children hospitals. Cost oftheoperation: 1 Million US$: MSF proposesamedical-nutritionalinterventioninthe circulated bytheinternationalpressfollowingfloods. the authorities,whichdidnotappreciatemessages climate ofmaximum control andsuspiciononthepartof not managetotravelaround.Everythingtakesplaceina exploratory mission attheendofApril(twopersons)did cated bythegovernmentisimpossibletoverifyand effects offloodingontheharvests…Thedatacommuni- exchanges withChinaandRussia)thecatastrophic problem hademergedduetoeconomiccollapse(dropin The teamreachedtheconclusionthatanutritional during theweek(suchapresencewasimpossiblebefore). tance ofexpatriatepresenceinthefieldforfournights Negotiations withtheauthoritiesfinishedaccep- months inKorea,3differentpartsofthecountry. After extensive flooding in the country, MSF spent three discussed during a futureboardmeeting). tion: NorthKoreaandBougainville(thelatterwillbe tions arefarfromsimpleandthere’sariskofmanipula- that the operations are ‘hanging onto’ whilst the interven- Brigitte explainedthattherearecurrentlytwomissions Operations]) North Korea(BrigitteVasset[MSFFrance,Directorof Extract: Directors, 31 May,1996(inFrench). Minutes oftheMeetingMSFFranceBoard D21 the reward. floods victimsismentioned as oneofthereasons of ate oftheSeoulPeacePrice.MSFaidtoNorth–Korean On 11September,1996,MSFwasselectedasthelaure- operations (Maurice, Odysséas, Jean-Luc, etc.). risks, withoutbeingnaïveandbyhavingconfidencein with this approach. of Directorsstronglyexpressedtheirdisagreement arriving. Again,somemembersoftheMSFFranceBoard where thewagonsofseeds,comingfromChina,were counties. Theteamwasauthorisedtovisittheplaces implemented seeddistributioninseveralNorthKorean after anearlierassessmentmissioninJanuary,MSF a FDRC[CRFD]requestforspringbarleyseeds,and From 25Februaryto8March,1997,inanswer devastating floods. the Netherlands provided medical assistance following of doctorsandsupport staff from France, Belgium and Korea, where,fromOctobertoDecemberlastyear,ateam victims ofnaturaldisastersinJapan,ChinaandNorth Bosnia andChechnya. It hassentmissionstohelp the to armedconflictsinRwanda,Burundi,Afghanistan, MSF’s recentworkhasincludeddispatchingmedicalteams Moscow Olympics and the 1984 LosAngeles Games. [...] Olympics brokethecycleofboycottsseenat1980 world peaceandtothethawingofColdWar.TheSeoul memorate thecontributionOlympiadinKoreamadeto established followingthe1988SeoulOlympicstocom- the 3rdSeoulPeacePrize.[...]ThePrizewas medical personnel,hasbeenchosenastherecipientof international volunteergroupofdoctors,nursesand Médecins sans Frontières (Doctors without Borders), the Extract: Korea. Ihope you receivedtheirreport.The decision,we Yesterday, the exploratoryteamcameback fromNorth Extract: D22 Committee, 11September,1996(inEnglish). Prize,” “Médecins sansFrontiereswinsSeoulPeace 1997 (inEnglish). MSF HollandProgrammemanagers, 22January, France Programmemanagerto MSFBelgiumand North Korea Press Email fromMartineLochin,MSF Release from Seoul Peace Prize D23

29 MSF and North Korea 1995-1998 MSF Speaks Out

took yesterday, is to try to do this programme. It means by rice or maize is applied in the DPRK from this year on, that MSF will look for donors to finance the program of as one of the measures to rehabilitate the flood dam- semences [seeds]. The programme is agricultural... but ages, and increase the agricultural production. The DPRK we think it is a possibility to keep a contact with North requested 14,000 tonnes for 100,000 hectares. The MSF Korea... and try again to find a possibility to investigate mission came back with a proposal for the distribution of the medical problems and to be involved in medical pro- 2,200 tonnes of barley seeds (see proposal dated January gramme in the future. The condition is to find a donor 20, 1997), which seemed reasonable according to the fact before the first of February to be able to begin the pro- that huge amounts would be difficult to manage in June, gramme at the beginning of March. It is very short. What when barley harvest and rice planting have to be done is your opinion? within a week or 10 days. 2,200 tonnes of barley seeds are supposed to be planted on 11,000 hectares. Some DPRK stocks will cover 3,000 hectares more and a UNDP grant some additional 1,000 hectares. The total surface “MSF Project in North Korea,” Email from Olivier is 15,000 hectares and should enable to produce enough Lesrel, MSF France Food Unit, forwarded by barley seeds (if not eaten), to plant the targeted 100,000 Mario Goethals, MSF Belgium Director of hectares in 1998. In January, only seeds were needed by Operations to William Claus and William the DPRK since they planned to repair in time their fer- Bourgeois, MSF Belgium Programme manager, tiliser factory, which had been damaged by floods. [...] A 19 February, 1997 (in English). D24 Memorandum of Understanding (MoU) was signed between MSF and the FDRC, which give details about the role and Extract: the presence of MSF in the DPRK, for the project. [...] After an appeal of North Korea for double cropping barley seed distribution, an assessment team was sent in January: June crop assessment a French agronomist and a Dutch doctor who worked for As planned in the MoU, the same MSF team will visit in MSF in North Korea before. We wrote a proposal after their June a sample of farms that will have received some MSF/ visit. EuronAid accepted to finance 2,200 tonnes of barley EuronAid seeds. The purpose of this visit will be to assess seeds delivered to Pyongyang. They arranged everything the crop in the fields, with the appropriate methodol- for the purchase with a contractor (Chemimex) and a ogy. The date will be just before the harvest, probably booking agent (Huding). They both left today for China. between June 10th and 20th. It will be also an occasion With our advice, they put a condition, which is that the to estimate the efficiency and benefits of the programme Chinese supplier delivers the seeds before Feb. 28 at the with Korean agronomists, in order to report to EuronAid. border. Only what is delivered before this date will be If fertilisers have been given by EuronAid, the mission can financed ant sent by EuronAid to Pyongyang. also include an audit of the fertiliser distribution.

They finance us for the expatriate and other costs, but the Medical projects big amount of seeds (around 1 million ECU) will be paid It has also been dealt [agreed] that the crop assessment directly by them. There is no risk for MSF then, but also mission in June will be accompanied by a MSF medical no big amount of money included in MSF account! It has doctor, in order to discuss and negotiate possible MSF been agreed that expatriates will go twice to North Korea: medical programmes for the future. To this end, Dr Kim -The agronomist and I for seed distribution monitoring, Jong Ha, Deputy Director, Department of External Affairs, coordination and reporting to donor (not much operation- Ministry of Public Health was met on March 7th. No rel- al work can be done over there). From Feb. 25 to March 8. evant information was collected. About malnutrition, it -Two expatriates in June for the crop assessment. Three is supposed to be assessed through MUAC, weight/height persons if we can negotiate to send a doctor to have a index and ...intelligence tests. But there is no result at medical assessment on a subject to be agreed. the moment. The UN agencies have been insisting for months for the realisation of a nutritional survey, without success. According to the ministry, medical needs are only drugs and medical equipment, without expatriates if pos- “Barley Seed Distribution to the Democratic sible. But he accepts to discuss further in June with the People’s Republic of Korea (DPRK),” 25 February MSF doctor. - 8 March, 1997 – Report, Olivier Lesrel and Patrick Lesgards MSF France Food Aid Unit (in General situation in the DPRK English). D25 The mission arrived in the context of Mr Hwang’s flight to the South Korea embassy in Beijing, but nothing was Extract: mentioned in North Korea. Just before the arrival of the History of the project MSF mission, on February 16th, was Kim Jong Il’s birthday In January, Médecins Sans Frontières (MSF) sent an assess- in Pyongyang, without great success apparently, since ment mission to the DPRK in order to analyze the request there was not a lot people attending the festivities, and of the Flood Damage Rehabilitation Committee (FDRC) for Kim Jong D was not seen, officially because of his father’s 30 spring barley seeds. Double cropping with barley followed mourning (3 years). On Thursday [the] 6th in the evening Last year,the North Koreangovernmentlaunched acall North Korea Extract: to dowell. [...] motivation oftheemployees.Exceptforanelitethatseem tion ofthesituation,includinginqualityworkand (e.g. forsubcontracting)mentionapermanentdeteriora - expatriates whohavecomeintheDPRKforseveralyears do notwork,anditisalwaysexplainedbythefloods.The that thereisafuelandenergyshortage.Manyfactories behind buildingsinPyongyang.Itisobviousandofficial selling foodorcigarettesalongtheroads,inhidden which isverythin.Lately,onecanseesomeindividuals same timethereisnotenoughfoodforthecattle,partof place every ten days in villages or town districts). At the to vegetablesandnon-cerealproducts(thesemarketstake excess riceonlocalmarketplaces,onlyallowed[limited] bags boughtinafarmbyindividuals.Thesamesells through theChineseborder.TheMSF[teams]sawsome the cooperativefarms.Thisriceissaidtobepartlysold of therice,whichisnotdeclaredinproductionfiguresby is thatthereadevelopmentofblackmarketforpart given tokeeplessthisyear.Themostcommonhypothesis person for oneyear), even if recommendations had been have kept[to]whattheyusedtodobefore(260kg/ mentioned in any visited farm. In most farms, workers decrease oftheyieldperhectare, which hasnotbeen million tonnes.Thedifferencecouldbeexplainedbya lion tonnes, and theloss due tothefloods are only 0.3 to export.In1996,onthesamesurface,itis2.5mil- to be 7-8 million tonnes. At that time, the DPRK used Roughly speaking, the cereal production in the 80s used nursery. All thechildren seen seemed healthy. many childrencanbeseeninthevillages,outside what isthehealthstatusofchildren?Thefactthat told [said]tobebreastfedoronholidays,butshewonders she visitsanurseryorkindergarten.Thesechildrenare never seemorethan10%oftheregisteredchildrenwhen be reported.TheUNICEFrepresentativesaysthatshecan seems that only small anecdotes and big hypothesis can significant signs of food shortages or malnutrition. It ment. No UN representatives seem to have seen real only onthebasisoffiguresgivenbyDPRKgovern- The food situation seemed to be described [as] severe, allowed. […] sible towalkacrossPyongyangaloneandallpictureswere as flexiblepossibleoverthere.OnSunday,itwaspos- priced roomsinKoryohotelandadaybyprogramme really welcome, and their stay was facilitated, with half diers. It was said to be training. The MSF expatriates were the centreofPyongyangwithhundredstruckssol- a UNmemberobservedhugemilitaryconvoycomingto Meeting, 28February,1997(in French). Minutes ofMSFFranceBoard Directors D26 rooms butthat wasnotpossible,sowehad togooutside see anysignsof malnutrition.Then,Iwanted togoother clean room and they said they were malnourished. I didn’t they saidwereoninfusions, withbeautifulblankets, the rest. And in that room, there were three patients, who were takentoonlyoneroom. Wewerenotallowedtosee asked toseeahospital.We went tothehospitalandwe During the explowith the Agronomist, Patrick Legard, I maybe therewasawaytostartsomethingmedicalaswell. well. Andthat’swhyIwent;toverycarefullyfindoutif is possibletohavesomekindofamedicalprogrammeas seeds, andMSFproposedthatadoctorgotoo,seeifit tion. Be vigilant. and recogniseitevaluateit.Collectconcreteinforma- future. It’spossiblethatthere’smanipulation.We’lltry this iswhat’sneededrightnowtoensureaharvestinthe cyber-humanity withour2,000tonnesofseeds;wethink lated by the CIA. We cannot accuse this team of being in information ontheinternetorsatellitephotosmanipu- elements todeterminetheirevaluationcriteriabesides take operationaldecisionsforitsfollowup,haveother carried outevaluationsinthefield,andwhohavehelped Philippe: Allthepeopleworkingonthismission,whohave wants him to see. the team who can see things other than what the regime with ourownrules,thecapacitytohaveadoctorin request of100,000),weshouldbeworkinginaccordance tonnes comparedtotheNorthKoreangovernment’slatest symbolic, withaderisoryprovisionofassistance(2,000 clearly definedasadictatorship.Ifourpresencethereis how fararewewillingtogoworkwitharegime dictatorship andtheCIA.It’saquestionofprinciples, we accepttheserulesandcriteriamanipulatedbythe accordance withrulessetdownbythedictatorshipand aid is diverted by the army. We intervene over there in biggest dictatorships.Hesuspectsthatalargepartof denounces this mission as assistance to one of world’s sion. Hethinksthatthedeclaredfamineisfiction. Frederic raiseddoubtsontheappropriatenessofthismis- doctor will join theevaluation team inJune. their distributionatthelevelofdifferentstatefarms.A Pyongyang andtheteamisinprocessofsupervising arrived attheSino-Koreanborderandweretransportedto financed bytheEuropeanCommunity.1,200tonnes We proposedtheimportationof2,000tonnesseeds, of NorthKorea.Anevaluationmissionwascarriedout. thought thiswasthebestway to tackle the problematic responded tothiscallviathefoodcell,becausewe since 1995,whenwehadamedicalpresencethere.We We’ve being trying to follow the situation in North Korea for thedistributionofseedsinresponsetoafamine. selves tohaveanagronomist,helpwiththe sion andnothingcameout.Theyproposedthem- In January1997,thatwasabriefexploratorymis-

31 MSF and North Korea 1995-1998 MSF Speaks Out

again. Then I asked to see the operation room. We had to ing, understand what they’re for.’ We understood that they wait about fifteen minutes and then the surgeon came and would do the logistics themselves but we told them there opened the operation room. And we could see the operation would be no European financing if we couldn’t do follow-up room. When we finished, we went outside and the three in the field, because this was part of the financing condi- patients who had been on infusions passed us on their way tions. They understood but it was difficult to convince them out. It was all staged. They wanted to make a good impres- because they wanted as few foreigners as possible, but also sion, to show you what you wanted to see. You ask to see because they didn’t know how we worked. For sure they were malnourished children, OK, there are malnourished children. locked into their system, but they have skills, structures, You want to see a room in a hospital? OK, here is a room in organisations. So they were more used to receiving funds a hospital. I think, in North Korea, that’s what they do from China for carrying out operations themselves than hav- amongst themselves as well, to the population. It’s all fake. ing snoopers like us on their backs. It’s a play, a movie. We don’t really know if everybody believes in it but everybody is supposed to believe in it, so We had to organise all this quickly, because we had to ok. distribute the seeds before a certain date. This time factor helped us get our visas because we said to them that [...], Physician, MSF Programme in DPRK, September if they weren’t issued quickly enough, we would arrive too to December 1995, January 1997, June 1997. late for the seeds and the programme would no longer have any sense, and so be cancelled. It was really interesting, particularly because it allowed us to go elsewhere than just the big cities. The countryside and villages are completely out of sync with Pyongyang, which is a sort of showcase. At the end of 1996, the North Korea Ambassador in Our visit schedule was decided each day, but it was very Geneva sent a spontaneous request to MSF for the flexible. It was drawn up according to places or the trains distribution of seeds, saying they were needed post- arriving during the night, and it wasn’t always possible to flooding. Brigitte Vasset, the Director of Operations, asked plan it ahead. I think we took up several carriages and we us to investigate the request with care. We told ourselves counted the bags. It had been decided to divide up the that it could be an opportunity to get back into the country, seeds amongst as many farms as possible because this was which we hadn’t managed to do via our medical activities. a pilot operation. They wanted to see if it worked or not Along with Marie-Pierre Allié and Martine Lochin from the according to the regions, the climate. programme managers, we started negotiations in an attempt to respond to their request and set up a pro- We had a driver and an interpreter every time. We had a very gramme. We set up an exploratory mission team consisting specific programme that we managed to change at the last of an agronomist, and a Dutch doctor who’d been part of minute on several occasions, arriving in places that weren’t the international MSF team in North Korea the previous completely prepared for us, so we could see what was really year. We insisted on having a member of the old team, going on. We went to the collective farms. There was a who’d spent time in Korea. He could be the link between the central building, and the people lived in little houses. […] past and present, spotting changes and developments, see- I remember a field, with a choir installed on a slope who ing if the people were worse off, the authorities tougher, sang to motivate the workers who were planting everything the military more present. We wanted to avoid having to by hand. There was no petrol for running the tractors. re-start at zero and find ourselves hoodwinked. Obviously the authorities weren’t pleased. They would’ve preferred all On the last day, I went to recuperate the material left by new people. the previous mission in the WFP premises. We didn’t have our interpreter that day; I was alone with the driver whom MSF’s evaluation mission arrived in North Korea in January we’d been with for ten weeks, communicating with him via 1997 with the aim of analysing the request made by the the intermediary of the interpreter. I was thinking out loud, Flood Damage Rehabilitation Committee for the distribution and I said: ‘We should just put the material in the front.’ of barley seeds. Suddenly I heard the voice of the driver exclaiming: ‘In front?’ He spoke French and I suppose he was there to watch We organised the purchase of these seeds – Euronaid3 over our interpreter! financed us – and transferred them from China to Korea by train. Then the Korean authorities handled the trains from Olivier Lesrel, Manager of MSF’s Emergency Food Cell the Chinese border to Pyongyang. Next, we went to see what (in French). happened when the trains arrived in the different areas of 14,000 hectares where they were to be planted. They would have preferred us just to hand the seeds over rather than go in person, it was clear. We told them: ‘Out of the question, we need to follow up our operations, know what’s happen- In April 1997, Chinese businessmen (they always were the main source of independent information on what was going on inside as they were allowed to move more 32 3. A European network of NGO dedicated to provide services regarding food aid. freely than anyone else) and officials from interna- the childrenwere. AsheadoftheUnited Nations’ World The firstthing CatherineBertininoticed was howsmall Extract: it wasbad,” said Mr. Liu’s wife. “This year it’sworse.” vide moregraphicimagesofanationincrises.“Lastyear the personalaccountsoftradersinthisChinesecitypro - Program, reportedseeingcasesofricketsandscurvy.But Holcombe, theBeijing-basedHeadofUNDevelopment food shortagesandrelateddisease.Lastmonth,Arthur experts whohavevisitedNorthKoreaalsoreported Union, NorthKorea’slongtimepatron.Internationalaid been mountingsincethe1991breakupofSoviet in thelasttwoyearshavecompoundedwoesthat planned economyisfallingapart.Disastrousfloodsthere much –tohelpaCommunist-styledictatorshipwhose issue as other countries try do decide whether – and how Gauging thedepthofNorthKorea’s crisis isacritical was in North Koreaafew days ago.[...] has a small Chinese medicine shop nearby and who said he because theyaresohungry,”saidatradernamedLiu,who “I’ve seenschoolchildrenstaggeringlikedrunkards who hadbeen abandoned bytheroad-side. child andtwoothersnearlydead,apparentlyfromhunger, Korean capital,saidthatonarecenttriphesawonedead supplies totheChineseEmbassyinPyongyang,North surname asReandwhowaswaitingtodriveconstruction children inNorthKorea.Amanwhowouldonlygivehis bridge Wednesdayreportedthattheyhadseenstarving A groupof Chinese truckdriverswaitingat the footof desperation in the ailingStalinist nation. ers anddriversreturn,theycarrytalesofstarvation, desperately needed goods to North Korea. When the trad- over theYaluRiverhere,haulingsacksoffoodorother About 200to300trucksadaycrossFriendshipBridge Extract: provision offoodaidwasinsufficient, tional agencieswhovisitedNorthKoreanoticedthat press. nalling thefaminewerepublishedininternational South Koreaforawhile.Meanwhile,fewarticlessig- knowledge of this situation had been widespread in people towhomtheycouldhaveaccess.Atthatpoint, heavy signsofstarvationamongtheNorthKorean “ English). Washington Post(USA),18April,1997(in North KoreaFamine,”StevenMufson,The “ 1997 (inEnglish). Jeffrey Bartholet,Newsweek (USA),21April, in, HelpisNotontheWay, ” CarrolBogert, Across YaluRiver,ChildrenDying–Traderssee Why theWorldDithers–AsanEpicFamineSets D27 D28

and witnessed That’s just aboutwhere North Korea is now.” net isbeingloweredinchbyinch, untilithitsrockbottom. World FoodProgram.“InNorthKorea,it’smorelike the fall throughthesafetynetfirst, ” SaysMichaelRossofthe control. “InAfrica,themostvulnerable groupsinsociety not apeasantsociety.Andthegovernmentremainsinfull an urban,industrialcountry-abackwater,tobesure,but mates ofAfrica.Butperhapsmostunusual,NorthKoreais padding ofwinterclothesthanitwouldbeinthehotcli - to see how malnourished people have become under the selling grainisacrimepunishablebydeath.It’sharder food –privatecommerceisillegalinNorthKorea,and where peopleselltheirlastbelongingsinordertobuy the governmentiftheylefthome.Therearenomarkets North Koreanswouldlosewhattinyrationstheygetfrom mass migrations of starving refugees hunting for food – Korea differsfromatypicalAfricanfamine.Thereareno What strikesthehungerexpertsfirstishowmuchNorth most of thedrayanimals have beenslaughtered. reap -especiallysincethere’snofuelforthetractorsand hungry NorthKoreansaretooweaktoplowandsow But willtherebeanextharvest?Reliefofficialsfearthat people aliveuntilthenextharvestinfiveorsixmonths. tons, though900,000metrictonscouldprobablykeep it facesawhoppinggrainshortfallof2.3millionmetric hit bythreestraightsummersofdisastrousflooding.Now was strugglingtofeeditsownpeopleevenbeforeit that’s like a slap in the face to North Korea.” Pyongyang can publicizethesituation”,saidonereliefofficial.“But the plightofNorthKorea.“Weneedtohavejournalistswho relief organizationstodrumupinternationalsympathyfor has madeitharderfortheWorldFoodProgramandother NEWSWEEK andothermediatocoverthedisaster.That paranoid government has repeatedlydenied visas to Korean faminemostlybecauseitisn’tonCNN.[...]The The rest of the world doesn’t know much about the North North Koreans starve to death?” Bertini. “Istherestofworldwillingtoletmillions it’s notgoingtohelppeoplein1997,oreven1998,”says “Even if you change the system [of socialist agriculture], 100,000 peoplewilldiethissummer if helpdoesn’tcome. number mustbehigher.U.S.intelligencepredictsthat died of malnutrition last year. Foreign observers think the and thegovernmentrecentlyconfirmedthat134children 100 gramsofriceperdaynow;aslowstarvationdiet, wherever theywere.MostNorthKoreansaregettingonly food leftalittlewarmthlingeringintheair?Slowlydying, perhaps, wherethestovestocookfamily’smeagre were “on field trips.” Where might they really be? At home, percent of them were even present; teachers said the rest schools –unheatedandliterallyfreezing-onlyabout20 hung slackfromemaciated,wristsandankles.Atmost be 6. They moved slowly to conserve energy. Their skin countryside. Kids who looked 3 years old turned out to day-care centresonarecenttriptotheNorthKorean Food Program,shegotunusualaccesstoschoolsand Still, manycountries areloathtobailoutthe Pyonggyang

33 MSF and North Korea 1995-1998 MSF Speaks Out

regime. After recent charges that North Korean agents feel it’s a famine in slow motion,” she said. “If no major kidnapped a young Japanese girl 20 years ago and spirited food aid is going in fairly soon it will just go further down her away to Pyongyang, Tokyo has delayed sending any and could deteriorate very, very rapidly,” she said. “We can food aid. South Korea has committed $6 million to the only hope for the best, we have to prepare for the worst.” World Food Program’s emergency effort but wants politi- The U.N. World Food Programme launched a $95.5 mil- cal concessions from its old enemy before it will do more. lion appeal this month for 203,000 tonnes of emergency “We can negotiate government assistance to the North only food for North Korea. The agency said on Monday it had if the four-party talks begin,” says Assistant Unification received just one-third of the money and estimated North Minister Moon Moo-Hong, referring to the formal peace Korea needed 1.3 million tonnes of additional food to negotiations that South Korea is eager to get underway. meet its basic needs in 1997. Zellweger said local officials Washington has pledged $10 million, which might buy a told her they distributed 100-350 grams (3.5 - 12 ounces) paltry 30,000-plus tons of grain and is considering upping of rice per adult per day, although some areas said they its contribution. But Defense Secretary William Cohen, had been unable to distribute since mid-March. That com- touring the region last week, also linked food aid to the pared with the minimum recommended by Caritas of 450 progress of political talks. And Republicans in Congress grams (1 lb) per person per day. “Officials say they will often berate the Clinton administration for “propping up” run out of food fairly soon... They asked me several times North Korea. Humanitarian officials say that’s playing to look at quantity and not at quality of the food aid we politics with innocent lives. “This should not be about bring in,” she said. [...] North Korea has said food supplies diplomatic posturing,” says Andrex Natsios, vice president will run out at the end of April. The WFP estimated there of the relief group World Vision and an aid official in the was only enough food to feed the country until June and Bush administration. “This is about vulnerable people who then its 24 million people would have to wait for the next have no political power, who are dying. I’m a Republican. harvest in October and November. But this is just not acceptable.” Still no one denies that the people really playing famine politics are North Korean officials who want to hang on to their Stalinist system. The two greatest famines of the century took place in Ukraine “North Korea’s Famine is a Product of its System, in the 1930s and in China in the early 1960s where the col- Not Nature,” Philip Bowring, International lective system of agriculture ruined the harvest. The world Herald Tribune, (Seoul), 3-4 May, 1997 (in understood the scope of the disaster only afterwards. That, English). tragically, is just where North Korea is heading. Extract: So how come the world’s most over-governed society, a semi-industrialized economy in a fairly compact country “Aid Agency Sees Malnutrition, Deaths in N. with multiple land and sea access points is starving? The Korea,” Reuters (Beijing) 29 April, 1997 (in answer is very simple: because of a political system similar English). to that which brought famine to rich parts of China during Mao’s Great Leap Forward and to the Soviet Union dur- Extract: ing Stalin’s collectivization campaign. As in those cases, North Korea is sliding into famine with reports of deaths North Korea’s famine has resulted primarily because the of children from malnutrition and farmers eating powdered political leadership has far more important objectives than wood to fill out their diet, an official of the international feeding its own people. aid agency Caritas said on Tuesday. “The overall situation is just going down,” Kathi Zellweger, director of interna- In the Korean case, the first objective is to keep the coun- tional cooperation for the Hong Kong branch of Caritas try as closed as possible, to prevent citizens’ being able said in an interview after visiting the reclusive Stalinist to compare their fates with those of neighbors in China state. “It’s like a ladder I’m climbing down and I don’t know or South Korea. where the bottom rung is,” she said referring to visits in Secondly, the scant resources that Pyongyang has avail- recent years. A day earlier the United Nations’ food aid able have been devoted not to purchasing grain and fuel agency called for large-scale emergency aid to North Korea for civilians but to keeping a million-man army in ammu- to avert a famine that could turn into “one of the biggest nition, fuel and other resources needed to offer a credible humanitarian disasters of our lifetime.” On a visit to areas war threat to South and the United States. [...] devastated by unprecedented floods in 1995 and again in The food shortage may be an embarrassment and an 1996 when entire crops were destroyed, Zellweger said she indictment of Pyongyang’s feudalism in Leninist clothes. saw fewer children in schools, listless infants and heard of But it also has its uses as a lever, allowing Mr. Kim to deaths from malnutrition. move closer to his goal of official U.S. recognition of his regime. The headmistress of a school in one county described the situation as the worst since the Japanese occupation of Under the cover of “humanitarian” aid, the United States World War Two, an invasion regarded by Koreans as one has its own diplomatic goals, notably to bring Pyongyang 34 of the darkest points in their history, she said. [...] “I into four-party talks – the two Koreas, China and the dear byKimJong II’sregimehasfailed;opening theNorth recognising that thedoctrineofself-sufficiency heldso For Pyongyang,however,this touchesonthreetaboos: political elite will not divert thenew supplies. had come from. And it wants assurances that the army or est indicationofwherethefirst deliveriesofaidin1995 Korea wasoffendedwhenPyongyangforbadetheslight - to North Korea to watch over its transportation. South two countriesandthatagentsfromtheSouthcango it cancrossthedemilitarisedzonewhichseparates tions: thatitsSouthKoreanoriginsareidentifiable, Red CrossoftheSouthhaslinkeditsaidtothreecondi - the questionseemsmorecomplexandpolitical.The nature, which has not yet been concluded. [...] In fact, to dependonadoublenegotiationofhighlypolitical to accordsubstantialaidPyongyang,butitcontinues The UnitedStatesandSouthKoreahavefinallydecided phe seems imminent. too weaktocultivatetheirland.Ahumanitariancatastro- dren starvingand abandoned by the roadside or farmers roots. TravellerscomingfromNorthKoreadescribechil- most of the rural population survives by eating grass and grain reserveshavebeenexhaustedsincemid-Marchand Committee oftheRedCross(ICRC)inPyongyang, Korea. AccordingtotherepresentativeofInternational The foodsituationisgettingdangerouslybadinNorth Extract: a desiretohelpfellowKoreans,butnoideahowdoit. would placehugeburdensontheSouth.Underlyingallis desire tohelpitchange,andtherebyavoidacollapsethat Detestation of the Pyongyang regime is balanced by a The South,meanwhile,istornbyitsowndilemmas: Communist cousins acrossthe Yalu River. Socialist KoreamightemergefromthefailureofChina’s refugee flood, and longer-term ones that a united, non- a NorthKoreancollapse. China hasshort-term fears ofa the regimeandavoidregionalinstabilityinherentin and Chinathereiscalculationthatsomeaidwillpropup be completelyruledout.OnthepartofUnitedStates destiny ofachievingreunificationbyanymeans,cannot but afinalthrowbythemilitary,stillimbuedwith shown atendencytoruthlesscunningratherthansuicide, escape fromtherealitiesoffailure.Pyongyanghasusually danger oftheNorth’schoosingsuicidalwarasameans also agenuineconcernthatlimitedfoodaidreducesthe calculating. Humanitarian feelings docount. There is treaty. TheU.S.objectivesarenoteignobleorentirely United States–whichmighteventuallyheadtoapeace French). Lefèvre, North –FamineSeemsImminent,”Pierre Surrounding AssistancefromtheSouthto “ No rth Korea: Trail of Political Strength D29 Le Soir (Brussels) 7 May, 1997 (in regime. country’s stateofdistressfollowing40yearsaStalinist Korean fortresstoforeigners;andshowingtheworld And this at thelevelof provinces. - Nutritional program in child institutions tures - Medical/nutritionalprogram inhospitals/healthstruc- Explo mission to seethe possibilities ofimplementing: Peter Van Caille (log)anda nurse firstof May. 1. TosendateamconsistingofHildeSleurs(doctor/HoM), North Korea, we propose: had withGeorged’Allemagne. In viewofthesituationin Please findhereafterabriefsummaryofthedebriefing I Extract: tion programme. objective was tolaunch a nutritional and food distribu- assistance toNorthKorea.Atthattime,theirmain in Europe,andsetupanewplantoreturnbring programme managerscontactedagainDPRKofficials even very serious, in certain areas. In April 1997, MSF on alimitedscaleandreportedworryingsituation, Korea. Theymanagedtoimplementanutritionalsurvey assessment ofthehumanitariansituationinNorth former MSFBelgiumExecutiveDirector)madean appointed byECHO(amongthem,GeorgesDallemagne, From 4-26March,1997,ateamofindependentexperts 7 April, 1997 (inEnglish). Wouter Kok,MSFHollandProgramme manager, Lochin, MSFFranceProgrammemanagerand MSF BelgiumProgrammemanagertoMartine “ April, 1997 (in French). lected byPierreHazan,Libération(France),30 Travelled aroundtheKoreanCountryside,”col- Testimony ofOnetheRareWesternerstohave “There’s aRealFamineinNorthKorea– (Belgium), 29 April,1997(inFrench). Country,” PhilippePaqui,LaLibreBelgique North Korea:“ 1997 (inEnglish). Faison, “From NorthKorea,TalesofDesperation,” North Korea,” The NewYorkTimes(USA),28April, Scenes ofHorrorinaStarving Email fromWilliam Bourgeois, D30 D31 Seth

35 MSF and North Korea 1995-1998 MSF Speaks Out

2. To ensure the international coordination for this mission. “Korea Mission,” Letter from Mario Goethals, Could you please give some feedback on the proposals? Director of Operations, MSF Belgium, to Mr Kim, Meeting with Georges 04/04/97. Georges visited NK during Chargé D’Affaires of the Permanent Mission of three weeks in March 97. It is estimated that the country the Democratic Republic of Korea, 30 April will have a deficit of around 2 million tons of cereals. 1997 (in French). D32 Officially, only due to the floods of 95. In fact, the agricultural production has been decreasing steadily since a Extract: number of years. This combined with the end of aid from Your Excellence, Russia and China explains the current problems. The crisis Our medical, non-governmental and international organ- is not only agricultural; the industry is at a standstill. The isation, specialised in public health, is concerned by the agricultural production is declining because: difficulties the Korean people are currently undergoing. -Damage by floods Médecins Sans Frontières would like to offer its assistance -Decreasing quality of seeds in the domain of primary health care and nutrition. -Lack of fertilisers Which is why we propose sending a Médecins Sans -Poorer ground Frontières team to evaluate the possibility of our organ- -No fuel no tractors no beasts of burden -> manual agri- isation providing assistance. This experienced team would culture. be composed of: -System of food distribution. The government leaves to the farmers what they need and take the rest for the rest Serge Depotter, Manager of the Food Security Operations of population (army probably having priority) -> no incen- Cell tive for higher production. Hilde Sleurs, doctor Peter Vanquaille, logistician Georges could not gather ‘proof’ that the situation is dramatic. The available information is not reliable (only I should be grateful if you would facilitate the issue of ‘politically correct’ information). But was able to gather visas for these persons. Propositions for activities will some convincing evidence. be submitted to the Korean Authorities at the end of the I. Data about stocks & imports & data about distributed evaluation mission. We are entirely at your disposition for rations: No stocks, only limited import (barter trade with any further information you may require and would very China, trading wood -> deforestation). Rations decreased much like to meet you in Paris soon. We would also like to 100 g/person/day. to ask for your guidance on which institutions or persons II. Looking around: Eating of bush food. Football fields in Korea we should contact in order to gather informa- used to cultivate. Children running behind trucks to gain tion about the current needs in Korea and who we should few grams of food, people looking for algae in rivers, develop concrete propositions with. everybody on the fields, [...] With our very best wishes, III. Markets/State shops: State shops are empty. Three Yours faithfully times a month markets are authorised. Price of rice is a bit less than mean monthly income. (Economy not really monitored). IV. Home visiting: Families have no food stocks except for “North Korea” Email from Martine Lochin, MSF some sweet potatoes + algae (changing of food habits?). France Deputy Programme Manager to MSF V. MUAC ‘survey’ done at three different locations in 5 Belgium and MSF Holland Programme Managers, crèches and 2 jardins d’enfants [Kindergartens]. Total 8 May, 1997 (in English). D33 children 437, sample 142 -> 135 under five (3 kwash). Results: 9% red, 22% yellow, 19% white. Except for meth- Extract: odological bias and the fact that in Wonsan it was a day Meeting with Mr Kom, Delegate Representative of DPRK off, Georges feels that there was no manipulation. in UNESCO. [...] Again, the concerns and worrying of MSF ->Results in institutions did not show great variations. about situation in DPRK for nutrition and medical. Many ->No official clearance was given to make a survey, offi- sources say that the situation is deteriorating quickly. cially it was training. Again, the proposition from MSF to help North Korean Note: Wosan is a port on the east coast. Port activity people. So, now, we want to know if we can have the stopped, children were from civil servants and officers. authorisation to do a new evaluation and start a program as soon as possible after this evaluation. MSF has big sup- Medical port from donors (UE, Norway, etc.). We have a team ready Production and importation of drugs stopped; only tradi- to go, and we think that it should be interesting that the tional drugs available. Hospitals have, no food, no drugs, team can visit health structures, kindergartens, schools... and no fuel. Questions for Mr Kim: 36 -How many people? talks. provoking therestartingoffour-powerpeace Japan decidedtoresumetheirfoodaidNorthKorea, In AprilandMay1997,SouthKorea,theUSA, and F, it iscoordinatedby Paris, etc. action ofMSFwiththethreesectionsinvolvedB,H explained thatitisthesameteam.Itaninternational PYG andMrKimareupsetbysomanydelegations.So,we going inDPRKwithoutpositiveresults.So,thefriendsof of MSFasktogoDPRK.Therearealotdelegations fax fromMario:MrKimthinksthattwoevaluationteams emergencies withthedonors.Bigconfusionbecauseof credibility/our donorsetc.andweareusedtoworkingin the explotopreparethem.Wehaveabigconfidenceand the program.Wesaidthatwewillinformdonorsabout donors soquicktobeablebeginassoonpossible he doesnotthinkthatMSFwillhavetheagreementof weeks but the explo will have to leave the country because the program. Mr Kim said that the explo will be OK for 3 able 2months.So,todotheevaluationandstart week) withtwootherpeople.Thesepeopleareavail- knows DPRK(MarteenGrootwhoisavailableonlynext How manypeople:Wesaid3peoplewithsomebodywho explo mission. MSF couldbelesslongdependingoftheresults will refuse. So, we introduced the fact that the action of Mr Kimsaidthat6monthsistoolong.ThepeopleofPYG -How much for theproposal? [...] -How long? zations tosend foodintotheNorthbynew routesandto aid iscoining from. Theagreementalsoallows aidorgani- Korea andtomarkthesacks sothatitisclearwherethe that willallowtheSouthtosend foodaiddirectlytoNorth in theoffing,twoKoreas reachedamajoragreement But thisweek,inasignthat greateropennessmaybe would allow South Korea toscore propaganda points. hungry children would be humiliating for the nation and feared thatdirectaidandwrenchingnewscoverageof time “Dear Leader,” now elevated to “Great Leader,” has the suffering.TheGovernment of KimJongII,thelong or toallowjournalistsvisithard-hitareasandpublicize has beenreluctanttoacceptdirectaidfromSouthKorea people maybestarving,buttheNorthKoreanleadership country’s need.VastnumbersofNorthKorea’s23million has beenNorthKoreanpride,whichisasenormousthe the centralobstaclestogettingattentionandassistance With aseriousfaminespreadinginNorthKorea,oneof Extract: V1 Tokyo, 29 May,1997(inEnglish). Nicholas D.Kristof,TheNewYorkTimes(USA), “ A HungryNorthKoreaSwallowsaBitofPride,” D34 surplus rice in storage.Some of thisricewill rot Inthe Korea inJapan, notedthatJapanhashuge stocksof denied thecharges.SoChung On,aspokesman for North the yearsandtakenthemto NorthKorea.Thehas that NorthKoreanspieshave kidnappedJapaneseover than most countries, partly because of recent reports Japan’s Governmenthastaken atougherlineonaid talks,” the officialsaid. now weexpectthemtobemorepositiveonthefour-party exists ontheKoreanPeninsula.“We’vedoneourpart,and an attempttoendthestateofwarthattechnicallystill North tobemoreflexibleandjointhefour-partytalks,in this week’sagreementwasintendedtoencouragethe forces eachyear.AnotherSouthKoreanofficialsaidthat starvation, itisspendingbillionsofdollarsonitsmilitary North Koreaneeds $300 milliontobuyfoodandavert North Korea’struculentattitude,andheaddedthatwhile Korea. Mr.Moonsaidthatthefundamentalobstacleis Moo Hong,theassistantministerofunificationinSouth problem ispeaceontheKoreanPeninsula,”saidMoon the twoKoreas,ChinaandUnitedStates.“Theurgent agrees toaproposalforfour-partypeacetalksinvolving they cansendlarge-scaleassistanceonlyaftertheNorth to thisweek.ButtheSouthKoreanauthoritiesinsistthat- from theprivatesector,suchas50,000tonsagreed Government hasalsosentamodestamountofallowedaid lion worthoffoodtoNorthKorea,andtheSouthKorean motives.” [...]TheUnitedStatesissending$251mil- look likebeggars,andtheyaresuspicious of SouthKorean they maybe,thereisalotofpridethere.Theydon’twantto recently deliveredaidtoNorthKorea.“Asdesperateas South,” said Bernard Krisher, an American in Tokyo who “The NorthKoreansareverysuspiciousofanythingfromthe directly to particular people orfamilies. it will stillbe impossible for South Koreans to send food But therewillbenoon-sitemonitoring,andinanycase designate thetowninNorthKoreathatwillgetaid. tions intheSouththatcontribute1,000tonsoffoodto aid. Thenewarrangementwillapparentlyalloworganiza- and soleportnowdesignatedbytheNorthtoreceivesuch ports —stillanimprovementfromthesinglerailcrossing will arriveonthreeraillinesfromChinaandattwosea- of corn,noodlesandotherfoodcoveredbytheagreement food rollinginfromenemyterritory.Sothe50,600tons demoralizing foritshungrysoldierstoseetruckloadsof North wasapparentlyconcernedinpartthatitwouldbe from theSouthatbordercrossingPan-munjon.The Korea stillrejectedtheideaofreceivinganyaiddirectly Even withitsmoreflexibleattitudeinthosetalks,North in Beijing—is put intoeffect. deal willdependonhowtheaccord—reachedMonday ers aremoreskeptical,andeveryoneagreesthatagood work out,we’llhavetosee.ButI’moptimistic.”Someoth- trying tosendfoodtheNorth.“Whetherornotitwill co-chairman ofaSouthKoreancoalitionorganizations think thisisamajorbreakthrough,”saidLeeYoonGu,the stipulate what region in North Korea will get the food. “I

37 MSF and North Korea 1995-1998 MSF Speaks Out

June rains and go to waste, when it could be used to help component has to be added to the MSF programme in the hungry Koreans, Mr. So said. second phase has not been decided yet. Mainly because insufficient objective data about the nutritional status of the total population and especially the under 5’s could not be retrieved. It’s the opinion of the mission that, based on anecdotal information, the clinical status of children In June 1997, the MSF France emergency food unit in the various hospitals and clinics that were visited and returned to monitor the crops resulting from the seed the overall picture in the streets of the various villages distribution implemented in February, and to negoti- and cities, the DPRK has not reached a famine-like situa- ate a medical programme with the medical authori- tion. A nutritional component may later be added, in the ties. They came across a MSF Holland exploratory team second phase, as part of a comprehensive MSF programme sent at the same time to North Korea. The result was in the DPRK. All hospitals and clinics that were visited – authorisation for MSF to set up a one month-long see the assessment report - reached the zero stock level programme to provide medical material to three hos- for at least western-style basic drugs. Patient with acute pitals. Then, a proposal for another six month-long diseases cannot be treated adequately. Most basic medical programme was negotiated. The North Korean officials materials are also not available anymore. made it clear that they were more interested in huge quantities of aid rather than in the quality, and were The mission proposed to start with an immediate targeted reluctant to have MSF expatriates present in several distribution of basic medicines and medical materials counties. Eventually, on 3 July, 1997, MSF and the to selected hospitals and clinics in 4 different counties. FDRC signed a memorandum of understanding valid for Institutions will receive MSF materials based on their one year. They agreed upon the implementation of a knowledge level, drug consumption, prescription behav- ‘medical and nutritional emergency relief programme’, iour, and whether or not they have been in contact with officially starting on 5 July, 1997, in 34 counties of MSF before. The first month of the project will also be used South Pyongyan, North Hwangae and Kangwon prov- to fine-tune the relationship with the DPRK and to further inces. While the first one month-long programme was assess the medical and nutritional status in the country. mainly financed with private funds, the 6 month-long programme was to be completely financed by ECHO.

Fax message, from Jules Pieters, MSF Holland Emergency Unit, from Bangkok on his trip back “Proposal DPRK/MSF Medical Emergency Relief from North Korea to MSF Holland Programme Programme, Project Period: 4 June - 4 July, manager, 6 June, 1997 (in English). D36 1997,” MSF, June 1997 (in English). D35 Extract: Extract: I really think it would be better for MSF to finance the Introduction first month out of our own funds. The most important The government of the People’s Democratic Republic of reason is that we agreed this with the government. It’s Korea (DPRK) requested MSF to field a small exploratory specifically stated in the MOU. Besides this, humanitarian team consisting of a team leader, a medical doctor and a aid in the DPRK is highly political and donors are trying logistics expert. This mission took place from 24 May until to influence organisations to lower their standards. IFRC 4 June 1997. The main purpose of the MSF explo mission [International Federation of Red Cross] and UNICEF simply was to re-establish formal contact with the authorities in state that their aid is ‘political.’ It is important for MSF Pyongyang. If allowed to travel, the mission’s ToR [Terms to be independent, especially the first month of trial and of Reference] was to assess the medical and the nutritional error. Don’t forget that the government is a smart one. situation in the DPRK at large and in specific areas of If we do not stick to the letter of the MOU that we all the country. The ToR also allowed the mission to propose agreed to, we give them the opportunity to do the same. an emergency programme to the government if certain The UNESCO delegation in Paris has had contact with ECHO conditions were met. The Government’s Flood Damage before. Later on I am sure many donors are willing to give Rehabilitation Committee kindly allowed the MSF mission generously for the DPRK. to visit 4 counties: Ichon, Unpa, Pakchon and Huichon. On the last day of the explo mission an extra visit was made to Furthermore: the maternity hospital in Pyongyang, the capital city. [...] Keep your fax messages and phone calls to Pyongyang strictly to the point, no jokes and no referrals to money if Proposed intervention by MSF not really necessary: no budget proposals, no donor cor- It was proposed by the mission to start an immediate medi- respondence. Also avoid the impression that there might cal relief programme, in two phases. The first phase of the be a difference of opinion on MSF European level (which programme will last one month, the second phase at least never happens of course). Never write North Korea as the 6 months, or any longer or shorter period to be agreed address. We’re working in Korea or the Democratic People’s 38 upon between DPRK and MSF. Whether or not a nutritional Republic of Korea. in furtherdetail. Asyouproposedearlier, Thursday [the] much liketomeet youinpersontodiscuss theproject project will amountto: ECU 3,875,000. We would very and financial proposal for this intervention. The total one foreachsection.Youwill findenclosedthenarrative cation andwewouldprefer to sign3differentcontracts, we wouldlikeECHOtoconsider threedifferentfundsallo- team (2 persons) will be based in Pyongyang. Therefore, ates will be present in each province and the coordination will besimilarineachprovince.Ateamoftwoexpatri - North Hwangae,MSFB:SouthPyongyan).Theactivities tion takingcareofoneprovince(MSFF:Kangwon,MSFH: Belgian, FrenchandDutchsectionsinvolved,eachsec - This will be an internationalMSF mission, with the health facilities. nourished childrenandprovidingdrinkablewaterforsome drugs, improving the nutritional management of the mal- health structures,trainingontheproperuseofessential consist ofsupplyingdrugsandmedicalmaterialstothe the next6months.Thisprojectwillcover3provincesand able toproposealonger-term project inNorthKoreafor health structures.Followingthisfirstphase,MSFisnow opportunity tomeethealthofficials,andvisitvarious During thismonth,theMSFteaminNorthKoreahad to selectedhospitalsandclinicsin4differentcounties. distribution ofbasicmedicinesandmedicalmaterials a one-monthprojectinJune.Thisconsistedoftargeted tional emergencyreliefprogramme.Afirstmissionstarted Democratic RepublicofNorthKoreaamedicalandnutri- Médecins SansFrontièresisplanningtoimplementinthe Dear Sir, Extract: than French or anyother world language. to playthegame.Englishseemsbebetterunderstood you, butitisreality.IfMSFwantstostayinKoreawehave a bitcomplicatedanditmaysoundoverthetopfor nurses arenottoohighonthesocialladder.Iknowitis mation’ between colleagues. It’s better to recruit doctors; avoided forexample;itisbettertouse‘exchangeofinfor- sensitive aboutthepoint.Theword‘training’shouldbe the colleagues.AtmomentKoreansareextremely in direct patient care, based on mutual trust between confidence. ThenMSFdoctorsmayverywellbeinvolved may, ofcourse,changeinthefutureafterwe’vebuiltup doctors cannotbeinvolvedindirectpatientcare.This really operational;we’reinKoreaanadvisoryrole.MSF to wearshirtandtieifnecessary.MSFstaffcannotbe ence and/orexperienceinanotherfield)whoarewilling experienced, 30+diplomatswithpublichealthexperi- with T-shirtandjeans(slightcaricature,sorry).Weneed We arenotlookingfortheMSFemergencyrush-rushstaff For future team members during thesecond phase: 11 July, 1997 (inEnglish). Programme ManagertoWernerScholtz,ECHO, Letter fromMarie-PierreAllié,MSFFrance D37 MSF presence now andthey do notseem to like it. The higherauthoritiesseemtohavenoticedtheincreased of this.Theyalsoliketohaveasfewexpatspossible. expats and then slowly expand. The DPRK is not in favour whelm us.Iwouldprefertostartinoneprovincewith4 the constraints we already have; it would simply over- Personally Iamnottoohappywiththe3provinces,given mates atotalcostofaround8,000,000USDfor6months. ince andtwoexpatsinPyongyang(8expats),Hildeesti- high energymilkforexample)with2expatsineachprov- -(medicines distribution,training,distributionBP5and entire provinces.IFweprepareacomprehensiveapproach like togiveMSFinonego.DPRKwantsuswork3 We needtohearfromECHOhowmuchmoneytheywould seems to be aproblemwith furniture. process. Theapartmentforexpatsisnotreadyyet,there ministry tomakedataavailableremainsaslowandtouchy very positive.Datacollectionandthewillingnessif Hilde andco.havenoproblemtravellingaround,thatis is notsomuchinterestedinquality,butmorequantity. much moneyandprogrammescanMSForganise?TheDPRK stage oftheprogramme.Mainquestionasalwaysis:how were toallowforexpatsintheprovincessecond Pyongyang seemstobeabitmorereluctantthanthey the programmewithcommittee.Thecommitteein Hilde andco.aretalkingaboutthesecondstageof Too many ears listening. She will call you today as well. Hilde calledmetotalkaboutmoneymattersinDutch. Salut, Marie-Pierre, Extract: ward to hearing fromyou soon. Thanking youinadvanceforyourattention,welook- 17th issuitableforus,ifitstillconvenientyou. Jules H.M. Pieters. hereafter calledMSF,represented byEmergenciesDirector, humanitarian organisation Medicinessans Frontières, Affairs, Mr. JongYunHyong and the international private called FDRC, represented by the Director for External The FloodDamageRehabilitationCommittee,hereafter MEMORANDUM OF UNDERSTANDING BETWEEN: Extract: English). France ProgrammeManager,16June,1997(in Emergency UnittoMarie-PierreAllié,MSF “ 1997 (inEnglish). Médecins SansFrontières,”Pyongyang,3July, Flood DamageRehabilitationCommitteeand “ DPRK” Memorandum ofUnderstandingbetweenthe Email fromJulesPieters,MSFHolland D38 D39

39 MSF and North Korea 1995-1998 MSF Speaks Out

TAKING INTO CONSIDERATION -Two medical and/or technical consultants (specialists) -That severe floods in 1995 and 1996 caused consider- can each pay a 10-day visit once during the programme able agricultural damage and losses of food supply to the period. The purpose of their visit will be, amongst oth- population ers, to advice programme staff on the implementation of -That due to consequent food shortages the nutritional the current project and the content possible additional status, and herein the health status, of the population of projects; the DPRK becomes seriously threatened -A financial controller can pay two 5-day visits during the -The mutual positive experience of past and present co- programme period to assist the programme staff with the operation between the FDRC and MSF proper financial administration of the project.

ACKNOWLEDGE THAT THEY HAVE AGREED THAT -This MoU is valid for a one year period, commencing 5 July 1997 -MSF can continue with a medical and nutritional relief I returned in June, with the agronomist and the programme in DPRK commencing 5 July 1997, for the doctor to see what the seeds had produced, how duration of 6 months. they’d been used. I was also supposed to try once -This programme will be known as “FDRC/MSF Medical and more, via this programme which had got us back into North Nutritional Emergency Relief Programme” Korea, to re-establish contact with the medical authorities -This programme (for details and planning see programme and see what we could do in this domain.I’d organised a proposal) will be implemented in close co-operation meeting between Maarten and the Health Minister in and collaboration with the FDRC, weekly meetings with advance. But in the meantime we came across another MSF Ministry of Public Health team, who’d come at the same time. Patrick and I withdrew -The programme will be jointly evaluated by the partners ourselves from the medical issues and we suggested to the after 4 months; the results of this evaluation shall be used other MSF team that it accompany Marteen to the Health to facilitate a decision to extend the programme for a new Minister meeting. And we carried on with our agricultural period (third phase) business. The other MSF volunteers were put up in a suite in -Medical and nutritional assistance as described in the an old hotel, 10 to 15 kms away in the suburbs, on their project proposal will be limited to the following project own. We explained to them that they’d been put in such an area: isolated spot to avoid contacts with the population. As they hadn’t seen anything of North Korea, everything seemed South Pyongyan Province: Pyongson city, Kaechon city, normal to them, they didn’t question anything. They were Dokchon city so bored that we saw a lot of each other and in the evening Counties: Unsan, Sukchon, Pyongwon, Mundok, Pukchang, they’d tell us what they’d been up to. Each time I asked Songchon, Daedong, Zungsan them if they were aware of what previous MSF teams had experienced. They were focusing on malnutrition issues. I North Hwanqhae Province: Sariwon city, Songrim city told them to check that the same malnourished children Counties: Hwangzu, Yontan, Bongsan, Unpa, Rinsan, weren’t being produced each time. When they’d got a better Sohung, Suan, Yonsan, Koksan, Singye. handle on the situation, they realised that this was the case. The same malnourished children were used - and they Kanqwon Province: Wonsan city, Munchon city were more ill than malnourished, incidentally - because Counties: Chonnae, Anbyon, Kosan, Tongchon, Kosong, there was no striking malnutrition at the time. Hoiyang, Sepo, Pangyo, Popdong. Olivier Lesrel, Manager of MSF’s Emergency Food Cell Total population: 4,345,000; Total counties: 34 [...] The (in French). total estimated cost of the programme is 4.5 million USD, MSF will seek funding for this programme from its (institutional) donors, amongst others, ECHO, USAID, European and other governments and the general public. [...] MSF can field eight experienced MSF expatriate staff for the They made it clear that it was only temporary and duration of the project: 1 Head of Mission, 6 (para)- that they of course could deal with the situation. ‘If medical staff and 1 logistician; you want to help you can!’ It was difficult because -The MSF expatriate staff can travel freely and perform they made it clear that ‘you donate your materials and we their duties in the described programme area, based on distribute the materials.’ That’s not the way we work so it a weekly planning to be provided to the authorities. The took more than two weeks to negotiate access under our expats working in North Hwanghae and South Pyongyan conditions. It was a very interesting period because it is an Province will be based in Pyongyang but can have regular unknown country - it’s closed and sealed off. We were one stays in the province. The expats based in Kangwon will of the very few westerners that were allowed in. The deal be based in Wonsan. [...] that we made was that MSF could have teams in the three -A MSF Operational Director can pay a 10-day visit once provinces and they had access to anywhere they wanted to 40 during the programme period; go under North Korean supervision of course. I did the nego- in your head, which is nothealthy. tiring. Youreallyfeellockedup andakindofparanoiastarts because you always have tobargain, negotiate. It’s very you’re alwaysrestricted with whatyouwouldliketodo one following you, you can’t do anything spontaneously, you’re notallowedtowalkbyyourself,there’salwayssome- what yousay,therearespeakerseverywhereintheceilings, year inNorthKorea.Itisclearthateverybodylistensto Korea, Idon’tknowifwouldhavesignedforanotherhalf have the time. I was also gettinga bit fed up with North quite sure anymore if they asked me to carry on or if I didn’t I diditinonemonthandthenwentbackagain.I’mnot May and Iwent in June, after they’d signed the agreement. things are.’ It was a bit last moment. Jules Peters went in ties again and distribute the medical supplies and see how been therebefore;theysaid:‘Youneedtogothesecoun- tionship; itwaspartofthedeal.Iwenttherebecausehad I think,thekitsdistribution was more to getagoodrela- new projects,notinthesecountiesbutataprovinciallevel. these counties.Atthetime,theywouldpreparethemfor where theyhadbeenworking,andseehowthingswerein July, MSFwoulddistributemedicalkitsinthecounties not have better access. continuing withthenegotiations. And then,wemayor there wecanlookaroundandit’sjustamatterofslowly ernment. But,ontheotherhand,wethought,onceare was acompromisebetweenMSFandtheNorthKoreangov- MSF couldnotoperatefullyunderitsownconditions.Soit cut casethattherewasalarge-scalefaminegoingonand that MSFshouldhaveintervenedbecauseitwasnotaclear- the permanentteam.Inaway,inhindsight,Idon’tthink es, Ithinkgotthebestdeal.Andthenhandeditoverto Amsterdam wasabitinbetween.Underthosecircumstanc- doctors workwith?’Youknow,thenormalstory!And wanted andPariswasvery,‘Whataboutaccesscanour I hadtofindanicecompromisebetweenwhatBrussels money ismoreimportantforBrusselsthantheprinciple.So huge ECHOcontractinitspocket.Andsometimes,Ithink, was veryadamanttogobecauseBrusselsasalways,hada this isthebestdealwecangetatmoment.’Brussels nator, agooddiplomat,and—youmaygetbetteraccessbut advice, let’stry.Oncewe’rethere,youhaveagoodcoordi- ‘Well, thisistheresultofjury-andlet’sgoormy coordinated betweenAmsterdamandBrusselsIsaid: tiations and reported back to Paris. Paris was the one that […], Physician, MSF Programme in DPRK,September the agreementwasthatduringmonthofJuneor Programme Manager]haddoneanassessment,and In June,JulesPieters[MSFHollandEmergency Jules Pieters, MSF Holland Emergency Programme to December 1995, January 1997, June1997. Manager (in

English). Nicolas. It canbeusedfor a secondnegotiation. we areputtinginnowextramaterialreallylooklikeSt with that.Weareworkingalreadyahugebudget.If on. A’damproposed6truckstosendNK.Idon’tagree in theareawhereweareworking.Wewilldiscusslater be therealityinmountainousareabutcertainlynot situation inthecountryiswithoutbeingpresent.Thiscan There aretoomanypressarticlessayinghowdramaticthe release onwhatweareseeinganddoing. I proposedtotheteamthinkonfactdoapress Extract: agency linkedtheresumptionofpeacetalkstofoodaid. ence. On22September1997,theofficialNorthKorean issue offoodshortagesbasedontheMSFteamexperi- cussions startedabout a possible communication on the – andwillremainsoforalongtime.WithinMSF,dis- ism. Opinionwasdividedontheseverityofcrisis executed becausetheyhadcommittedactsofcannibal- deserter officerreportedthatsomepeoplehadbeen increasing coveragebytheinternationalmedia.A again raisedbyseveralreliefagencies,andgained provinces ofNorthKorea,thefoodshortageissuewas From Auguston,asadroughtwasnowaffectingsome please keep us informed? any reports on the figures or research in DPRK. Could you tion whilstwegettheconsentfromfield.Dohave about ourpresenceandwitnessaccountofthesitua - vague. Webelieveit’sveryimportanttoinformthemedia crete figures and the overall picture of the situation is about thedisasterinDPRK.However,therearenocon - been ahotissueinHongKong.Themediatalkfrequently Hong Kongtoday.ThefoodshortageproblemofDPRKhas DPRK andthefund-raisingappeallaunchedbyOxfam For yourinformation,Ienclosethenewsclippingabout Dear William/Jean-Marc, Extract: The 3boysin the photographareafewof the600,000 Extract: 1997 (inEnglish). MSF HollandProgrammemanagers,19August, Belgium ProgrammemanagertoMSFFranceand “ 1997 (inEnglish). China Morning Post (Hong Kong), 21 August, “Please HelpOXFAMStopthe Hunger,” August, 1997(in English). Officer toMSFBelgiumProgrammemanager,21 Fax fromJaniceFung,MSFHongKongPress North Korea,” Email fromWilliamClaus,MSF D40 D41 South

41 MSF and North Korea 1995-1998 MSF Speaks Out

malnourished children in North Korea. If no food aid potential for future agricultural growth. Therefore, areas comes quickly 2.6 million children are at risk. It’s the around the capital of Pyongyang are farming better than worst drought of the century. With no rain for 50 days, the less fertile northeastern provinces, he said. “It is clear most rivers are dry. The government has run out of food that international food assistance had made a difference, supplies. People are forces to eat grass, seaweed and wild and where it has not reached, the condition of the people plants to survive. is worse,” he said.

“North Korea Sends Troops to Farm Fields,” “Famine Refugees Drowning,” South China Susanne M. Schafer, South China Morning Post Morning Post/Agencies in Washington, (China), 3 September, 1997 (in English). 3 September, 1997 (in English).

Extract: Extract: WASHINGTON (AP) - Teetering on the edge of famine, North Starving North Koreans, too weak to ford an icy river into Korea has sent troops into farm fields to bring in the harvest China, have been drowning by the dozen as they try to for the military, a senior U.S. officer said Wednesday. The flee their country in search of food, a South Korean monk operation has resulted in more food but at the cost of cut- just back from the area said. The famine is nearing a peak, ting summer training in half, North Korean leader Kim Jong with tens of thousands dead of starvation and child mal- II clearly has ordered that more food be given the nation’s nutrition threatening to stunt the next generation, says million-man military, said the senior officer, who is based a former US disaster assistance chief now heading a non- in South Korea and focuses on its defense. “A lot of effort government relief coalition. Pum Nyun, a Buddhist monk is being focused on trying to get a crop in,” said the officer, calling for more food aid for North Korea, said he saw 11 who spoke with reporters on condition of anonymity. bodies floating in the Tumen River in June. “In Summer, North Koreans try to cross [into China] but the water is so The United States, China, and other countries have cold that they don’t have the strength,” he said through donated thousands of tons of food to North Korea, where an interpreter. “They fall and they cannot get up. Chinese inefficient farm policies, flooding and drought have led people say they found 100 bodies in June alone.” Pum Nyun to three years of disastrous crops. The upcoming harvest also quoted a Chinese official whom he refused to name is expected to be very small because of a severe drought as saying in June that 2.8 million North Koreans – more this summer. Aid agencies have expressed concern that than 10 per cent of the population – had died of hunger donated food may sometimes be diverted to the mili- and hunger-related illnesses. tary or elsewhere and have urged the Koreans to allow expanded monitoring to make sure that is not the case. North Korea has relied on international aid to feed its [...] North Korea’s military has its own collective farms 22 million people for the last three years. The monk, in and has been so busy working in the fields that training Washington for a conference of aid organisations on the for both air and ground forces has fallen off, the officer North Korean famine, said he had visited the Chinese- said. [...] Despite the difficulties afflicting the nation, the North Korean border area five times this year and inter- senior officer said he has seen no lessening of discipline viewed roughly 35 North Koreans. Andrew Natsios, a vice- among the troops, nor a fracturing of its political and president of the World Vision relief group, said the famine military leadership. “is upon us, even though the graphic pictures aren’t there because of reluctance on the part of the [North Korean] And Mark Kirk, chief counsel for the House Committee Government to admit how bad things are.” He said the on International Relations, said he agreed after being peak of the famine could come in 30-60 days. A report granted what he called “wide access” inside North Korea that “120,000 people starved to death last year is I think last month during a visit by a panel delegation. “The accurate, and I think several times that are dying now,” he military personnel looked in very good condition,” Kirk said, citing surveys by the UN World Food Programme as said. Despite hearing some reports of dissension among well as World Vision. “The grave danger is next year,” he the military before entering the country, “we saw none of added, saying there was signs the coming harvest “will that.” Committee chairman Rep. Benjamin Gilman, R-N.Y., be a disaster – worse than last year’s harvest which led to asked his staff to study just how U.S. and other foreign famine this year.” food assistance to North Korea was being used. China, which provides the majority of North Korea’s food aid, is unconcerned” about monitoring just where it goes, and expatriate North Koreans in Japan believe most of that Mémo from MSF Holland, 16 September, 1997 aid is given to government and military officials, Kirk (in English). D42 said. Kirk said he would describe North Korea as suffering a “severe food shortage,” rather than a famine. North Extract: Korean officials are dispensing food according to their World Vision claims 1 million North Koreans died from 42 own determination of need and whether there is any hunger. Dead bodies are said to be left in the streets, this idea. would considerthis.IwillcontactcommsinMSFBabout on thisissueandcomeupwithacommunicationplan.He in ordertoresearchthepossibilitiesforcommunication NK soon.Isuggestedthatapress-officergoeswithhim already withcommunicationswhattodo.Heisgoing don’t have the information. William had been discussing big. But,wealsocannotsayitisnottrue,because truck drivers.Nothingshowsthattheneedisindeed in China,wherebeforethemoststorieswereheardfrom should haveseenandheardsomethingmore.Wearealso [up with]thesestories?Williamfeelsitcan’tbetrue:we on theground,believesWilliam.Sohowdotheycome not themountainousNorthernarea.WorldVisionis aid organisationsonlycover15%ofthecountry,and sent outalarmingstatements).Theproblemisthatall a longrow(beforeOxfam,ICRC,andtheVaticanalready MSF B.Soundsworriedaboutthismessage.Itisonein age’ andstartbigreliefaid.CalltoWilliamClaus,desk community tostoppretendingthereis‘justafoodshort- coffins needtobere-used.Theycalltheinternational devastating harvests. die ofstarvationwithoutoutside aidafterthreeyearsof North Koreans–nearlyafifth ofthepopulation–will country. Internationalaid organizations say5million pool coverageoftheopening ofanuclearplantinthe drought there.CNNalsorecentlyhadacrewproviding digital video camera, he reported on the status of the permission of North Korean authorities. Using a small who flewinonacommercialflightfromBeijingwiththe its presidentofinternationalnetworks,EasonJordan, In August,CNNairedfootagefromNorthKoreatakenby The secretivecountryisgenerallyoff-limitstoWesterners. infections. are somalnourishedtheybattlinglife-threatening either deadfromstarvationortooweaktocareforthem, reports thatbabies,orphanedbecausetheirparentswere of “PublicEyewithBryantGumbel”Wednesday.VanSant by Peter Van Sant will be shown on the premier episode out tobenothingmorethanherbaltealeaves.Thereport paddies andlinesofpeoplewaitingforreliefwhichturned footage alsoshowsstuntedcornfields,abandonedrice since theendofKoreanWar,CBSsaidSunday.The first civilianflightfrom U.S. soilallowedintothecountry nization Americares on what the network described as the ated babies.ThecrewenteredNorthKoreawiththeorga- along railroad tracks and an orphanage filled with emaci- devastation fromfamine,includingdeadbodieslying sponsored reliefflightdocumentedwidespreadhuman A CBS crew that flew into North Korea on a privately Extract: York, 28 September,1997(in English). Article fromTheAssociatedPress(USA),New million people couldhavedied. in Chinasuggested thatanywherefrom500,000 tothree US aidgroupWorldVision,said asurveyofNorthKoreans office ofCatholicagencyCaritas. ButAndrewNatsios,of nerable,” saidKathiZellweger,director oftheHongKong Koreans admitthis.Butthe aid isreachingthemostvul- of foodaidgrain.“Ofcoursepeoplehavedied.The North off large-scaledeathswiththehelpof800,000tonnes about thedeathrate.MostsayNorthKoreahasstaved refugee, aformersoldier,said.Westernexpertsdiffer But the Army had already tightened border security,” one would trytofleeChina.“Itwillbetheironlyhope. ever. Those interviewed predicted that tens of thousands this winterbecauseautumn’sharvestisthelowest- of 23 million. The death toll is expected to rise steeply In 1995,NorthKoreawasestimatedtohaveapopulation feed themselves.” people don’twanttohavechildrenwhentheycannoteven stem the population decline,” the student explained. But “ of contraceptiveshavebeenwithdrawn.“Theyaretryingto Doctors areforbiddentoperformabortionsandallforms Government orderedNorthKoreanstohavemorechildren. everyone elsehadtofendforthemselves.Thisyear,the city, partymembersandsoldiersweregivenfoodbut is whyIfled,”aformerteachsaid.Shesaidthatinher is preparedtolet70percentofthepopulationdie–that “victory.” Inpoliticalstudysessionsweweretoldthathe it wouldbeenoughtorebuildthecountry and achieve if just30percentofthepopulationsurvivedfamine According to North Korea’s leader, Kim Jong II said that 30,000 outof a populationof500,000 had died. had told him that in the eastern port of Hamhung about know peoplearedying,butdon’tcare,”hesaid.They lot ofpeoplewithfacesswollenoedema.“Officials who regularlytravelsthroughNorthKoreasaidhesawa people arecrazedwithhunger.”AChinesebusinessman escaped withthisfamilymonth.“Inmyvillagesome one over50,orchildrenunderseven,”saidapeasantwho day, especiallytheyoungandold.Youhardlyseeany- from whattheyhadwitnessed.“Peoplearedyingevery a deathrateofonein20thepopulationwasbelievable various provinces,interviewedontheChineseborder,said and someWesternaidexperts.ButNorthKoreansfrom Ethiopian famine–hasbeendismissedbySouthKorea The massivedeathtool–aboutthesameas1984-85 ents areseniorfiguresinNorthKorea’sWorkers’Party. Party documents,”saida25-year-oldstudentwhosepar- China. “ThisisthefigureI’veseenreportedinCommunist hit NorthKorea,accordingtorefugeeswhohavefled At leastamillionpeoplehavestarvedtodeathinfamine- Extract: 1997 (inEnglish). China MorningPost(China),30September, Yanji ontheChina-NorthKoreaborder,South “ Million Dead in KoreaFamine,”JasperBecker in

43 MSF and North Korea 1995-1998 MSF Speaks Out

the South China Morning Post, one of the better-informed journals in the region, cited North Korean refugees as say- “The Famine Behind Closed Doors” Romain ing that at least one million citizens had died of hunger. Franklin, Libération (France), 7 October, 1997 The next day, a recently defected officer declared that (in French). D43 several people had been executed for resorting to acts of cannibalism. World Vision, an American NGO, which has Extract: provided 1,680 tons of food to North Korea since 1996, The biscuits are square, some brown, others green. They’re estimated in September that the famine was responsible food substitutes that North Korea produces en mass in for one or even two million deaths in this country of 23 the factories outside the capital Pyongyang to offset million inhabitants. Such mortality (5%) is not impossible the famine raging for 3 years in a country living behind in the light of comparable precedents: the Chinese famine closed doors under the dictatorship of Kim Jong II, heir of 1959-1961 led to 30 million deaths – unbeknown to to the world’s first communist dynasty. “The first biscuits the entire world, including the numerous delegations who are made with tree bark, the second with leaves. They fill visited the country during these ‘three black years’. Scenes up the stomach, but obviously have zero nutritional value. of cannibalism were staged in several Chinese provinces. In addition, they’re very difficult to digest, and numerous Later, the Chinese authorities, rather than blaming the inhabitants suffer from internal haemorrhages,” relates crazy Maoist policies, held “natural disasters” responsible. Catherine Bertini, Director of the World Food Programme (WFP) whom I met last Friday in Paris. The North Korean Hazards of nature. authorities have also been reduced to gathering algae on North Korea, held sway to the personality cult of Kim the side as food substitutes: “But at least algae has a cer- Sung (deceased) and his son and successor Kim Jong- tain nutritional value” added the WFP director. II, also attributes the current economic wreckage to the hazards of nature, which the director of the WFP denies. Passing through Paris to convince the French government For her, only .3 million tons of the deficit of 2.3 million to provide food aid to this country, Catherine Bertini tons of cereals (equivalent to the entire maize production fears the situation will deteriorate. “All food is distributed in 1994) can be attributed to the successive floods and centrally by the government, even in the countryside. The droughts that have battered the country over the last rations last one month. But now the government has noth- three years. The fact that North Korea is perceived as ing left to distribute and the famine is really serious. With a state with little respect for human rights, potentially winter approaching, people who are already short of food aggressive towards its southern Korean neighbour, and are going to have less and less.” She estimates that the possibly in possession of a nuclear arm, does not facilitate food shortage, at the end of the harvest in progress, will the WFP’s task. But nonetheless, it hopes to gather suf- stand at 2.3 million tonnes of cereals, which represents ficient international contributions to follow through with around a third of the North Korean production. [...] its aid programme. A new fund raising appeal will take place in November. External help. Previously dependent on grants provided by the socialist bloc and bartering with eastern countries before the collapse of the Berlin wall, Pyongyang has had to accept calling for external help since 1995. But North Korea, one of the most repressive and secret regimes From October 1997 onwards, MSF Belgium, the section in the world, seems only willing to reveal the absolute in charge of backing up the programme carried out minimum required of the famine in order to attract inter- negotiations with DPRK authorities about a possible national aid. Despite a presence in the field, it was impos- extension in more counties, with more expatriates. sible for the WFP to form an exact idea of the catastrophe. MSF France and MSF Holland programme managers were The organisation has received no countrywide government not convinced by the value of this extension. In the statistics on the famine. A nutritional study carried out by meantime, more and more journalists were questioning the WFP concluded that of the 4,200 children examined, the humanitarian situation in North Korea. V2 Thus 17% were suffering from malnutrition: a very low percent- there were also discussions within the operational and age, and so difficult to believe. Even more so because the the communication departments about the relevance of WFP is not allowed to examine the subjects presented to a communication gesture on North Korea and its possi- it and was refused permission to carry out an up to date ble content. MSF subsequently obtained authorization survey. “Which is why it is impossible to extrapolate,” con- for an exploratory mission in a northern province, and cludes the WFP director. “The only thing we can be sure on 24 November, 1997 was granted further authority of is that the food deficit is serious.” by the FDRC officials to implement the next phase of its operations, adding an extra province and expanding No way of checking the figures. to work in 59 counties, with 12 expatriates. In March, North Korean officers stated that barely more than a hundred children had died from the consequences of famine. This figure is highly unlikely. Elsewhere, some 44 extreme hypotheses are being put forward. Last Tuesday on theground. Sinceonemonth,wearefully operational I prefer to wait till we have more data and a stable team [meeting] Idon’tliketoreview ourinitialobjectivesnow. Thanks foryournewobjectives. AsIsaidinthereunion Extract: the media on whatwe doand what weseein NK. explo mission in the North to make [give] information to The propositionwasmadetotaketheadvantageof 6. Communication (Maarten absent): delay before to take a decision. (see William’sreport).MSFFandHasktwodaysof *Assessment missionbyasurgeonandananaesthetist according to the results of theexplomission. MSF Bhasnothingagainst the ideaandwilldecide gency needs. MSF H is against it except if there are enormous emer- program must be fulfilled. MSF Fisagainsttheidea.Firstobjectivesoffirst *On theextension of afourth province (Chagang): more per province). more humanresourcestofulfilourengagement(2expats has beenaccepted.Negotiationshavetobedone ent programinthe3provinceswhereweareworkingnow cal extensiontothecountiesnotyetcoveredbypres- *The propositionofthelocalauthoritiesforageographi- source of funding. interest tosupportit.Eachsectionhasdecideits’own accepted. Concerningthefinancing,ECHOhadshownits *An extensionofsixmonthsthepresentprogramwas options were proposed following the visits of William: -The questionofanextensionwasraisedasdifferent ground andso the programshave a greatdelay. as someoftheexpatriatesareonlynewlyarrivedon sible tomaketodayagoodbalance[evaluation] on that state ofthepopulation.Williamexpressesthatitisimpos- of thepopulation,gatheringinformationonhealth medical structure,improvementofthenutritionalstatus program: increasing of the access of the population to the -Debate onthefulfilmentofobjectivespresent Extension of the presentprogram (Med). [...] by JacquesTremblay(HoM)andDominiqueLafontaine ince hasbeenaccepted.Itwillbedoneassoonpossible The principleofanexplo mission intheChangangprov- Extract: agers, 30 October, 1997(inEnglish). to MSF France and MSF Holland programme man- William Claus,MSFBelgiumprogrammemanager “ English). Meeting onNorthKorea,”22October,1997(in Report “Intersectionprogrammemanagers The ObjectivesoftheMission,” D44 Email from D45 Looking also forward to have yourfeedback. that ourdiscussionaffecttheoperationalityinfield. say Iamcertainlyreadytodiscussbutwantavoid are working in a modular system it doesn’t matter. As you my objectives,whicharenotthesameasyours,butwe have noproblemofmakingvolumeinDPRK.Itenters an exitstrategyorahandingoverstrategy??).SecondlyI will then have data (Nice that we are talking already of are progressingdaybyday.Attheendofmonth,we are reallyworkingnow(3monthsinthefield)andthey surprise!! Inoneoftheprovinces(SouthPyongyan)3TFCs with thethreesections.Unnecessarytorepeatwhyand Marie, doyou know anythingaboutthis?William, follow- Oxfam HK)barely brokeevenonasimilar appeal.Anne- Hong Konggovernment.Whereas OxfamUK(accordingto HK$ (387,000US$)fromthe Disaster ReliefFundfromthe raised 1.9MHK$fromthepublic (245,000US$)and3M for a “non-China ” emergency since Goma 94. Oxfam HK care. Thisappealmetahuge response,thelargestinHK in Augustahigh-profilejointappeal.PeopleHKdo question marks as we do, at the same time they launched 1. Agencies in HK usually have, privately at least as many to gopublic on North Koreaat this stage? about NorthKoreahereinHongKong.ButisMSFwilling We findourselvesunderincreasingpressuretospeak Extract: tives for MSF inDPRKuntil early next year. -We agreethatwewouldstopthediscussiononobjec- tion of yesterday: For formality’s sake, I’ll like to put in writing our conversa- Dear William, Extract: activities. The activitylevelwillbestabilisedonpresentsetof extension of staff. -This asreactiononrefusalofauthoritiesfortheproposed year, no extension of activities willtake place. -We decide this now on the agreement that till early next is relevant for the discussion ontheobjectives/review. completely, andthuswillallowevaluation.Thisevaluation -It willhaveallowedthepresentprogramstodevelop renewal -ornotoftheMOUwillbethenbecomeanissue. -We thinkthattobeamorerelevanttimebecausethe November 4, 1997(inEnglish). Claus, MSFBelgiumprogrammemanager, MSF HollandprogrammemanagertoWilliam “Objectives forKorea,” tors, 20 October, 1997 (inEnglish). programme managers and communication direc- “North Korea,” Fax fromAlainGuilloux,toMSF

Email from WouterKok, D46 D47

45 MSF and North Korea 1995-1998 MSF Speaks Out

ing our HK – Beijing telephone conversation of October other agencies are suggesting is false, we should take our 15th, I am faxing herewith the Oxfam HK press release responsibility and find ways to correct the picture. where they quoted a ministry of public health official on malnutrition. Could you lay your hands on the AFP wire attribution this figure to Oxfam? “DPRK,” Email from Pierre Salignon, MSF France programme manager to MSF Belgium, MSF France and programme managers Holland programme “Communication on North Korea,” Email exchange managers and directors of operation, 5 November, between Ruud Huurman, Press Officer, MSF 1997 (in English). D49 Holland and William Claus, programme manager MSF Belgium, 3 November, 1997 (in English). Extract: D48 I agree on the decision that till early next year (when?), no extension of activities will take place. Extract: *But in fact, yesterday, you decided to use the reserve of My dear Ruud, ECHO budget for the purchase of blankets and bed sheets -I hope you followed the press articles that appeared in the for hospital(s) in the provinces in which we are working. international press stating that their was a huge malnutri- Why not? It’s difficult for me do have a clear picture of tion including cannibalism and other sources of eating. the situation. So I trust you and the teams if they agreed This information came especially from Caritas and other with this proposal (?). But it’s an extension of activities. related confessional organisations. I am surprised that On this specific issue, I will give you the position of Paris there is no report available on what Caritas saw (which is tomorrow. the reason why we didn’t know it) and again it is based on *On the other hand, William is open if it’s possible to personal thinking and analysis (difficult to do an assess- send an assessment in the north. We have to be clear ment by helico on malnutrition; at least I am not able to that if it’s the case and if we have clearance to do so, we do it but with the help of god you never know isn’t it?). will have to agree on the objectives of this mission and -So the information is not reliable. to be careful not to start new activities if needed before -To avoid to many actors in the game, Alain is informed speaking together. I understand that if we accept to go as the other DO’s. there, we will have to start activities anyway. For me it’s a -We have no authorisation to have more expats on the problem. I agree it’s important to assess the area regard- ground (see with Wouter Kok) it can be the subject of ing the food situation. At the same time, I’m worried we a communication but my dear friend Peter will keep you continue to extend MSF activities in North Korea without informed about it. being able to control anything, like ‘puppets’ in the hands -If we communicate it will be based on our own experienc- of the authorities. es and personally I’d try to avoid the collaboration with -Regarding communication, we feel here it’s more and Caritas on it. Thanks for your questions, and I certainly more needed for MSF to have a public position, about the understand your concern. food issue. In the provinces in which we have a presence, WC we have no proof about malnutrition. If I’m right, MSF B opened around 10 TFC = 150 children (Do you have more From Ruud Huurman: data?) without seeing a big problem about the so-called May I underline again that we should be very aware of the ‘famine’. Do you think it’s relevant for MSF to start to say communication part of the North Korea intervention. We that in the areas in which we have access, it’s impossible had several waves of media attention: what is going on, to confirm WFP/UNICEF and co statements? I think it is. what are we doing, how bad is it really? [...] Responding The problem: We don’t get information from the North to media required good balancing, since some agencies except messages from Alain Guillou. In fact, if we go in (World Vision, UN-bodies) have been reporting on disas- the north and the situation is under control, it will be dif- trous famine, where we didn’t really have very substantial ficult not to speak out, even if there is a risk to be pulled information and only from the South. Personally I wasn’t out from the country. What do you think? aware that other NGO’s (Caritas-see notes Alain) had travelled quite a lot through the country. We have based ourselves on info from the 3 provinces where we are working. It was from the beginning, stated that reports “DPRK? Continued,” Email from Wouter Kok, on severe famine couldn’t be substantiated by anyone, MSF Holland Emergency programme manager to because simply so one had access. I was always told that MSF Belgium, MSF France and MSF Holland pro- other agencies have no people on the ground. The North gramme managers and directors of operations, was presented as a complete black box. This is contra- 6 November, 1997 (in English). D50 dicting the above-mentioned visits. May I suggest again that we share the information carefully and that we fol- Extract: low closely on the communications side? If we and other Communications: 46 agencies have substantial evidence that the picture that We all agreed in Brussels that it is about time to take a with JacquesTremblay inDecemberisimportant. William to myquestions, itwouldbeeasier...Ifeel alsoameeting give youadefinitiveposition. Maybewithyouranswers an answerinthecomingdays. Sorry,nottobeable answer totheKoreanauthorities? Idon’tseehowtogive DPRK after February 98. Do we have time before giving an to knowifwecouldmeet speakofourobjectivesin sion currently.Iseetheprocessgoingonandwouldlike see withmyreaction,it’sdifficult for metotakeadeci- Do wehave an idea of the cost of this extension? You can for aspecificamountofmoneytoputinthisextension? proposition (6months?)andiftheauthoritiesaskedus I wouldlikealsotoknowthedurationofFDRClast is Yes, why? must continuetoextendouractivities?Andifyouranswer NGOs arearrivingnowinDPRK.Sodoyoufeelreallywe the so-calledfamine.Atsametime,moreand working there,ourfirstobjectivewastocollectdataabout DPRK. But we can’t forget that when we decided to start of ourprogrammes.Suretherearestructuralproblemsin manipulated withoutbeingabletocontroltheextension (the righttocontinue).”ButIhavethefeelingthatweare us: “You giveme this (money, material), I give you this I knowthenationalauthoritiesarenegotiatinghardwith gramme without choice. we willbepushedtostartanimportant distribution pro- Hamgyong (cf.infoaboutsocalledfamine),butI’mafraid understand alsoourdesiretoassessthesituationinNorth Do wehaveinformationaboutPyongyangspecifically?I extend, toassessthesituation?Whatareourobjectives? north Hamgyong.Willitbepossible,beforedecidingto Pyongyang (centreofthecountry-9counties)andin don’t understandtheprojecttoexpandouractivitiesin (supervision would be easier...(?). At the same time, I tant), andtoincreasethenumberofexpatsinfield distribution prog and the administrative tasks are impor- team toreceivesupportforadministrative/logwork(the strategy? IunderstandtherequestfromPyongyang (8 before).Ihaveproblems to understandwhatisour ties inNorthKorea.59counties(35,before).13expats begins in February 98, MSF would increase its activi- But Ihavesomequestions:Withthisnewproposal,which Secondly, IsawthelastFDRCproposal.amnotsurprised. Extract: a strategy. I hope.Can you confirmthis William? tutional reasons.Thecommsdepartmentsareworkingon against accusationsofexploitationtheissuesforinsti- position towardsthis“famine.”Alsotoprotectourselves November, 1997 (inEnglish). and MSFHongKongexecutivedirector,18 gramme managersanddirectorsofoperations, MSF Belgium, MSF France and MSFHolland pro- Salignon, MSFFranceprogrammemanagerto “ DPRK-Last FDRCProposal,” Email fromPierre D51 out onwhat our teamssee? strategy asyouagreewithmypositiontostartspeaking Concerning communication,couldyoutellmewhatisyour and Wouter, please feel free to tell clearly what you think. Sincerely Pierre We needtodiscussthismatteralso.Maybenextweek... the situation,whichalreadywrotearticles.Idon’tknow. speak butmaybewithspecificjournalistsonly,knowing what todo,say,thewaysayit?Weneed why not to wait the return of Eric from his visit to decide other hand,isitreallyneededtodoapressrelease,and but it’sdifficulttodoapressreleasewiththem).Onthe do wewanttouse(surereceivednewsfromthefield, announce thevisitinnorth,andwhatkindofinfo speak out. It’s nottheproblem.Butwhydo we wantto I don’tunderstandthestrategy.agreeonneedto why wewanttodoapressreleasenextMonday.Infact comms department yesterday and would like to know How areyoutoday?Ireceived this messagefromyour From Pierre Salignon: just back from theexploratory mission. 2. Weekof08/12:pressconferencewithEricGoemaere, announce the departure oftheexplo mission. nutritional reporttothemediaandatsametimewe 1. Weekof24/11:wesendapressreleasebasedonthe Communication strategy: be accompanied by ourExecutive Director EricGoemaere. This missionwillleaveattheendofNovemberand for an explo-mission to the northern part of the country. South Pyongan.Moreover,wereceivedtheauthorisation report on the situation in 4 counties in the province of Last Monday(17/11)wereceivedthefirstnutritional From Peter Thesin, Dear colleagues, Extract: regards ourdiscussion onthepossibilityof the nextphase gramme, asdiscussed inourconversation on Nov.22.As ber of MSF expatriates needed for implementing the pro- areas forthenextphaseof your operationandthenum- I am pleased to inform you of our position on the target Dear Sir, Extract: 1997 (inEnglish). programme manager,19and21November, Press Officer and Pierre Salignon, MSF France exchange betweenPeterThesin,MSFBelgium “ 24 November, 1997 (in English). Democratic People’sRepublicofKorea, Flood Damage Rehabilitation Committee, from JongYunHyong,DirectorExternalAffairs, “ Next PhaseofMSFOperationinDPRK,” C ommunication on North Korea, D52 D53 ” Letter Email

47 MSF and North Korea 1995-1998 MSF Speaks Out

of your operation in 68 counties, including Pyongyang are playing a dominant game of bureaucracy with us. In suburbs, I have consulted the proposed number of 13 MSF DPRK, we should NOT be diplomatic!!! We should just be expatriates with the authorities concerned, but the latter polite, patient but very straight-forward. Otherwise, they allowed only 12 persons for some reasons. Such being the are much better than us in games and role-playing. case, I am obliged to advise you of implementing the next phase of your operation in 59 counties except Pyongyang Expat Paranoia suburbs with 12 MSF expatriates you proposed in your let- All expatriates are paranoid about the DPRK intelligence ter of Nov. 12. system, and their microphones, jails, etc. Please tell expatriates that DPRK is the safest country in the world for an expat IF you are neither spying nor insulting Kim II Sung. Everybody is worried about his shadows, driv- “End Mission Report,” Payam Fazel, MSF ers, translators, waitresses...cool down nothing is really Physician in Kangwon Province, North Korea threatening us. from August to November 1997, 25 November, 1997 (in English). D54 Approach toward Authorities As a result of the same paranoia most expats have a very Extract: naive approach toward Koreans. We should not forget that This is a brief review of the activities carried out by MSF dictators speak two languages: passive and aggressive in general and MSF France in particular in DPRK which is and they do it equally well. We should not be naive in our followed by the evaluation of the undersigned of the MSF everyday rights and as we are their first experiences, we function and his recommendations for the future. [...] should open our space as much as possible. This is quite 3) Malnutrition Management: There are several questions possible I did this and it worked well. Peter was very in the minds of people about this interesting issue. The straight-forward and tough at the same time and I believe response of the author is the fruit of his stay in the field; he was successful in his relationship with them. several visits paid to the hospitals and discussion with food experts, and different embassy staff members who MSF International had stayed in the country for longer time. It is a mess!! We are far from this dream. It is costly, interfering, and chaotic. We should first agree on our I don’t have solid proof for what I claim but I feel strongly plans, policies, financial system, and then we should mix. in favour of the followings: One desk decides, two desks nag and threaten to divorce, Is there a natural disaster occurring in DPRK, with the visitors from three desks to the field, each one will give famine and malnutrition catastrophe as the result? NO, some noble ideas; poor expats are confused to which the yield has been theoretically much less than optimal groom do they belong!! A lot of money spent for what?? but not to the degree you can call it a natural disaster or To be honest the only thing the sections have in common famine. Is there a malnutrition catastrophe in DPRK? YES, in our name: MSF!!!!! there was a malnutrition catastrophe in Kangwon Province. This is evidenced by the occupation of more than half of Recommendations the paediatric beds of the county hospitals by seriously I mention briefly and straight: malnourished cases in different visits my colleague and I 1) I believe it is extremely inadvertent to expand either paid in the same Province. More than 50% of cases were, horizontally or vertically more than this. If anybody categorised as Kwashiorkor (Fiona’s report). There is a pro- wishes to expand more he should nominate himself to be found discrimination in the distribution of food between the Minister of Health in the next cabinet of Kim Jung people who are actively serving the government and those II. In the time that most NGOs are taking the respon- from low a socioeconomic level who are not of primary sibility of few counties, MSF has spread its wings over importance for the government. As the authorities explic- three Provinces and extending his leg nosily to the fourth itly claim, the military is their absolute priority. province to dig. The excuse to explore in the Northern province is to see what is going on inside!! We should I credibly believe they store the new food provided but make up our mind are we MSF or Intelligence Service?! not well monitored by the food aid organisations, and ACF and CZESVI are arriving along with some other NGOs; they consume the replenished old food they have in their let’s give way to somebody else to be blessed by Jesus buffer stock. I have been credibly told that the situation is Christ by humanitarian work!! Americans are begging for much worse in the 6 counties in Kangwon that we are not some room in DPRK let them take over and open the way allowed to visit. We have been negotiating on the inaugu- for McDonalds and KFC. ration of a TFC at the border of these counties to receive referred cases of serious malnutrition. I recommend this 2) I believe the Koreans would kick us out as soon as they to be followed. [...] I believe our representation is very receive the materials for the next 6 months. weak in a ceremony-based country like DPRK. The HOM in 3) I believe MSF should withdraw as soon as the emer- particular has hidden himself indoors most the time. We gency needs of malnutrition are met. have got a diplomatic/game like relationship that further 4) I believe all expats leaving DPRK need psychological (or 48 complicates the situation. This is the main reason Koreans possibly psychosexual!) rehabilitation. to continuefollowing thesechildren,paying themregular Korea inJanuary. Butweaskedothermembers oftheteam evacuated. Wespentagoodmonth inhospital,returningto In December,BrigitteandI caught typhoid,andwewere point when thingstook off inour province. remained during the next two/three months, but this is the is whenourworkingcontextgotclearer,evenifabitofhaze and seethemeverydayfollowtheirdevelopment.This clothes, training for the personnel,andthatwewouldcome told themthatweneededroomsforthesechildren,beds, care. Weaskedforthebuildingtobereorganised. said thatwewouldn’tleaveuntilthesechildrenhadreceived piled upinacornerwheretherewaslittlewarmth.We overlooked andstillhadabitofgroundheating.Therewere abandoned exceptforaroomattheend,whichhadbeen changed; thechildrenwerestillthere.Thebuildingwas We returnedtogetherthefollowingday.Thesituationhadn’t on. Brigittesaid:‘Iwanttoseethesechildrentomorrow.’ there wereproblems;wedidn’tunderstandwhatwasgoing process ofdying.Itwasanunimaginablesight.Weknew in acoldroom,naked,piledupcorner,childrenthe to thebuildingnextdoor.Shediscovered3040children several –wedecidedtobeabitpushy.Brigitteforcedvisit – wewerealwaysinthesamebuilding,butitwasoneof The nexttime,inthesamecentre,situation something wasn’t right. she wasgiven,butfromthatmomentonwards,weknew they weregoing.Idon’tremembertheexactexplanation the hospital in a cart. She stated to shout, asking where unexpectedly, shespottedsomechildrenbeingtakenoutof training session.Shelefttheroomtosmokeacigaretteand, see themagain.OnedayBrigitte[thenurse]washoldinga really serious state. But afterwards, the next time, we didn’t children aroundfordemonstrationneeds,evenina During trainingsessions,therewerealwaysmalnourished tence, somewhere,ofseriouslymalnourishedchildren. international visitors.Onourside,wesuspectedtheexis- then, theydidn’trevealreallymalnourished children to of aslightopeningonthepartauthorities.Until started receivingreallymalnourishedchildren.Itwasproof Towards November,somethingchanged.Wegradually herent explanations. We didn’t have control over everything. accompanied byanadult,whooftengavenebulous,inco- the other provinces. coming fromandtohaveaccessmoreofthem,in children. Thentheytriedtofindoutwherewere sight. Theyhadtofightbeallowedcareforthese ably orphansthathadsofarbeenkeptoutoftheir the existence of severely malnourished children, prob- South PyongyanProvince,theMSFteamdiscovered In November1997,inahospitalofPyongsongthe malnutrition inourtherapeuticcentres,always mostly receivedchildrensufferingfrommoderate At thebeginning,duringfirstfewweeks,we the system have nothing. town, distributedinapre-definedcentre,sothoseoutside system, each person has his own ration of food in his own practically nofoodresources.BecauseintheNorthKorean they hadnostrengthleft.Itwastheendofwinter; case. They’dbeenroundedup.Theywereinsuchastate; far away.Weunderstoodimmediatelythatthiswasn’tthe explanation that they had families, but their parents lived from thestreets.Soeachtimeweweregivenofficial But themanagersdidn’twanttousknowthattheycame ed upandsenttothiscentre for nutritionalrecuperation. no families,theylivedinthestreets,andthey’dbeenround- them, wecaughtone.Werealisedthatthesechildrenhad When theysawus,startedrunningaway.Weranafter of 5-6arrivedressedinrags,accompaniedbyoneperson. we wentthereweremorechildren.Oneday,sawagroup there, they were accepted up to a certain point. Every time possible they’dfinishedupinthisstate.Thechildrenwere being toknowwhomthesechildrenwereandhowitwas with lots of oedemas. This was the first phase, the second And allthechildrensufferedfromreallyseveremalnutrition, registers. Welookedafteraboutahundredinthishospital. to hide. I have all the information; we photocopied all the children startedgettingbetter.Therewasnothingreallyleft were inBelgiumandFrance.Fromthismomenton,the visits, andkeepingusinformedoftheirprogresswhilstwe explanation. the nextdaytheyhadgone. Hesearchedaroundforan immediate emergencycareprocedure forthesechildren,but legs andchaffs on their skin. Hewanted to startupan age, inrags,naked,seriouslymalnourished,withswollen older children,betweensevenandnineyearsoldonaver - One dayhewasshownagroupofextremelymalnourished children comingtothecentrewasnotatallrepresentative. very goodatforcing.Hecomplainedthatthepopulationof had toforcetheissueotherwise.Thedoctorattimewas anything to yell at the authorities about this screening. We screened. Butitdidn’tstopus.Itwouldn’thavechanged that thepeopletryingtoenterthesecentreswerebeing country –theyshouldhavebeenfarhigher.Weweresure with anyimagewehadofafamineragingthroughthe their mothers.Inaddition,thenumberswereincompatible malnourished butalwayswelldressedandaccompaniedby dren whocametoournutritionalcentreswereeffectively children inareallybadstate.Itwasstrikingthatthechil- having doctorswhocoulddigabout–theycameacross in

DPRK, August 1997 toSeptember 1998 (in French). Dr. Eric Goemaere, Exectuive Director MSF Belgium, about –thatwasthepointofthispresence,forme, one oftheprovincesnearcapital,andbydigging The MSFBelgianteamsetupnutritionalcentresin Dominique Lafontaine, physician, MSF Programme (in French).

49 MSF and North Korea 1995-1998 MSF Speaks Out

to the team. Geographically in the province where we are: we can now access the village level and visit clinics These children had no parents whilst all the others and more and more counties are open. Still we cannot had at least their mother or some other family mem- go in all counties in the province (for ‘security reasons’). ber. We could really see that these children were Interesting to see that leaders of those counties are now outcasts. We were sure of this; because we saw what a complaining at provincial level of not receiving aid like lamentable state they were in when they arrived. Their skin the others... More and more provinces become accessible was a disaster. hey came to us from time to time, some- every month: we where able to travel in North Hamgyong times from far away. It’s not easy to travel in Korea, there’s for the first time and UNICEF received authorisation last no means of transport. week for international staff based in Ryangan and IFRC just received a green light for Changan. No province is Marie-Rose Pecchio, Coordinator, November 1997 to inaccessible but still some districts in provinces are. The September 1998 MSF North Korea (in French). main barrier we still face is the access to households: out of the question for the moment to enter households so no possibility to make any randomized nutritional or morbidity survey.

In late November and early December, Eric Goemaere, 3. Do we control the aid distributed or does it go to the MSF Belgium Executive Director, paid a visit to the MSF army or party leaders? This question is raised by every programme in North Korea. single journalist from Hong Kong to Brussels, to give the almost obsessive importance of it. MSF, since 95 and the first intervention linked aid with a totally new condition for them: presence of international staff on the field. This “Some Questions after a Short Visit to DPRK,” was then an enormous problem and seen has an arrogant Report from Eric Goemaere, MSF Belgium attitude; it became normal today. MSF has done a pioneer Executive Director, 15 December, 1997 (in job with a condition nowadays written in the ‘code of English). D55 conduct’ made between agencies in Pyongyang for aid distribution. As our aid is therefore closely supervised by Extract: international staff; we can answer very clearly, that NO aid 1. As we are obviously in a military dictatorship, with is going to beneficiaries outside the plan. Although we little space for individual freedom, how can we justify our are not responsible for food aid, the information collected presence? [...] with WFP and EEC (DG8) are all-conclusive in the idea that 3. For the MSF teams, it is important to keep in mind this food aid is fairly well distributed and that militaries have totally unacceptable environment and origin of the disas- probably their own channels. But this of course is indirect, ter which is of course mainly man-made, whatever influ- not systematic and therefore much less reliable informa- ence the natural disasters could have had in recent years. tion than what concerns our medical aid.

The main principle in this kind of environment for human- To resume the general impression, I would quote the UNDP itarian aid is to beware not to reinforce by any means, representative, present in the country for 2? years: “One the control and exploitation exerted by an oligarchy on should not come to DPRK to look for massive leakages of the people (‘the victims’) a principle usually referred to in aid; no system is totally waterproof but this one is prob- our language as ‘first do not hurt’. In other words, MSF by ably the more in the area.” [...] In this environment, MSF essence, most of the time does not work in what can be should more than ever develop an image of independence. called a democracy: the question is not there! But I would Independent, as far as possible, from the government at rather put it in “are we trapped through our work in the first (see above). Independent from the donors for which, concrete block, or worse reinforcing it, or are we contribut- aid is linked to political bargaining. The 97 program was ing to create cracks in it?” To be able to answer this ques- financed at 95% by ECHO and 5% by the Norwegian gov- tion, they are several indicators like: ernment. ECHO will most probably have again a big share A: Essential in the 98 budget as MSF is their best medical “window.” -Choice and direct access to the beneficiaries’ control of ECHO already warned that they would be reluctant to the aid distributed possibly by direct dialogue with local finance North Hamgyong and made it clear to the gov- actors (doctors, nurse...) ernment... “If they did not choose ACF.” The opportunity B: Important (in the medium term) should not be missed to show that we are not dependant -Possibility to address the real roots of the problem on ECHO to start a new program. [...] possibly to change the organisation of the health care system and drug distribution system in accordance with 6. Is there a famine in North Korea like suggested by the needs. some reports? The food situation is year by year more precarious. We have not seen in N Hamgyong, suppos- 2. Do we have now full access to the beneficiaries? Access edly particularly affected by the draught as they cultivate 50 has improved dramatically in the last 6 months according maize only (more sensible to draught than irrigated rice). obliged togoand decoratethetombeverytime theytravel. the Koreanscannot comebackwithoutabouquet. They’re knew, buteveryonedisappears tofindabouquetbecause you knowtheplaneisarriving. Youdon’tknowhowthey see everyoneheadingoffto find abouquet.That’swhen is expensiveforaNorthKorean. Andthensuddenlyyou all. Sopeopledon’tbuyflowers inadvance–abouquet four, five,sixhourslateandsometimesitdoesn’tcomeat didn’t you?’InBeijing,theplaneforPyongyangisalways tomb ofthegreat-veneratedone.Youforgotyourbouquet, a bouquetofflowers.Iwastold:‘thisistodecoratethe to getintoanofficialMercedeswhereIwasinstantlygiven were already there and I couldn’t get into the MSF car. I had The MSFteamwelcomedmeattheairport,butofficials from false anymore. ‘Yes, it’s all false.’ They don’t know howto differentiate true matter offactdiscussionwith,eveninconfidence,saying: they’re doingit.There’snotevensomeonewecanhavea become sousedtostagingthingsthattheynolongerrealise more weight to their own representative than to the HOM. the teamisfarfromgood,eachsectiongivingsometimes training. Lastbutnotleast,theinternationalspiritin counties if far below our criteria for good supervision and One team of 2 international staff for a province with 15 has been much appreciated and needs are still there? we notprovideseedsthisyearasthe97intervention ation onthequalityofwateratperipherallevelwhydid 8. Someadditionalremarks.Weshouldconsideranevalu- city population (ifcity county hospitals are dropped). [...] level except considering them as first reference for the Exceptionally, weshouldprovideaidatprovincialhospital population) withonereferrallevel:thecountyhospital. tion onclinics(torestorefromthebasisalinkwith program? [...]Decentralise:weshouldfocustheinterven- 7. Whatarethekeywordsforourmedico-nutritional 2 children/family). [...] stupid declarationknowingtheKoreanmentalityfortheir “dead bodies” in the rivers, or infant cannibalism (rather comparable with “millions of deaths” as describes, or nutrition was unknown. We have not seen a situation are indicatingacrisissituationforcountrywheremal- problems, thefactthatfiguresdoubledinlastmonth, But seeingthatTFCs are new for thepopulation,transport 1/2 months,in38centres,whichisnotadramaticfigure. feedings: >1,500moderateandseveremalnourished in 2 number ofchildrenwhopassedthroughourtherapeutic ment. Theonlyindirect“indicator”ofmalnutritionisthe was performeduponchildrenselectedbythegovern- one madebyUNICEF/SCFinNovember(17%<80%W/H) We havenonutritionalsurveyforthesamereasonand accomplices to achieve such a set-up and they’ve people arefooledbyitall.Atleast20%havetobe It’s completelysurreal,everything’sfalse80%of shortage rather thanafamine.On9December, Eric collapse ofthe healthsystemandmentioning afood the press.MSFissuedapress releasefocusingonthe thesia), takenbyanMSF physician, wereshownto Korean surgeonsinverypoor conditions(noanaes- Kong. Bloodypicturesofsurgery performedbyNorth Korea, EricGoemaereheld a pressconferenceinHong On 7December1997,onhiswaybackfromNorth after operations. The conditions were apocalyptic. in traditionalmedicine. They usedfishing line for stitches There were little pellet things, which were apparently used there, ahospitalwithouteventabletofaspirin.Notone! seen suchastateofdilapidation,I’veneverwhatIsaw of doctorsinNorthKoreaandthosepoordevils.I’venever nutritional survey inpeople’s homes first. There are lots wouldn’t open a nutritional centre without carrying out a to anewprovince, forcing a bitfurther. We’d saidthatwe being anaccomplice.Hereweweremakingadvances,going tion, it was OK, so long as we didn’t stop. Stopping meant we weremakingadvances,andadvancesintherightdirec- went astep too far, and atthatmoment inch’ Allah.Whilst this cover-up,forcethroughitanywaywecould,until My ideawasthatinthisprogrammewehadtobreakthrough idea of whatwas going on. harder. Wecouldonlylookaroundusandtrygetan The factthatwedidn’tspeak Korean madethingsmuch out ofthequestiontohaveanyunaccompaniedcontacts. round thisprovince.Hereagain,everythingwasfalse.It no carsanywhere.Therewasfactorysmoke.Wewentall road level, with cars driving along. On our side, there were by ariver.Justovertheotherside,wecouldseeChinaat us. It’s the famous province, which is separated from China trip for months. He wondered what they were going to show to gooncertainconditions.Hehadbeennegotiatingour Coordinator atthetime,JacquesTremblay,theyallowedus long negotiationswiththeauthoritiesconductedby problems; a provincewherenoonehadbeenyet.Following was consideredtheprovincemostatrisk,withbiggest I wenttheretovisitanewprovince,NorthHamgyong,which of bending down. to pushmeabit,makingstumblegivetheimpression deposit theflowers.Irefusedtobenddown.Theguidehad A little further on, there’s a monument where I had to empty. Theyspentcolossalamountsofmoneyonthishotel. in theregion.Westopon142ndfloor;it’scompletely the formofapyramid,whichmustbebiggeststructure in thedistance,there’sasortoftowerBabel,hotel Pyong Yang.Therewasnobodyaroundandthensuddenly, these twoMercedesonthisdesertroadinthedirectionof a bouquetwasplacedinmyhands.Andthenwerodewith So Iwasasked:‘youforgotyourbouquet,didn’tyou?’And Dr. Eric Goemaere, Executive Director MSF Belgium, (in French).

51 MSF and North Korea 1995-1998 MSF Speaks Out

Goemaere also gave a press conference in Brussels, tions. It’s up to you whether you take them into account delivering the same message, which was questioned or not. We’ve retained 3 points from Eric’s paper: within the MSF movement. (1) It seems there’s no proof of famine in North Korea, but to date it hasn’t been possible to carry out a real evaluation (nutritional survey) of the gravity of the food problem. It seems that there’s a potential risk and problems “Forward Plan/North Korea Press Conference!” of malnutrition in certain provinces. Yet it’s not always Email from Samantha Bolton, MSF International possible to have indicators allowing us to form a more Communication Coordinator to MSF movement detailed idea of the reality. So the situation is confused; press officers, 4 December, 1997 (in English). the MSF teams have certainly seen cases of malnutrition, D56 but are unable to draw conclusions on the gravity of the situation. Extract: (2) There’s an important (structural) problem on the medi- 1) NORTH KOREA - PRESS CONFERENCE! - This weekend cal front. We were surprised by how you’ve formulated the Dr Eric Goemaere is coining back from North Korea on message (as it’s a draft, we’re allowing ourselves to com- an assessment mission and will be passing through Hong ment). He’s calling (this is the feeling we had after read- Kong on Saturday through Sunday to do a press briefing ing the document) for an increase in unrestricted interna- with the international and local press on Sunday at 2pm tional aid. In fact, on reading the document he appears HK time. This is am Europe time, so great for Monday to support the DPRK authorities, portraying them as open, paper deadlines. [...] The main message is to demystify in agreement with the free circulation of MSF teams (yet the famine - that basically it is the result of the collapse up to now this has never been the case in any of MSF’s 4 of the communist system and that as far as MSF can see working provinces, or only to a very limited extent…) and through the medical and nutritional work in 3 of the 9 encouraging the transportation of aid to the beneficiaries provinces, the malnutrition levels are far from severe (we have doubts about the food). although there are medical needs. (3) He asks the international community not to put condi- As you probably have noticed, the Red Cross Federation tions on its aid. has been doing a big fundraising campaign on the famine, but one of the dangers is that the Federation is run locally A final point, we are uncomfortable seeing in a paper and cannot always work as independently (this info is FYI intended for public distribution the announcement of a and not for public use). Peter Thysen MSF B comm is pre- significant extension of our activities in the Northern paring a report on the situation, which will be distributed Province, when this possibility was supposed to be dis- to all, although NOT for release until further notice. I am cussed by the three sections intervening in North Korea leaving for Hong Kong tonight, to work with Eric and the on your return. The formulation of the document implies new Hong Kong, press officer on the press conference this that this decision has been already been taken, undertak- weekend. Can be contacted through the Hong Kong office ings given and that neither Paris nor Amsterdam have a (Justine Gerald is the press, officer and is on ccmail). word to say on the matter (ref my message sent to you Will send you a better update asap and please stand by and Alain Guilloux before your visit). for the press advisory from Justine and for the info pack from Peter. This is potentially a very big story but must We have the impression here that it’s really important to be handled with care. remain prudent and articulate a public MSF message on North Korea, which focuses on several elements: (1) Your account of your visit in the north as proposed; (2) But underlining the fact that the situation varies according to the provinces MSF works in; “Communication North Korea – Urgent!” Email (3) That it hasn’t yet been possible (for the last 2 years) exchange between Pierre Salignon, MSF France to carry out a nutritional survey such as we understand the programme manager, and William Claus, MSF term, and in the absence of serious indicators, it’s difficult Belgium programme manager, 6-8 December, for us to evaluate the gravity of the nutritional problem. 1997 (in French). D57 Is there a famine or not? 1 or 2 million deaths? Difficult to reply. The only thing we can say without reserve: our Extract: observations in the field lead us to think that the food From Pierre Salignon situation is fragile at the moment (but with only 350 Hi everyone, children in our TFC out of a population of 6 million, we’re We’re pleased to hear that Eric’s visit went well. Thanks not going to talk about severe malnutrition). The causes for sending us the working document in preparation for are diverse (harvests, dependence on the outside world, the press conference. We read it with interest, and we cessation of Soviet/Chinese external aid etc., but also the consider it as a first draft. So here are some remarks/ North Korean system itself, over and above the embargo). reflections on the text, but above all on the contents of (4) This is why it’s important to make a public request for the information, which we feel should be diffused or not. a real evaluation of the gravity of the nutritional prob- 52 Don’t take offence, but we have quite a few remarks/ques- lem, which hasn’t been possible to date due to a lack of WC (re expats in thefield). which will give us a comfortableposition for negotiations in 4provinces,whichmeanswehaveacertainweight, to beonthegroundbeforewecanreact. MSF nowworks the north,Ihavenoproblemwithwhatyousay.Weneed I findyourmessageclear.Regardingourcommitmentsin know if they’ll get to HKintime. I’ve justreceivedyourreactionstothearticle.Idon’t Hi Pierre, From William: Pierre All the best That’s ourthoughts,inshort.Ihopeyoufindthemuseful. on this point). the aidreachesbeneficiaries(wehavemoredoubts in thefield(whichiscertainlytrue),butaboveallthat tance leavestheimpression that thereisnotenoughaid world has ever known. Your call for international assis- striking examples of communism andtotalitarianism this on NorthKorea,acountrywhichremainsoneofthemost when itwillbethesubjectofMSF’sfirstpositiontaken is important,andthisshouldnotbeunder-estimated being abletoevaluatepartofthehumanitariansituation and themedia/internationalcommunity.Theriskofnot anced messageinrelationtoboththelocalauthorities course tothepointsabovewillcreateamuchmorebal- Which is why we have the feeling that limiting our dis- is the impression yougive). Korean authorities,asifeverythingisfine(oratleastthis you don’traisethedifficultiesencounteredwithNorth a lotofmoneytothiscrisis.Youtalkanembargo,but international aidwhendonorsarealreadyinclinedtogive It seemscontradictorytouscallforanincreasein discuss all this at operational level when Jacques returns). ‘98 oranagreementwiththeauthorities(wefirsthaveto sion of our activities, nor talk about 8 million ECUs for It seems more prudent to us not to announce an exten- Idem for the limits of ourintervention). domain isanotherissuetobediscussedonyourreturn. (whether ornotitisforustodevelopouractivitiesinthis tered byourteamsinthehospitalsandhealthfacilities best illustrationofthisisthemedicalsituationencoun- (6) There’snodoubtthatthepopulationissuffering.The DPRK. (5) It’sdifficulttogivearealpicture of thesituationin the north were perhapsmore positive onthis point…?). authorisation andrealfreedomofmovement(thevisitsto hospital leveland notjustataprovincialcapital hospital uted anddistribution monitored,itmust be atacounty place, thepatientscomeback. Ifdrugsaretobedistrib- health systembutthatwhen thestaffandsuppliesarein again. Itisclearthatthere is aconfidencecrisisinthe hospitals andhealthcentres couldofferbasiccareonce month, as more and more people got to know that the admitted tothefeedingcentresdoubledafterfirst children. What is significant is that the number of children provinces, 1,500isnotalargenumberofmalnourished of protein).Outapproximately2millionpeopleinthe severe oedema (qualitative malnutrition - due to a lack MSF supports.ManyweresufferingfromKwashorkoror treated forseveremalnutritioninthe38feedingcentres Kangwon, 1,500childrenunder5yearsoldhavebeen and ahalfmonths:SouthPyongyan,NorthHwanghae, provinces whereMSFhasbeenworkingforthepasttwo at avillageorhousehold level. Inthethreesouthern trition aroundthecountryhavestillnotyetbeenpossible al surveys to assess food distribution and levels of malnu- Access around the country is improving, but full nutrition- in, nomarkets, no fuel, no transport ... for thelastgrainsofriceafterharvesthasbeentaken that copingmechanismsareweak:peoplescavenging street. Howevertherearesignsthatfoodisaproblemand like skeletalpeoplecollapsingfromstarvationinthe etc.), therearenovisiblesignsofwidespread“famine” there is food scarcity (Government and WFP data on crops, care anddrugmanagement.Althoughitisacceptedthat tise, themedicalstaffurgentlyneedtrainingin-patient stay athometodie.Withoutpatients,medicineandprac- have notbeenabletohelpandpatientschosen plies tothehospitalsforpast3-4years,doctors varies elsewhere).Butbecausetherehavebeennosup- most westerncountriesitisapproximately1x800and In NorthKoreathereis1doctorper300inhabitants(in Distribution must be monitored and training is essential.” and dumpdrugs, food andassistance indiscriminately. must not make the same mistakes as in Bosnia and Rwanda But DrGoemaerewarned:“Theinternationalcommunity the northern most province of DPRK(North Korea). returned fromanassessmentmissioninNorthHamgyong, Director ofMédecinsSansFrontières(MSF),whoyesterday help is urgently needed” said Dr Eric Goemaere, Executive no care except fortraditional ‘Korio’ herbal medicine and has collapsedleavingalmosttheentirepopulationwith and therefore no patients. The health system in North Korea thetic, nobasicmedicines,heating,soapandmilk “There aredoctorsandbuildings,butnoaspirin,anaes- Extract: English). Release, HongKong,7December,1997(in Distribution andTrainingofStaff,” - HelpisNeededUrgentlybutNeedsCareful “The HealthSysteminNorthKoreahasCollapsed D58 MSF Press

53 MSF and North Korea 1995-1998 MSF Speaks Out

level (e.g.: in North Hamgyong province there are 17 county hospitals outside the capital, each supporting 20 clinics for 2-3 villages each, or 2-3,000 people). “Follow up North Korea,” Email from Samantha Bolton, MSF International Communication Dr Goemaere added: “Direct donations will never cover the Coordinator to MSF Press officers, 8 December, needs of 23 million people. The assistance needs to be 1997 (in English). D60 diversified to reach the needs of the people”. It is not just food and drugs that are needed but also seeds, tools, fer- Extract: tiliser and fuel and even the basic materials for restarting Dear all, the four drug producing factories which used to produce Samantha and Justine here. The press conference went most of the medicines for the hospitals. Dr Goemaere well yesterday considering it was a Sunday and that the concluded: “In hospitals and village clinics I was impressed chicken bird fever press conference took many of the local by the doctors’ motivation. Although access is improving papers away. The press conference started at 2pm HK time steadily, aid agencies still have to obtain, from the North and lasted for just over an hour. We started with clips from Korean authorities, greater access to those in need. On the video and then Eric Goemaere spoke using overhead the other hand, those providing relief have to diversify the maps of North Korea and of the provinces visited. The type of aid provided to increase North Korea’s capacity to press release was also translated into Chinese. Please see produce food and drugs. If these steps are not taken, the below - and read until the end! – Re: who attended plus people of North Korea will become even more vulnerable to follow up needed thanks and gros bisous famine and disease over the next year.” […]Unfortunately, many of the correspondents were in Kyoto, Japan for the Environment Summit (as per usual Scandinavians and Germans are big on environment issues) - there are also not that many French based cor- “North Korea,” Email exchange between Anne- respondents here - they are mostly based in Bangkok. Marie Huby, MSF UK Executive Director, Anouk DIPLOMATS/POLITICOS - The following embassies/high Delafortrie, MSF Belgium Press Officer and commissions were represented: Russia/FIS Consul + Press William Claus MSF Belgium programme manag- Attache (asked Eric questions about ‘the grand master er, 8 December, 1997 (in English). D59 plan’ and how local political officials were behaving etc); the South Korean Consul (HY Song - who also requested Extract: a copy of the video - will give him the shortened copy as 1) Dear all, edited down by WTN - with only short medical extracts); Over the past few days, a lot of UK organizations have US Senate Foreign Relations Committee (staff); special started raising funds for North Korea. Though it seems assistant to Martin Lee (Head of Democratic Party HK - that these are ‘tactical’ ads, i.e. a way to show institu- opposition); Alliance Française (Henri Gerard - Editor in tional donors that they are trying alternative sources of Chief “Parole” magazine). funding, there is bound to be more media interest in the 2) OTHER INTERVIEWS/PHOTOS - WTN – pre-conference next few days and weeks, so my question is: - which sec- interviewed Eric and made a cut of the video for the world tion is really in charge of our activities in NK? wide sat feed. Interview in English only. AP and AFP photo -Which press office is in charge of info? Can anyone of you also took copies of the photos Eric took, to make cop- help? We really need a fact sheet on what MSF is really ies for the international and local press use out of Hong doing. I have read the sitrep, but it is pretty anecdotal, Kong. Although not clear yet if any picked the pix up. AP so we need to try and make sense of the information. It has also agreed to make copies of the video for anyone is becoming uncomfortable, to say the least, to have to who wants copies of our short, edit which was used to tell journos that MSF has not encountered a famine while make the WTN edit. NBC also DHL’ed a copy of the MSF everyone else is crying wolf; if this is so, then we need to shortened version back to NY so that the producer there argue our case much better, many thanks for your help. could check it out in view of doing the “1’15” personal Anne Marie point of view” clip (can’t remember the exact name of the program slot) […] Both video and photos were to be 1) - Got the following message from UK, William, Jean- clearly marked MSF. Marc, is there a co-ordinating section for Northern Korea? 3) CONGRATULATIONS – Congratulations to the North -Is there a good overview of activities you could mail to Korea team and to Eric for getting the pictures in the first me or I could copy? place – it is no easy feat in such a country and definitely Thanks meant that we had a bigger impact than we would have Anouk had otherwise. It was just after lunch and the press corps and dips present were really feeling queasy at what they were seeing!

54 Korea, butthe doctorsdidnotknowhowto useeventhe medical kits,including drugsnolongeravailable inNorth The hospitalwasamongthose toreceiveMSFbasic has sent staff toNorth Korea since1995. days, shedidnotsurvive,”addedtheheadofMSF,which operation. “The woman had septic shock and after two wound to mop up blood before pressing ahead with the then insertedanalready-bloodstainedswabintotheopen with scissorsandpliersbecausetheylackedscalpels.They remained silentasthesurgeonscutandtoreatherskin only alocalanaesthetic.Boundtoherbed,thewoman a woman grimacing as doctors removed her appendix with Kwangwon provinceandscreenedhereyesterday,showed Médecins Sans Frontières’ headquarters. Sunday, theotherinBrusselsat11:00nextTuesday, press conferences.OnewilltakeplaceinHongKongthis his conclusionsfromthisexploratorymissionduringtwo of the medical personnel. Dr Eric Goemaere will share pitals, accompaniedbyKoreandoctorsandothermembers to access.Hemetthepopulationandvisitedseveralhos- province ofNorthHamgyong,whichisadifficultregion visit includedtraveltothenorthofcountry, lowing informationrelatingtonutritionalproblems.His Sans Frontières,hasjustpaidavisittoNorthKoreafol- Doctor EricGeomaere,ExecutiveDirectorofMédecins Extract: An MSFvideo with nocareexceptfortraditionalkorioherbalmedicine. ” Korea hascollapsed,leavingalmosttheentirepopulation they havenothingtoofferthem.ThehealthsysteminNorth no milkand,therefore,patients,”hesaid.“Theyknow but noaspirin,anaesthetic,basicmedicines,soap, isolated Staliniststate.“Therearedoctorsandbuildings, disorders anddiarrhoea,headded,afteraweekinthe of soap,hadledtowidespreadrespiratoryailments,skin The famine,combinedwithpoorwaterqualityandalack (MSF) director-generalEricGoemaeresaidinHongKong. to useoldbeerbottlesasdrips,MédecinsSansFrontières a shortageofintravenous fluid systems has forced doctors dix with scissors and pliers. She died two days later. And were capturedonfilmtryingtoremoveawoman’sappen- agency saidyesterday.Surgeons,workinginsoiledrobes, with traditionalmedicine,theheadofaninternationalaid refusing toseektreatmentfromhospitalsequippedonly The healthsystemhascollapsed,withthesickanddying Extract: (in English). Morning Post(HongKong),8December,1998 “Sick, DyingRefuseTreatment,” 8 December, 1997 (inFrench). Sans FrontièresinNorthKorea,”MSFBelgium, “Invitation toaPressConference,Médecins V3

taken atahospitalinsouthern D61 South China

on theKorean peninsula. Geneva tomorrow inanattempt to endthe 50 yearsofwar Korea, ChinaandtheUSpreparedtositdownfortalksin medicines. His comments came as North Korea, South said, addingthehospital’sshelveswerefullofherbal paracetamol, sowehadtotrainthemhowuseit,’he most simpledrugs,saidMrGoemaere.‘Theydidn’tknow aid cannotbe linked toanypolitical conditions. people,” concludedEric Goemaere,forwhomhumanitarian ther still,andthiswillleadto thedeathsofthousands drip forlong.Theslightestcatastrophe anditwillsinkfur- can’t keepacountryof23 million inhabitantsonanIV water, buttheydon’tallowit toturnitselfround.Butwe “Certain countriestrytokeep NorthKorea’sheadabove no longer produce anything. factories producingmedicinesarenolongersupplied,and the outputdecreasesyearafteryear.Insameway, And atthemomentthereareneitherseedsnorfuel,and requiring alotofseeds,pesticidesandmechanisation. cy, Koreahasdevelopedanintensiveformofagriculture are combined,heexplains.Inthenameofself-sufficien - only partoftheexplanation.Naturalandstructuralfactors Belgian doctor,thefloodsanddroughtinNorthKoreaare to dieathome,”statedEricGoemaere.Accordingthe or fouryears,thesedoctorscan’thelppatients,whochoose patients. Asnosupplyhasbeenpossibleforthelastthree medicines, no heating, no soap,and no milk. And so, no and buildings,butnoaspirin,anaesthetics,basic health domain.“Therearedoctorsandlotsofgoodwill, One thingisforsure:thesituation’salarmingin but hewasn’t allowed togo into peoples’ homes. to see,particularlyinthenorth,onChineseborder, doctor wasallowedtovisitthehealth centres hewanted been allowedtostayoutsidethecapital.”TheBelgian to thepopulationsisimproving.MSFteamshaverecently certain districtsisnotauthorisedbytheregime.Access nutrition,” heexplained,“becauseaccesstofamiliesand survey withtheaimofestimatingrealdegreemal- yet beenpossibletocarryoutacompletenutritional accounts of abandoned bodies by roadsides. “It hasn’t that high”notedDoctorGoemaere,whodeniescertain MSF hasbeenworkingforthelastsixmonthsarenot from severemalnutritioninthesouthernprovinceswhere collapsed. The figurescollectedforchildren suffering he observed.“Ontheotherhand,healthsystemhas short, thereare no visible signs ofalarge-scalefamine” of thesituationtopressyesterday.“Whilstfoodis Sans Frontières Belgium, gave a more nuanced description the country,DoctorEricGoemaere,DirectorofMédecins Returning fromanexploratorymissioninthenorthof Extract: D62 (Brussels), 10December, 1997 (inFrench). “MSF/North KoreaisonanIVDrip,”LeSoir

55 MSF and North Korea 1995-1998 MSF Speaks Out

pressurise international humanitarian aid organisations into applying international standards in order to create enough “North Korea is not Suffering from Famine, but humanitarian space to work correctly. At the same time I from Under-nourishment,” Dorian Malovic, La used this moment to raise the issue of the nutritional survey Croix (France), 17 December, 1997 (in French). that had to be carried out and the selection of provinces and households it required. I’d also brought a film out of North Extract: Korea showing an appendectomy. There was no anaesthetic “There’s no general famine in North Korea, no bodies or and the surgeon was shown from three different angles cut- cannibalism… that’s rubbish,” protested the President ting ‘inside’ with a pair of scissors. The patient was given a [Executive Director] of Médecins Sans Frontieres (MSF), cork to bite on. An MSF doctor filmed it. Why did they let Belgian section, Eric Goemaere, following his return from him film? Because even in North Korea, we can play on the an eight-day mission in one of the most closed off coun- complicity between doctors. MSF was the first organisation tries in the world. “This country suffers from malnutrition to have teams living in the field, and we ended up establish- and its inhabitants are just managing to keep their heads ing certain complicity between the doctors. There were fleet- above water. In one week, in the towns in the north of the ing moments when things worked loose from the control. country where the situation is really precarious, I only saw But they were rare. These doctors were not torturers; that’s four or five women selling a few vegetables on the sly on not true. They were really disturbed that, as doctors, they street corners that’s all.” Authorised for the first time to had to perform an appendectomy in such conditions. It’s visit the provinces in the north of the country, the MSF not exactly ideal, with IV drips in beer bottles! No one felt mission could observe the total collapse of the health worse about this than them and they ended up leaving us structures: “There are lots of doctors in the hospitals I to film, asking themselves: “if this doesn’t bring in any visited, but they have no medicines, infusions, aspirin, help, what will?” compresses […] and no more patients. People prefer to die at home.” The projection of this film provoked a strong reaction. There are some highly important anti-Korean lobbies, and the film In the southern regions, where MSF has been working for provided ‘scoop’ images proving that things weren’t going several months, people are starting to use the dispensaries well in North Korea. But there were already quite a few again because the organisation provides medicines. So the people who suspected as much! We weren’t looking to put western doctors have been able to assess the state of the pressure on the government with this account. We had no children’s’ health and make an initial evaluation: “We’ve illusions about the fact that the North Korean government observed that the number of malnourished children coming followed press releases abroad. I have to say, as a general to see us (in an area of two million inhabitants) has doubled remark, that I find MSF often takes delight in bearing wit- these last two months, passing from 1,500 to 3,000. There ness to denounce authorities yet frequently does it in places are shortages of protein, because the nutritional input of a and at times that have no coherence with this objective. It’s diet of maize or rice is incomplete.” The combined factors often been done with the objective of drawing attention to of drought and floods partly explain this catastrophic situ- ourselves and being able to claim afterwards that we told ation, but the country’s entire economy is in a state of you so, making ourselves look smart. collapse: no factories are running, there’s no more petrol, no more electricity, everything freezes in winter […] for Dr. Eric Goemaere, Executive Director MSF Belgium, Eric Goemaere, increased assistance is needed with the (in French). guarantee that it will be distributed equitably (as the World Food Programme does), but diversification with local production is also required. “There’s a political stand off on this subject,” he said, “but Koreans must receive the means to restructure their production. Nonetheless, certain coun- Eric created a real scene in Hong Kong, saying: ‘The tries don’t want to see North Korea pull through. For me, we hospitals are empty, operations are carried out with- cannot leave 23 million people on an IV drip.” out anaesthesia, people are dying of hunger, and aid must pour into North Korea. Yes we can ask questions about the regime. Me, I’ve seen what’s going on, I saw someone being operated without an anaesthetic, I’ve seen people being transfused with a bottle of water attached to The first account I gave in Hong Kong just after com- a tube etc.’ He brought back some film. We were really dis- ing out of Korea aimed to describe what I’d seen in appointed by his intervention. I said to him: ‘It’s true that the province of North Hamgyong, the extreme the hospitals are empty, but you went for sensation on dilapidation of the health facilities. It wasn’t supposed to something that doesn’t really warrant it. And you didn’t say be a denunciation at all; I was just relating what I’d seen. the most important thing, which is that aid is used for […] I aimed to describe what things were like for the vic- everything except saving the people. This is where our tims in North Korea, to say that things weren’t going well at responsibility lies. In saying that people are being operated all and that humanitarian aid should be conditional to be on without anaesthesia, you’re not taking any real risks.’ At 56 sure that it really reached the victims. We were aiming to the time we were asking ourselves a lot of questions about we thoughtto ourselves thatitcouldbeinteresting togo We areattheend of1997,beginning1998. WithMarcel, thousands of people crossing the border. situation, whichwasfalling apart withhundredsoreven talked aboutsoexplicitly,deaths duetothefamineanda survive. Itwasthefirsttime wehadheardfaminebeing Korea forChina,wheretheycamelookingassistanceto about theseclandestineNorthKoreanswhohadleft Korean friendsIhadthere.Therewasmoreandtalk expatriated inChina,particularlyviaanetworkofSouth a locallevelinBeijing,viatheSouthKoreancommunity following descriptionsofarealitywhichstartedemergingon North Korea following discussions with François, but also started gettingreallyinterestedinwhatwasgoingon also lookedatMSFJapanforthefirsttime.Wereally hope offindingsomethingtoexploreinSouthKorea.He South Korea,havingstudiedthere.Heturnedtoherinthe tive officer for the Korean programme in Paris and knew at the border. think aboutconductinganassessmentofthesituation inside NorthKoreacouldactuallyseetheybeganto etc.) was contrasting so much with what the team this information(descriptionofwidespreadfamine, a ResearchDirectoroftheMSFFranceFoundation.As team starteddiscussingthisissuewithFrançoisJean, assistance inthenortheasternprovinceofChina.The the Chineseborderinadesperatebidforfoodand numbers ofNorthKoreansfleeingtheircountryvia South Korean community in China, about increasing started toreceiveinformation,throughtheexpatriate From late1997onwards,theMSFFranceteaminChina assistance. idea thathewasgoingtoshuthiseyesandbringinmassive Korean regime’sgameofpropaganda,bysupportingthe we justthoughtthathehadgotsuckedintotheNorth anaesthesia; ourimagehasbeentarnished,etc.’Asforus, try andwhenheleaves,saysthatweoperatewithout to takeitbadly:‘It’sgreat,weinvitesomeoneourcoun- should pullallthestopsout.TheNorthKoreans pretended that weshouldn’tskimponouraidtoNorthKorea, was acountryshortofeverything.Heinsistedonthefact his declarationwasthescandalofshortage,factthatit also expresseddoubts.Butintheendwhatemergedfrom shared ourquestions,becauseweworkedtogether,andthey the senseofassistancetoNorthKorea,andIthinkthey calling onSophieDelaunaywhowastheadministra- with François[Jean].HetookupcontactsinParis, At the end of 1997, we started having discussions Dr. Philippe Biberson, President MSF France (in French).

the Sino-Korean border ourselves. it not,andwedecidedtogoseewhatwasgoingonat Korean networkattheborder,someofitreligious, contacts inBeijingwhowereveryconnectedwiththeSouth to it.Atthetime,wewere leaning onourSouth Korean going on[insidethecountry],andwedidn’thaveaccess Lafontaine, wecouldsensethattheyfeltsomethingwas going on.WhenwelistentoMarie-RosePeccioorDominique direct information.Thevolunteersfeltthatsomethingwas we werehearingfromourteamswhohadlittleaccessto North Korean in flight. We’re very far removed from what we’d neverbeeninpersonatthispoint,andmeta all theaccountswewerehearingatadistance-because and seewhatwasgoingonattheborder,especiallyas if this was the case, it should not prevent us from discuss- consider thenew provinceasanMSFBmodule, andeven to theauthorities(idemfor fundingsearch).Wedon’t MoU concerningthenorthern provinceandpresentingit with you/the team before going any further with the ‘new’ We expresslyaskedforfurther discussionsontheseissues the numberofdistrictstobe coveredwith3expatriates). uation, accesstothepopulation,limitingandtargeting work onclinicanddistricthospitallevels,nutritionaleval - ing ourinterventionwiththeauthorities(particularly ince withoutimposingourconditionsandsorenegotiat - 1. Nostartupofanewprogrammeinthenorthernprov - which we made ourposition clear: just comefromameetingwithyouinBrusselsduring message. Wefindyourpositionunacceptablewhenwe’ve We can’thideoursurpriseanddisagreementwithyourlast William, From Pierre Salignon: Extract: and the limits ofthe program. MSF Franceboardmembersquestionedtheapproach were stillrequestingfurthernegotiation.Onceagain, the MSFFranceandHollandprogrammemanagers manager was about to be signed with the FDRC, while A new MOU agreed to by the MSF Belgium programme regarding theextensionofprograminNorthKorea. Meanwhile, debate and questioning resumed within MSF China, December 1996 toJanuary 1999 (inFrench). Marine Buissonnière, administrator, MSF France in 1998 (inEnglish and French). directors andofoperations,9January, programme managerandcopytoexecutive manager, copytoWouterKok,MSFHolland Pierre-Pascal Vandini,MSFFranceprogramme gramme managerandPierreSalignon between WilliamClaus,MSFBelgiumpro- “DPRK, NorthHamgyong,”EmailExchange D63

57 MSF and North Korea 1995-1998 MSF Speaks Out

ing this intervention together as it will have a significant unique entity in this country and the least you could do is influence on the global strategy of MSF in North Korea. take the positions of the other 2 sections working in the 2. No extension of our activities in the 3 southern prov- country into account. There’s our feedback. You know our inces, which also require some streamlining. position. We can’t continue to collaborate on North Korea 3. Planning an MSF F and MSF H visit to the field as soon in these conditions. Given our disagreements, we think as possible. that all decisions concerning this 4th province should be 4. Planning a discussion in April between MSF B, MSF F, frozen for now. and MSF H for redefining objectives for the post-July ’98 period. All the best (despite everything) Pierre and Pierre-Pascal

Point 1 is essential for us because it influences the global strategy of MSF in North Korea. We never accepted starting in all 15 ‘counties’ in the north with just 3 expatriates in “Korea and Frustrations,” Email from William the field, especially as our positioning in the 3 southern Claus, MSF Belgian programme manager to provinces shows that the existing volume of programmes Pierre Salignon and Pierre-Pascal Vandini, MSF is no longer manageable with the number of expatriates France programme managers 11 January, 1998 we currently have in Korea (2 in each southern prov- (in French). D64 ince…) or at least not in a way that satisfies us. It’s not just a question of having more expatriates. We first of all Extract: have to improve the definition of MSF’s objectives. They’re Hi my friends, thanks for your feedback. A general remark not very clear right now and require more work before we on the international issue. throw ourselves into a new province. You’re going to tell 1. This mission was run by Paris for 2 years. I don’t us that we’re in North Korea to supply essential medicines remember having said no to the start up of a seed dis- and medical material, ‘train’ the medical personnel and tribution programme last year. A programme decided by carry out nutritional activities. Fine, but is this enough? Paris, executed by Paris, and presented afterwards to What limits/conditions (MSF’s principles of intervention) Amsterdam and Brussels (fait accompli!!) Check it out in should be attached to this investment, whether in terms the archives. So I don’t understand your reaction on the of volume, money or duration? Our strategy in North Korea international front. I have the impression that it’s fine is far from clear and it’s not by increasing the volume of when Paris is BUS [back up section] but once another sec- our activities that we’ll get this sorted out. We haven’t tion takes over, the tension starts mounting. How strange! got a grasp on what’s going on in this country (whether Re your points: it’s the game being played by the Koreans themselves, the 1. As you had the funding for the start of the mission international community or, donors such as Echo). And (Paris desk) I think that B should have the next round that’s why we have to be prudent. We’re already one of the (see the email). You have the impression that everything big players in North Korea, which encourages us think that is accepted without negotiation (at least, that’s my under- we’re now in a position to try and discuss intervention standing). Yet I can assure you that Jacques had daily conditions during our meetings with the North Korean battles with the FDRC to win extra ground. As I’ve said authorities. – and this doesn’t show up in your message – one of our main objectives was to carry out an explo in the north. We asked you to use this argument to avoid developing new We did it (!) but there’s a price to pay, and in my opinion activities in the north without posing conditions before- it’s justified. It’s not a bad thing to carry out distributions hand (in particular access to the population, working at of medicines in empty clinics and hospitals! Is it against village level, nutritional evaluation and more targeted MSF’s ethics to supply medicines and start up nutritional work at clinic and district hospital levels). The discussion activities??? Even if it’s in 15 counties (for your informa- on a new MoU for the northern province seemed a good tion, more than half the counties are situated in towns); opportunity to refuse to just dance to the North Koreans’ so I see no obstacles to starting up this programme. tune. Of course this could lead to tensions with the NK but Jacques will come to Paris in 2 weeks. You could question we’re ready to deal with them. Instead you’ve put us, once him further then. again, in front of a ‘fait accompli’ without giving us a word to say on the matter, and we cannot believe that we can’t It’s true, we’re already a major player but that doesn’t raise more issues with the North Koreans, as if our hands bother me. Is it a bad thing??? Whatever the case, it are tied. If this is the case, it poses a real question on puts us in a strong position for future negotiations. (I our freedom to work in North Korea and the price to pay hope your reaction isn’t based on worn out reflections on for being there. Contrary to what you think, we have the volume). I entirely agree with the second point. A visit impression that now’s the right time to make our requests, from H and F would certainly facilitate understanding of our demands, even, to the NK authorities. the policy followed to date. If my memory serves me well, I was the one who proposed such a visit during the meet- This mission has nothing international about it anymore. ing. I think it should include the points you raise: We’re really unhappy about these latest developments, - Access to populations 58 especially when it’s so essential to present MSF as a - Nutritional survey out anMSF survey, particularly in the villages). -Freedom to evaluatethenutritional situation (carrying accorded more expats we will takemore on). the field. This does not mean, however, that if we are mainly becauseofthelimited numberofexpatriatesin -Possibility forMSF,afteran evaluation,tolimititswork, or ask for more). the 2 or 3 days currently possible for visits in the districts, -Freedom ofmovement(perhapsweshouldn’ttalkabout only 3 expatriates). my position on investing in 15 districts in the north with the organisation’sfinanciallimits/capacities(youknow ticular targetingaccordingtothenatureofneedsand -Freedom forMSFtodecidewhichdistrictsrequirepar - introduce quality into our work. (clinics anddistricthospitalsforexample);objective: whilst limitingthenumberoffacilitiestakenincharge -Freedom forMSFtotarget/re-orientatetheseobjectives ants). -Direct accesstothepopulation(accessvillageinhabit- requests, such as: think itwouldbepossibletointroduceafewelements/ northern province and the 3 southern provinces, do you for thismission.ConcerningtheannexofMoU that I’vedrawnuponNorthKoreawithParis’objectives How areyou?WellIhope.attachthecountryfactsheet Hi William, From: Pierre Salignon: William, to adjustyourself to their change ofattitude. passed on,atleastwithregardstothetone.Trythistime, international setup.Iseethatthismessagehasbeen delegation ofconfidence,twoessentialelementsinany sages concerningtheDPRKgoagainstprincipaland inquisitions and ultimatums contained in the last mes- I contactedBernardandPhilippeinParistosaythatthe Dear, From: Eric Goemaere Extrait : We’ve had to doittoo.So I’m continuingas planned. completely reflectanothersection’soperationalpolicy.” have toacceptorrespectothers’decisions,eveniftheydon’t “When we’redealingwithinternationalissues,wesometimes sorry iftherearefrustrationsbutasMarcGastellusays: with agoodanalysis(whichisn’tthecaserightnow).I’m I hopethatwe’llhaveenoughdatabythentocomeup - Vertical approach 1998 (inFrench). MSF Belgiumprogrammemanager,22January, France programmemanagertoWilliamClaus, ager andEmailfromPierreSalignon,MSF to WilliamClaus,MSFBelgiumprogrammeman- Eric Goemaere,Executive Director MSFBelgium “North Korea–MoU/Objectives,” D65 Email from are expensive. it correspondedtoalotofmaterial andmedicines,which too. Itwasalotofmoney,but Iacceptedthecostbecause many argumentsforsayingno. Itrustedthem,andParisdid people whothenproposedthisprogramme.Ididn’thave been anexploratorymissioncarriedoutbytwoexperienced ECUs. Asfortheopeningoffourthprovince,there’d sistent. They were the ones who’d signed for the 5 million was fineandnowit’sus,not.’Theyweren’tbeingcon - green light.SoIsaidtotheFrench:‘Whenitwasyou, Allié [programmemanagerinJuly1997]whogavethe negotiated allthisfinancialvolume.ItwasMarie-Pierre they’d completely forgotten that they were the ones who’d Pierre the 2annexesofMoU.Thanksinadvance,allbest not preventusbeingmoreexplicitinourrequestsand described during our last meeting. Nonetheless this does Having said this, I’m aware of the constraints you was retained. and thenre-openthediscussion;secondproposition country as soon as possible to evaluate our programmes sway; others think that we should organise a visit to the be giveninacountrywhere‘perfectdictatorship’holds think it’s inconceivable that humanitarian assistance can programmes. Certainpeople,includingFrédéricLaffont, the limitedroomformanœuvreindevelopmentofour needs, whicharehuge,havetobemeasuredupagainst being divertedwithoutanycontrolonthesituation.The there. Nevertheless, there is still a major risk that aid is first NGOtopenetrateNorthKoreaanddevelopactivities government onlyauthorises12expatriates.MSFwasthe increase the 1998 budget to 8 million US dollars whilst the The openingofaprogrammeinnewprovincewill to 3.5millionECUs,financedbyECHO. Belgium) fortheperiodJuly1997toMarch1998amounts health personnel. The global budget (Holland, France and rial, setting up therapeutic nutritional centres and training since July 1997, distributing medicines and medical mate- ical regime.MSFhasopenedprogrammesinthreeprovinces (food, medicines, health care etc.), mainly due to the polit- down, withnolocalproductionandwidespreadshortages limits? (PierreSalignon)NorthKoreahascompletelybroken North Korea:whatapproachtoadoptandwhereareour Extract: because itover-inflated our financialvolume.But a bigdiscussion.TheFrenchwereagainstthismove When weopenedupina4 William Claus, MSFBelgium programme manager 31 January, Minutes ofMSFFranceBoardMeeting, 1998 (inFrench). th province,itsparkedoff D66 (in

French).

59 MSF and North Korea 1995-1998 MSF Speaks Out

MSF Belgium was the section that wanted to go “Mission Impossible in North Korea,” Emails further because for them it was a kind of distribu- from William Bourgeois, MSF Belgium pro- tion programme. We said jokingly here in Amsterdam, gramme manager and Jacques Tremblay, and I know that they did the same in Paris: ‘as long as MSF Coordinator for MSF North Korea to Pierre Belgium can fill up the shelves, they are happy.’ It looked Salignon, MSF France programme manager, 29 like it was distribution driven - not driven by the real needs January, 1998 (in French). D68 of the North Koreans but by the willingness to supply drugs. That was the image that we had here and that they also had Extract: in Paris. Allow me to comment on the nonsense appearing in “The Mission” of January 21, 1998. I would just like to say that Pim De Graaf, MSF Holland Executive Director this kind of stupidity really doesn’t help the cause of MSF. (in English). […] I’m not sure whose opinion within MSF F is reflected in such rubbish – the article confuses ‘I’ with ‘we’ […] Could you forward this alternative view of the situation to whoever is concerned?

In January, a short article about MSF on North Korea North Korea (Mission Impossible) published in the MSF France internal newspaper fuelled Surprise surprise: the “Belgians” aren’t extending their controversy between the sections. In North Korea, the programmes but the programmes of MSF. […] In the members of the MSF team were experiencing difficul- north of the country, after 6 months of negotiations in ties in monitoring the aid and getting better access the name of MSF for bringing aid to a population in dif- to the population. But in their field reports, most of ficulty. […] You’re not against on principle, sorry, but in them shaded these concerns, betting on step-by-step the field we have quite the opposite impression. For sure improvements and gradual gain of a space to work. we’re being taken for a ride (with or without respect). And lest we forget: following the tact and diplomacy exhibited by the master hand in 1995, MSF was given its ‘exit visa’ from Korea, perhaps a new way of going about evaluations “North Korea,” The Mission, MSF France’s “worth their salt” at a distance. [...] As for the bad smell, Satirical Internal Review, 21 January, 1998 (in I give 10/10 in the odour stakes to the author of this French). D67 shit on Korea. He/she deserves a good dressing down for displaying such ignorance on the subject and contempt for Extract: the teams in the field. North Korea - the Belgians are extending their programmes to fifteen sub-regions in the north for a vast Moving on, supply operation. So for the year ’98, the World Company’s -ECHO doesn’t finance this programme (in the North) and budget (3 sections present, MSF F, H, B) for this country MSF will have not 3 but 13 expatriates for its programmes alone will border on 50 million francs. Forgive us for in Korea (not easy to count to 13 with just ten fingers, being a bit circumspect in view of how enormous this is. I know) Not because we’re against it on principle (that’s not our -the MSF B team arrived at the beginning of the pro- style) but because it feels a bit like we’re being taken for gramme, not 3 months after the start of a 6 month pro- a ride (with all respect): no evaluations worth their salt gramme. […] The ‘MoU’ for this programme was signed have taken place in the areas in question, so the situation under MSF F coordination, we should know what we’re isn’t very clear; the North Korean government is obviously looking for when injecting ‘cash into one of the most very keen that MSF extends its programmes, it’s good for closed off countries in the world‘. its image, and incidentally good for its stocks; and ECHO, -it would be a bit pretentious to think that we can change who’s funding us (with even more than we asked for), has everything without any direct involvement, except per- found, via MSF, a cushy number for getting its cash into haps for a musketeer of disinformation. And if we could one of the most closed off countries in the world. I don’t bear in mind, however strange it might seem for certain know about you, but I think this smells bad. The other holier than thou persons, that the medicines we distribute small problem, but only a small one, is that for such a really are used by a population in difficulty that doesn’t huge financial volume, MSF B can only put three expats give a damn about the petty quarrels between sections or in the field. Buy hey; it doesn’t really mater, given that individual (donkey) pride... contact with patients is forbidden.

60 too badlyeither. AndIthinkit’sthanksto us.Asforthe through the pharmacy. People are being treated, and not expat doctor,wecheckedthe prescriptions,andwewent Hwanghae province:Iwentround allthepatientswithan treatment. I’vejustcomeback fromafieldvisitinNorth cines andtraining,thereare patientsagain,receiving ing, tocutitshort.After3 months ofdistributingmedi- visits: nopatients, no personnel,nomedicines – nonoth- The hospitalswereemptyduringtheteams’firstfield Strategy. nutshell, farremovedfromanykindofGlobalOperational treat them.Abitsordid,sorry,butit’stherealityin a their childrenwilldiebecausetherearenomedicinesto ity thatit’scompletelybeyondthem.Alltheyknowis souls crushedbyasystemofsuchunimaginableinhuman- Strategy. Thebeneficiaries,hereinKorea,arethepoor under an utter mess called Global Political and Operational in theiroffices,who’veburiedthisnotionofbeneficiaries I’m afraidtherearequiteafewpeople,‘MSFbosses’hidden those who don’t know what a beneficiary is, look it up. for ourpresenceinKorea.It’scalledBENEFICIARIES.For sometimes, justtalkaboutthemainreason anyway, despitetheirefforts.I’dbesohappyifwecould possible to derail the European Union, but it went ahead we do.YouremindmeoftheEnglishwhodideverything I thinkwe’llmanageit,with or withoutyou.It’s high time something calledMSF,ormorepreciselyMSFInternational. years, I believe.We’re in 1998,and we’re trying to build privilege, are over–andhave been forabout 500or600 when thearistocracyfoughttokeepholdofpowerand Messieurs les French, you should know that feudal times, we’re here for. We’re here forGlobal Strategy. who caresthattheKoreansneedhelp.That’snotwhat we’d bepackingourbagsafteracoupleofmonths,and we’re stillallowedtostay,despiteitall.Ifit’dbeenus, them, check that our medicinesareused properly. And our patients,touchthem,discusstheirtreatmentswith much fasterlasttime.Anddoyouknowwhat,wecanvisit haven’t been thrown out yet? Weird! Things moved so you realisethatMSFhasbeenherefor6monthsandwe we’d do a much better job if we were in your place. Do happy becausetheweeBelgeshavegotcoordination: section squabble,onceagain.TheweeFrenchiesaren’t about NorthKoreaisnothingmorethanapitifulinter- a suspicionthatattheendofday,allthisbrouhaha ence toyourinsultstheMSFteaminKorea.[...]Ihave of Mission,here’smine,thenewHeadinrefer- Following thereactionofJacquesTremblay,ex-Head Extract: French). Belgian andMSFHolland,31January,1998(in ager, copiestoprogrammemanagersofMSF Pierre Salignon,MSFFranceprogrammeman- Rose Pecchio,newCoordinator,MSFDPRK,to “Those BadFrenchSmells,” D69 Email from Marie- - it’sworking.... Thanks for nothing, headquarters. strategy forbuildingupHRloyalty,thenguesswhatguys entirely composed of first missions. If this is MSF F’s new over the last few months. Here, the MSF field team is Paris’s elevatedopinionofourexpats’workinthefield might be. I’m ashamed, as Head of Mission, to pass on to pulloutofthedirt, unpleasant thoughthatthought doesn’t sayasinglewordabouttheKoreansMSF’strying the same organisation as this anonymous figure, which less sotheorganisationitself.I’mashamedtobelong nothing toadvanceMSF’sinternationalissue,andeven things todo.Aboveallwhensuchlow-leveldebatedoes of yourchildishstories,F-H-B.I’vegotsomanybetter In conclusion,I’dlikeyoutoknowthatI’msickandtied done with this material and cash. because we,MSF,cansee‘withourowneyes’what’sbeen money for medicines and medical material. I’m all for it to me.Andallthebetterifotherswantgivestillmore God ourFatherorGorbatchev,it’salloneandthesame estly don’tgiveadamn.Whetherit’sKhomeini,thePope, our workwhichallowsustoreachobjectives,Ihon- wants to‘getitscash’intothecountry,andsosubsidises with MSF,soIknowwhatI’mtalkingabout.AndifECHO our othermissions??I’vecarriedout14,during7years gave totheDG8representative).Canwesayasmuchfor our imports to the last tablet of aspirin (except the five I the hospitalsanddispensaries.Overhere,wecanjustify enough. Weneeddouble,giventhedilapidatedstateof 10 millionUSDwe’respendingin’98–Ithinkit’snot the patients,we talkwiththem,weexamine themifnec- ri-clinics almost everyday.Duringthosevisits welookat can’t do. The last 4 months I have visited hospitals and standing Iwanttoexplainwhat wecandoandwhat able totouchthepatients. Tocorrectthatmisunder- that. Inthearticleauthor mentioned that we aren’t we writeaboutourjobbut I amnotsooptimisticabout only hopethathewilltaketheefforttoreadreports anonymous soIcan’treplytheauthorpersonally.can in “TheMission”ofMSFF.Unfortunatelythearticlewas -Recently wereceivedanarticle,whichwaspublished and then ask forextra people thanvice versa. believe thatit’smoreeffectivetotaketheextracounties will havesometimetotaketheextracounties.Ialso already alotoftrainingintheprovincesomysuccessor counties of the IFRC with the same staff. I have done programme intheNorthHwanghaeprovincewith4 counties. PersonallyIbelieveit’spossibletoextendthe -Extension oftheNorthHwanghaeprovincewith4more General discussion Extract: January, 1997(inEnglish). Herbert Raajmakers,MSF(H)Physician,31 – MedicalReport,NorthHwangaeProvince,” “ Monthly Report from 23/12/1997 to 31/01/1997 from 23/12/1997to31/01/1997 D 70

61 MSF and North Korea 1995-1998 MSF Speaks Out

essary, we look at the medical charts and we discuss the review to be politically correct or indulge in double speak. treatment with the doctors. We also go to the operation On the contrary, it aims to put its finger on sore spots and rooms and see operations. Of course we go to the pharma- make us laugh. I hope we can put this behind us. cies and the warehouses to look at the drugs. Bénédicte.

As I mentioned in my earlier reports we have reasonable PS: ‘Messages,’ the (real, serious) internal review, is open freedom to visit the health structures at random. Every for debate on MSF’s intervention in North Korea. You’re week the situation improves and the atmosphere becomes welcome to contribute your opinion. I’ll do a rectification more and more open. We are not allowed to obtain in the next ‘Mission’ on the number of MSF expats in the objective data about the health situation of the people. field. And I’ll try, as far as I can, not to mention sections, The data we have received so far are not reliable. Of but just ‘MSF’. MSF F is also caught up in this North Korean course you can question our being here and if we should adventure. expanded our programme. But that discussion should be held openly and be based on facts not by an anonymous person who don’t have a clue what they are talking about. “MSF DPRK,” Monthly Report from 01/02/1998 to 28/02/1998, 28 February, 1998 (in English). D72 ’The Mission,’ Putting Things Straight,” Email from Bénédicte Jeannerod, Communications Extract: Officer, MSF France to Jacques Tremblay, Minutes [of the] team meeting about […] Medical Project Coordinator, MSF North Korea, 2 February, 1998 progress (in French). D71 -Drug distribution as performed until now is satisfactory. The drugs are in the right place, with only small excep- Extract: tions. Most of the doctors prescribe them in the right Message for the attention of Jacques Tremblay from way. The training, how to use them has, been picked up Bénédicte (The Mission) [learned] adequately. The impression is that the doctors Hi Jacques, have enough basic knowledge to use them in an appropri- I never imagined that this issue of the Mission would kick ate way. The patients numbers visiting the hospitals are up such a storm. Sorry, but there are debates on the issue improving (as is the weather), we therefore are also able here. They concern: to monitor the diseases in our provinces in a better way. -The considerable financial volume deployed by MSF in (How?) Relations/contact with authorities is good, it is certain missions (particularly in North Korea, but not only clear they trust us more and more. It is seen as very posi- – ref Angola); nearly 50 million francs - that’s a fifth of tive to be present in 4 provinces, to work on a broad scale. MSF France’s annual budget. But we worry about the Korean medical system, that it is -ECHO’s monopoly over certain MSF budgets. not sustainable, and that MSF will never be able to make -The imbalance between the huge financial volume it sustainable as well... deployed in North Korea and our proportionally weak presence in the field. Future ideas -The difficulties of carrying out uninhibited explos and To be able to make decisions on which we will focus on having unrestricted access to the population. the future, it is generally felt that we first need clarity about the project objectives and aims. The drug distribu- These questions have been raised during your discus- tion in the 4 provinces is good/necessary, by which we sions with other sections. And you don’t all agree with get a general idea about the morbidity (maybe enough?), the approach adopted. There’s no benefit to hiding these but monthly morbidity-data gathered never will be reliable things. On a more general note, our dependence on ECHO when there is only one doctor per province. For that, we and the size of our budgets generate big discussions within better can concentrate on taking care of one county per MSF. These questions do not raise doubts on the quality of province, and garner better data by a common presence our volunteers’ work in the field, nor on their good faith, (but can we extrapolate that to other parts of the coun- their generosity, their motivation, their competences etc. try?). So are we giving priority to large scale/less reliable You know very well that this isn’t the issue. The work systems, or small scale/more reliable information? Maybe achieved by our volunteers should not be a pretext to kill we can do both? [...] a debate. The real issue at stake is the mission’s general strategy, the choices made by directors, and not everybody 1.1 MSF B by Dominique Lafontaine has to agree with them. You and I both work in an associa- Monthly medical report for the South Pyongyan Province tion adhering to freedom of speech. An association, which – February 1998 [...] depends on questioning certain choices and the capacity Monitoring of its members not to take themselves - too - seriously. During our field visits, we can now go deeper when we That’s the name of the game. Don’t get in this frame of collect information from our guests. There are still a lot 62 mind because of ‘The Mission.’ And, don’t ask for this of touchy points, but step by step we begin to understand are because we can’tsupportthe whole health system. future I think it is important to decide what our priorities distribution is done well is to go into the field. For the use them.Forthemoment onlywaytocheckifthe of stockkeepingandtheirown formssomaybewecould ficult. AsIhavetoldbefore theyhavetheirownsystem us. The collecting ofdata to provethis is muchmoredif- treatment ofthediseasesbuttheyareeagertolearnfrom need moretrainingandinformationaboutthedrugs cal equipmentisreasonablygood.Ofcoursethedoctors people whoneedit.Theuseofthedrugsandmedi - success. The drugs we have distributed have reached the My personal feeling is that the programme has been a The programme 1998 [...] report North Hwanghae. Period: September 1997/February It isnotamonthlyreportbythisfinalreport.Medical 1.2 MSFH: by Herbert Raaijmakers possible to demonstrate the impact of our programme. [...] years. So,ifwehaveaccesstothesixlastmonths,itwillbe are kept in reserve for putativecontrolduring at leastthree each day(so,roughly,the number of consultations). They nosis, thechosendrugs,andnumberofprescriptions These areawealthofinformationastheygivethediag- deeper way,theprescriptionsmadebyKoreandoctors. ity and of the drugs consumption, we plan to analyze in a wrong. Tohaveabetterunderstandingofthelocalmorbid- data, it’sclearthatthemorbidityfiguresarealsototally a linkbetweentheseconsumptiondataandthemorbidity all consumptiondataaredubious.Asintheirmindthereis existence ofthehiddenstockmeansthatreliability forms duringourregularvisitstothehealthcentres.The We continuetocollecttheconsumptionandmorbidity be totally different according totheanswer. it evenifthepopulationneedsdrugs.Ourattitudewill than expectedorbecausethereisarealwillingnesstodo if theystockbecausethepopulationconsumptionislower fully useduntilnow.Theunansweredquestionistoknow that thedistributeddrugsareatrightplacebutnot now) able to see the hidden stock. That means clearly we pushthedifferentresponsiblesarealways(until needs arefulfilledbyourprogramme.Nevertheless,when mainly because we are not sure that the population’s and thedrugs.Thegivenexplanationdoesn’tsatisfyus, is always to keep in stock the essential stuff as the food Korea isalwaysinawar-gameandthegeneralmentality leave thecountryonedaywithoutanyreplacement.North them laterafterourdeparturefromthecountry.MSFwill keep awaythesedrugsforanegativepurposebuttouse and I’mpersonallypersuadedthattheintentionisnotto delivered tothepopulationinpresenttime.Wethink in aspecialstock.Thatmeansthatnotallthedrugsare a lotofdrugsarewithdrawnfromourcontrolandheld distribution. Actually,wehavetheclearimpressionthat before. It is the case with the monitoring of the drugs of ourproblemscanbeputinabetterperspectivethan We willneverreachacompleteunderstandingbutsome more andonthesystemprevailinginthiscountry. normally accompanied bythedirectorof hospital,the few times during the first weeks. ln the counties we were the problemswithhim.We only mettheheadofFDRCa would see him regularly and discuss the programme and cial healthdepartment.During thefollowingmonthswe counties wewereaccompanied bytheheadofprovin- the introduction easier. During our first round to all the fore alreadyknewwhattoexpectfromus,thismade earlier missionis1995inthecountyUnpa.Theythere - In NorthHwangaethepeoplealreadyknewMSFfroman counterparts Background on working conditions, Introductions and report but her finalreport. [...] MSF H:byIngeVerdonck.Infact,itisnothermonthly cooperation between thethree desks. [...] before Iseeaneedformedicalcoordinationandalso am justherefordistributionand‘drugdumping’.Assaid I don’tknowifreallydidsomethingsustainableor still veryunclear.Ihavebeenhereforthreemonthsand [...] Theobjectivesandthestrategyofthismissionare Future repeatedly been deniedaccessto the TB sanatorium. the orphanageof<5yearsandonefor>5.Wehave we havebeenabletovisitallcounties.Wevisited but theroadsarestillverybadduetomud,despitethis The winteristurningintospring,thesnownearlygone Access were fake. […] the director of public health admitted that the numbers pected thefiguresarenotreliable.Whentoldaboutthis charts percountyforthemonthofDecember.Assus- I havereceivedthedrugconsumptionlistsandmorbidity Data drug distribution. [...] more problems than before with the monitoring of the month has been disappointing for me; I have encountered deliberate changemadeinfavourofsomehospitals.This transport. In my province there is, as seen above, a The difficultieswithdistributionarenotonlylackof February 1998 [...] 1.3 MSFF:RickardLjung.MedicalreportKangwonProvince professional on thismatter. I believe that the responsible persons should act more Needless tosaythatthisputIlotofstressontheteam. ent perdiems,threedifferentR&Rarrangements,etc. different budgets,threesalaries,differ- At themomenttherearethreedifferentpolicies, you decidetoactasonemissionintheDPRKthandoso. cooperation andtrustbetweenthethreeMSFsections.If pointments duringthelastfivemonthswaslackof the extendingofprogramme.Onemymaindisap- that thisprocessdoesn’tstopandthemainconditionfor trust betweentheKoreansandMSF.Formeit’simportant my stayintheDPRK,Ihavenoticedmoreopennessand ing theri-clinicsthanifwefocusonhospitals.During hospitals andwewillreachmanymorepeoplebysupport- level, Wesimplydon’thavethemeanstosupportall My personalfeelingisthatweshouldfocusontheri-clinic

63 MSF and North Korea 1995-1998 MSF Speaks Out

head of the health section and sometimes (vice) chairman 4. Politics: Many answers are politically sensitive, so that of the county. This made it easier to discuss more general reality cannot be discussed. health issues. The negative side of being accompanied by 5. Expectation: Many times doctors say they do not have so many people was that it was sometimes impossible to something because they presumably hope MSF will provide have discussions or training with the doctors or patients. it (add this to the problem of politically sensitivity to In the other provinces the teams were accompanied admit that they do not have something, and you will never by other people. For instance in Kangwon they had, in know how to interpret an answer). the first months, a doctor with them who could initiate 6. Systematic information: We had permission from the actions (like replacing non-functioning heads of wards), head of the department of health to distribute a ques- which was more difficult for us. tionnaire to all doctors of the clinics during the training (mainly questions on morbidity figures). But after the first Access to health structures and other institutes time, when FDRC in Pyongyang heard about it, it was for- We normally went four or five times a week to the coun- bidden to ask these questions in this way. We could only ties. We had to present our weekly programme on Friday ask it in individual interviews in clinics, probably because morning a week ahead. We had no problems with access this would give less systematic information. to the counties and hospitals. Although most visits were 7. Interpreters: Last but not least, all information goes therefore pre-arranged, sometimes we would come unex- through the interpreters. They might change some infor- pected because the county was not warned in advance by mation because of political reasons. They might forget the FDRC about our visit, in which case we did not notice to translate things because they do not understand this much difference in the situation (people were only less might be important for us. They might translate our ques- prepared and we had to wait longer till doctors were ready tions differently (for instant in a suggestive way) because to show us around). It was more problematic to have free they do not understand interview techniques. Their access to the climes if we wanted to do random visits. English is not good, so that they have often problems to Partly because the road conditions were not good enough, translate correctly. […] and partly due to lack of time (may be intentionally caused by the counties). We could do some random visits, Evaluation of the nutrition programme but we had to fight for it. We could visit nurseries when I think the description of the nutrition programme is a we put it in the programme (not at random, they are not little meagre. The fact that there are no objectives makes under the department of health). We also regularly visited evaluation problematic. This might be in the MSF phi- the provincial orphanage for younger children and once losophy: “We just go for it.” However, after half a year of the orphanage for older children. We could not visit any “going for it,” I think I spent a few minutes on reflecting other health structures (disabled, retired, TB hospitals). on the programme. […] We tried to arrange visits through provincial level (impossible because they do not fall under the department of Need for better project design health, our counterpart) and through FDRC in Pyongyang. As stated in the beginning, I think the design of the We were not allowed to go anywhere by ourselves, but had nutrition programme is a bit meagre; it only describes an always one of the translators with us. assumed problem and two solutions. It misses all steps in between. I can understand that this information was not […] Gathering background information available at the time the MOU was drafted. But I would During our visits I interviewed doctors and patients. Most have expected that a more complete proposal would have of the information was not very useful because of several been written for the 3rd phase, because without a proper reasons: programme design one can expect more problems in the 1. Nervousness: Especially during my first visits most implementation of the project and one has a high risk of people were too nervous to answer me because it was the failure in reaching one’s aims. I think we are still in a first time they saw foreigners and because many higher phase that we do not know exactly the extent of the mal- officials accompanied us. Later this was hardly a problem, nutrition problem or the causal factors. I therefore think since the doctors had at least seen us during the training, that one of the objectives for the next phase should be to and patients had heard about me from other patients. The gather more information. [...] faces of patients showed that they were even disappointed if I did not talk to them. Evaluation of working for MSF in the DPRK 2. Instructed answers; I had the clear impression that the The main problem during the first months has been the doctors were instructed beforehand on what to answer to MSF coordinator; his lack of communication made it abso- us on certain topics, since all gave the same answers. […] lutely unclear to me what MSF was doing here or planning 3. Lack of knowledge: Some answers were doubtful because to do. In comparison, the Koreans were easy to commu- probably the doctors were also not aware of the real situ- nicate with, which made it a joy to go to the field. So in ation. For instance, the percentage of malnutrition and that way the coordinator had a very stimulating impact. the number of patients seen did not fit (the doctors did In December we got a new coordinator, which improved have not a real idea about the percentages of people with the situation. However, understandably, it took some time a disease). And probably no one knows the real malnutri- before she was completely introduced to all aspects of the 64 tion figures because no one did systematic research on it. programme. So now I am leaving, finally the nutrition many adolescents playingballgamesoutside wholooked benefited from therapeuticfeeding,butthere werealso classroom, twochildrenlooked asthoughtheywouldhave ing, and another 30 have been treated in the centre. In a to theprovincialpaediatrichospital fortherapeuticfeed- there isnotreallyenough.15 childrenhavebeenreferred tor commentedthatthegovernment providesfood,but building isverylarge,sothiscouldbepossible.Thedirec - children’s centreapparentlyhouses800children,andthe the conditionofchildren.TheKangwonsecondary these institutions,butthisfurtherfuelsspeculationabout There hasthereforebeenreluctancetoallowentryinto a lotofattentionfromwouldbehumanitariansightseers. because theorphanagesareanemotivesubjectandattract children had been denied. In part, this seems to be Until recentlytheexistenceofinstitutionforolder from the agencies. this institutionwouldbenefitfrommoreregularattention appears tocareforthechildren,however,Ibelievethat children. Thedirectorofthiscentreisverycharming,and nurse. Therapeuticmilkisgiventothemajorityof fifteen totwentychildreninoneroom,withone-carer/ suffering from minor diseases. There are usually about developmentally delayed,aswellundernourished,and had previouslyseen,andmanyofthechildrenlooktobe of thechildreninthishouseisdistinctlyworsemanI was unaware that the second site existed. The condition today, Ihadvisitedthecentreaboutonceamonth,and dren, from 0 to five years old living on two sites. Until confuses metoo![…]Thechildren’scentrehas280chil- children’s centrewhenaged12-17.Thisnomenclature and thenreturntoKangwonprovincethesecondary children fromtheageof6-11gotoacentrein‘thenorth’ There isonechildren’scentreineachprovince.Apparently child adequately,orifdemandsofworkareexcessive. single parent families, and the parent cannot care for the orphans. Some children will attend if they come from centres, although not all of the children present are […] Orphanagesaregenerallyreferredtoaschildren’s 1.3 MSFF: Fiona Laird.[...] hospitality towards us. […] patients. Itisheart-warmingtoseetheirgratitudeand to seetheimpactofourinputsontreatment provide themwiththemeanstodotheirworkwell,and under suchdifficultcircumstances.Itisapleasureto vated; itisencouragingtoseehowtheydotheirbest work with the Korean people. The doctors are very moti- information, wereoftentiresome,Iverymuchlikedto the suspicionsofpeopleanddifficultiestogetreal functioning of the health system. Although the system, diversity of experiences, which gave many in-sights in the very interesting.Theworkindifferenthospitalsgavea close collaboration with doctors in many institutions was most suitable way to get an effective programme. The of the actual health system, and adjusting to this in the cal andrewarding.Itinvolvedgettinganunderstanding very interesting. The work has been very diverse, practi- programme canbediscussed. The workinDPRKhasbeen that it has prevented the deaths of many children. This MSF first started working in DPRK, and there is no doubt The currentnutritionprogramme wasappropriatewhen The Future direction, allowing a fuller analysis of our work. improved, the programme is gaining cohesiveness and been welcomed.Nowthatcommunicationandsupportare missions withMSF,andexperiencedleadershipwouldhave nutrition members of MSF-F and MSF-H were on their first on theeffectivenessofprogramme.Themedical/ lack ofcommunicationhasmoresignificantimplications of: “Wehavefoundtheenemy,anditisus.”Professionally, and mistrustingisnoteasy,butformetherewasafeeling level, workinginacountrythatissecretive,suspicious was negligible,orwithinMSFBelgiumonly.Onapersonal in theteam,andcommunicationfromheadofmission left a legacy of disunity. An internal cold war existed with- Fazel, ledtoPayams’departureattheendofOctober,and the head of mission, and the MSF France doctor, Payam were very difficult. Communication breakdown between Until Christmas,workingconditionswithintheMSFteam MSF of MSF will neverbe successful inthis country. him touseless.Unlessthismentalitychanges,thework milk, because an official (of what department?) had told doctor explainedthathewasusinginadequateamountsof pital, butinturn,hetoo,isprobablyunderorders.One restrained bytheinstructionsofdirectorhos- requires constantpushing.Thepaediatriciansareusually and systematicdrugtreatmentofmalnourishedchildren Usually thepaediatricwardhasonepairofgloves,ifany, The storeroomsoftenremainfullofunusedequipment. the improvements in healthcare that would be hoped for. Distribution ofthemedicalkitshasnotbroughtabout unacceptable. But thesechildren still exist somewhere. discussed withthedirectorofhospitalthatthiswas made totheward,includingachangeofstaff,afterI this onceonly,andthereweresignificantimprovements uncared for,withshavedheads.InKangwon,Ihaveseen this hasbeenseen,thechildrenhavelookedparticularly back totheinstitutiontheycamefrom.Inallcaseswhere children areseeninaTFC,andthendisappear,presumably tragic, and disturbing towitness.Severely malnourished using malnourishedchildrenastheplayers,whichare Unfortunately, therehavealsobeenelaboratecharades, these problemscanbeovercomeordismissedquiteeasily. given differentdataonthreesuccessivevisits.Usually ‘economy oftruth’.Dataisunreliable,andonecountyhas tion orfeedback, and sometimesthereisevidenceof an reluctance to admit to problems, to get direct informa- […] Communicationisnotalwayseasy.Thereoftena The Working Context living in reasonable conditions. the impressionfrombothvisitsisthatthesechildrenare ingly walkedpastroomsfullofwastedchildren,butsofar fit andwell.Itismybiggestfearthatwehaveunknow-

65 MSF and North Korea 1995-1998 MSF Speaks Out

has been stated by the hospital staff. However, I think that it is now losing effectiveness, and if numbers in the TFCs continue to fall, it may become difficult to justify “US gives 75 Million Dollars in Aid to North continuing. I think steps need to be taken quickly, to Korea,” Sarah Jackson-Han, AFP (France), 5 adapt to the needs of the children being seen in the TFCs February, 1998 (in English). and to reach those children not being seen. The proposed supplementary programme using dry rations seems appro- Extract: priate, but needs to be implemented soon. MSF has been US Give 75 million dollars in Aid to North Korea by privileged to have relatively large numbers of expatriate Sarah Jackson-Han, WASHINGTON, Feb 5 (AFP) - The staff in DPRK, and has had comparatively excellent access State Department on Thursday announced 75 million dol- to the medical structures and the population. We therefore lars in new food aid to North Korea, its largest single have the most experience in implementing therapeutic contribution to date to the struggling communist coun- feeding in DPRK. For this reason, I believe we have a lot to try. The money, channelled through the US Agency for offer the children’s centres, and would like to increase the International Development (USAID), follows a new appeal level of support that we can offer them. At the moment, by the UN World Food Programme (WFP) and an agree- doing so does not look easy, but having seen the children; ment by Pyongyang to sharply increase the number of I would fight to do it. international aid workers in the tightly closed country. It will be used to buy 200,000 tons of grain targeted at “North Korean civilians that are most vulnerable,” notably children, State Department spokesman James Rubin said. Letter from Fiona Laird, MSF Nurse in North Korea to Pierre Salignon, MSF France pro- The WFP last month launched a drive for 378.2 million gramme manager, 28 February, 1998 (in dollars in food aid, nearly double the amount requested English). D73 for 1997. The US share of 75 million dollars will be provided in three tranches from April 1998 until March 1999, Extract: Rubin said. Previous US food aid to North Korea, since [...] At the moment I am feeling very disillusioned with 1995, has totalized nearly 71 million dollars, including this programme; I think it was originally well planned. 65.5 million dollars to the WFP and 5.2 million dollars to But, we still do not really know what is happening in UNICEF. Under an agreement with the WPF, North Korea terms of malnutrition, milk is not distributed and less and has agreed to double the number of WFP staff in the less children visit the TFCs. It makes me wonder what we isolated Stalinist country to 46 people, including 26 food are achieving. Similarly, the hospitals use some of the monitors, USAID said. The WFP will also open two more drugs, but we do not know if they use them correctly, regional offices in North Korea charged with oversee- and a lot of the equipment remains in storehouses. I do ing deliveries, the agency said. A senior US official who not want to be too cynical in my report because I believe asked not to be named said the new offices would open we have achieved many things, at least feed over 2,000 in Hyesan, in north-central North Korea, and in Wonsan, children. Also I know that my view is influenced at the a port-city-on the eastern coast. Aid officials chose those moment by the difficulties of working in this country. I two cities because of Hyesan’s remote, mountainous envi- do not think that you will experience this in two weeks, rons - which make food delivery difficult - and because of but lack of freedom, is very oppressive, and everything we Wonsan’s status as a major port. “It’s useful to have people do is controlled. As individuals we are puppets, but it is there to help handle and monitor the commodities as they very important that MSF does not become one. I will be enter the country,” the official said. interested to hear what you think after visiting here. I hope to see you in Paris, at the end of March. The WFP already has four offices up and running in Chongjin, Hamhung, Sunuiju, and the capital Pyongyang. The new staffing arrangements paved the way for this latest US contribution, aimed at alleviating widespread shortages caused by flooding, drought, and a moribund On 5 February 1998, following an appeal launched by socialist economy. Those donations have drawn sharp the WFP in early January, the US State Department criticism, however, from members of the Republican-run announced 75 million dollars in food aid to North Congress, who fear North Korea may be diverting food Korea. DPRK authorities subsequently accepted the aid from its intended civilian recipients to the military. doubling of the number of WFP aid workers in the US officials say the current food situation in North Korea country. is difficult but not dire, as previous aid shipments and a local crop-harvested, in October and November have made a difference. They also insist the aid is subject to adequate monitoring and say that more emergency assistance is needed. “Without substantial additional food aid, they will be back to where they were,” said one US official. 66 frappeur’ France. 4. “1998–FamineenCorée duNord:Unpeuplemeurt”JasperBecker,’l’esprit where we currently work? we haveanyfiguresonhospitals’activityintheprovinces authorities tokeepaidcomingandNorthKoreaafloat? Do survey inthearea?AnyhintofamanipulationbyChinese Korean refugeesinChina.HasMSFcarriedoutanysimilar on theirownretrospectivemortalitysurveyamongNorth famine tollfigureappearedinaWorldVisionreportbased in Chinathe‘GreatLeapForward’yearso.The2million- author of‘HungryGhosts’,aninvestigationthefamine (front page).ForyourinformationJasperBeckeristhe Please find herewith the latest from South China Morning Extract: that wasanextractofabook also releasedareportonthefamineinNorthKorea, the famineinChinaduringMaoZeDongregime, Jasper Becker,ajournalist,andauthorofbookon lity of its information, was released. At the same time, known forthequalityofitsnetworksandreliabi- ground bothinsideandoutsideveryearlyonis Sharing Movement’, an organization that was on the In February1998, a surveyby the ‘Korean Buddhist the South. ate movesthatwouldendangerthe37,000UStroopsin ensure itnevergrowssohungrythatresortstodesper- lure NorthKoreaoutofitsinternationalisolationandto outbreak ofthe1950-53KoreanWar.USofficialswantto embargo onanyUStradewithNorthKorea,imposedatthe The newcontributioncomesdespiteastrict48-year-old Korea, requested somesupport from MSF USA. who waslobbyingforanincreaseoftheUSaidtoNorth organization wasworking.TonyHall,USCongressmen, the borderorinNorthKoreanhospitalswhere his MSFcolleaguesaboutapossibleassessmenton country. MSFHongKongexecutivedirectorquestioned refugees in China that had fled the famine in their in France. Both provided accounts of North Korean Fax 11 February, 1998 (inEnglish). international communication coordinator, MSF USAprogrammeofficerandUNliaison, MSF Holland,andUKexecutivedirectors, from Alain Guilloux, MSF Hong Kong Executive DirectortoMSFBelgium,France, 4 hehadjustpublished D74

when theyhaveeatentheirfillwejustgetthe leftovers.” there wasfoodfromAmericabutthecadrestakeallofitand Before that, we had nothing for two years,” shesaid.“I heard “ for food.Withnoworkherself,shehadaccessto and herhusbanddisappearedintothecountrysidetowork Pyongyang. MsKim’sshoefactorycloseddownlongago than almost anywhere else in the Stalinist state savefor left the North Koreanbordertown of Hyesan farbetter off due, machine parts stripped from shutdown factories has Barter tradewithChinaincopper,timber,goldoreresi- Chinese Korean peasantswouldpayfora NorthKorean out Iwasmarried, hetookherandIranaway,’ shesaid. across atnight.‘Hewantedto sellmebutwhenhefound She andayoungerwoman found aguidetoleadthem she decidedto cross theriver and begforfood in China. Left withnothingbuttheragged clothesshestoodin, her copperdisappearedwhenborderguardssearchedher. dead bymorning.Herchanceofearningmoneyselling wherever she stayed, several of her neighbours would be body fromafevershehadcontractedatthestationand sell somethingorcrosstheborder.Shehadsoresonher the railwaystationandotherpublicspaces,hopingto she, likethousandsofothermigrants,beddeddownin people inhercarriagehadstarvedtodeath.InHyesan, had noticketordocuments.Whenthetrainarrived,eight railway guards seized her food and beat her because she der town,duetofrequentpowerblackouts.Onthetrain three daystotravelthe480kilometresHyesan,bor- ago. Whenfinallyatrainleft,itwascrammedfullandtook Indeed, manyhadswappedtheirdocumentsforfoodlong longer bother to register the identity of the victims. dragged away20corpses,somanyinfactthattheyno waited fordaysatrain.Eachmorning,railwaystaff At Hamhung’srailwaystationMsKimandmanyothers to feed her family. two kilogramsofcoppershehopedtotradeandbuyfood Hamhung, amajorindustrialcityontheeastcoast,with children, agedfiveandseven,withtheirgrandfatherin far claimedatleasttwomillionlives.MsKimlefther escape thefaminewhich,accordingtoreports,hasso to thoseofthousands of othersfloodingintoChina to Korean Chinese family took her in. Her story is similar begging forfoodandshelter.Movedbyherplight,ethnic old wanderedaroundthebackstreetsknockingondoors, In the small border town of Changbaishan, the 32-year- across thefrozenYaluRivertoseeksanctuaryinChina. past theborderpatrolsand,onemoonlitnight,walked Robbed, beaten,starvingandinrags,KimAesangcrept Extract: At Spring Festival, we were issued five days’ ration of grain. At SpringFestival,wewereissuedfivedays’rationofgrain. Post, 11 February, 1998(inEnglish). North KoreanBorderTheSouthChinaMorning Death inNorthKorea,”byJasperBecker,onthe “Famine Refugee Tells of Mass Destitution and

67 MSF and North Korea 1995-1998 MSF Speaks Out

woman as many local females left to find work elsewhere. and number of deaths appear to be changing,” according Ms Kim wants to stay in China and, like many others, to Pomnhyun, a Buddhist monk who has supervised the especially the young; she hopes she may find work when surveys from October 1 of 1997 to January 31 this year. He spring comes. Now, government restrictions make this has recently returned from his 11th visit to Chinese border almost impossible. ‘What should I do? If I stay what hap- villages with North Korean refugees. pens to my family?’ she said. In Hamhung, government propaganda promises that by the year 2003, there will be […] The ethnographic field interviews were administered enough for everyone to eat. “They say within five years, by 23 Korean-speaking Korean Chinese associates of the things will be better but no one believes them. By then how Korean Buddhist Sharing Movement, a leading Buddhist many will be dead?” Ms Kim asked. NGO in South Korea. The interviews were voluntary with strict assurance of confidentiality of the respondent’s identity. Participants in the news conference will include congressional staff, officials from the U.S. government, “Famine Witnessed by 472 North Korean Refugees the Hill, and the NGO community, diplomats from donor Interviewed in China – Refugees Estimate the countries, think tanks, and the media. The field research North Korean Death Rate to be about 29% in the findings to be disclosed in the news conference are sup- Last Two Years,” North Korea Update, ported and endorsed by the leading South Korean NGOs, Congressman Tony Hall’s office, US Capitol, - which have altogether sent over 100,000 tons of food document forwarded by Jim Bishop, Interaction aid in the last year alone to North Korea, […] to Antoine Gérard, MSF USA Programmes Officer, 25 February, 1998 (in English). D75

Extract: Famine Witnessed by 472 North Korean Refugees At the time, in the United States, the general public Interviewed in China Refugees estimate the North Korean didn’t really know what was going on in North Korea. death rate to be about 29% in the last two years. It was very limited to the world of American NGOs, the State Department, USAID and Congress. Tony Hall was Time: Wednesday, February 25, 1:30 p.m., 1998 Placer the representative of Ohio in Congress, an ex- member of the Place: US Capitol, HC-7. About 500 North Korean refugees ‘Peace Corps’ in Iraq and Sudan, who campaigned for the interviewed in Chinese border villages estimated the death United States to increase its aid to North Korea. In February rate of 29% during the last two years of famine in North 1998, he sent us a letter asking MSF to support his initiative Korea. The data in the largest survey yet of North Korean calling for increased aid to Korea. refugees in China conducted by the Korean Buddhist Sharing Movement provide the most comprehensive and Antoine Gérard, Head of Programmes Department, uncensored picture of the course of the North Korean fam- MSF USA (in French). ine to which the outside world has yet had access. Four hundred seventy-two refugee respondents provided information about their immediate family members of 2,583 including grandparents, parents, and unmarried children, 231 hometowns, and the nation. First, the survey findings In early March 1998, MSF started a new round of include death rates by gender, age, and household since discussions with the FDRC regarding those activities to be August 1995, the time North Korea was swept by the worst implemented when the current MOU would cease, in July. floods in its history. Mortality rates among children and the elderly, the primary victims of famine, are elaborated with the attributed causes for their death including epidemic disease and malnutrition. “First round,” Email from William Claus, MSF The survey with refugee respondents also reveals the Belgium programme manager to MSF France and death rates of over 200 urban districts of their hometowns MSF Holland programme managers, 8 March, with 100 - 150 population. Second, the surveyed popula- 1998 (in English). D76 tion reveals various coping mechanism North Koreans are desperately using in the third year of famine. Third, the Extract: survey findings include a graphic presentation of popula- Hello there, tion movements of North Koreans at famine risk. “Despite We just finished our meeting with FDRC. From the side of the agricultural harvest from October 1997 and ongoing FDRC it was stated that: international food assistance, the North Korean famine 1. The emergency phase is over and now efforts must be continues to claim a large number of victims - particularly focused on rehabilitation. They see a role for MSF as a both in the tightly /controlled north province of Jagang bor- provider of technical assistance in the field of national dered with the mountainous Chinese side and in the city of production of drugs and provision of raw materials. They 68 Hamhung in South Hamgyong province – though the causes are still interested in the provision of drugs. cal imagesthat insomewaysremindus of theKhmers We cameaway with somenightmarishhuman andecologi- people are disconnected from reality. noia andobservationreigns. Thingsaresoshutoffthat no perspectiveonwhat’sgoing on,andaclimateofpara- orders, withnoinformation from theoutside.Theyhave People’s livesarecompletelyriddledwithpropagandaand country wasmobilisedbyradio-transmittedcommands. the populationbowstoNation’scommand.Theentire ridiculous, childishandpathetic,butitalsoshowshowfar on theirbacks,camouflagedcowsandcars…Itallseems ing childrenfromtowns,soldierswithcamouflagednets when facedwiththethreatofwar,exercisesinevacuat - ‘alert week’. This involves a period of general mobilisation quent powercutsinthecapital.Wewerethereduringan Sung, puttingflowersinfrontofhisstatue!Therearefre - the firstthingwehadtodowaspayallegianceKimII off regimeintheworld.WhenwearrivedNorthKorea, totally differenttoanyother,hostingthemostclosed They werestaggered by whattheysaw.Thecountryis our teams are working) but not the province in the north. in Korea.Theysawthreeprovincesthesouth(where A surrealcountry;PhilippeandPierrevisitedthemission North Korea (Philippe Biberson and Pierre Salignon) Extract: had no visibility as to the way the assistance was used. Korea. Theirroundofvisitsrevealedthattheteams gramme managervisitedMSF’sprogrammesinNorth France PresidentandPierreSalignon,MSFpro- From 10-20March,1998,PhilippeBiberson,MSF distribution side we will see whattheywill propose. it ismoreinthefieldofAEDESorotherpartners.On involved inthistypeofrehabilitationprogramme.Ithink tion willbe.PersonallyIamnotinfavourthatMSFbe gramme MSF will do.We see onFridaywhat their reac- To beclear,therewasnodiscussiononwhichtypeofpro- - Access to institutions. - MOH should beourcounterpart. programme. we may not do a nut survey will lead to a closure of this very weakattendance(lessthen1%)andthe fact that -Regarding theresultofnutritionalprogramme= level) -More investmentinqualityandaccessibility(grassroots phically) without goingindetail. -A reduction of thedistribution programme (geogra- From our side weproposed: 1998 (inFrench). France Board of directors Meeting, 27 March, Biberson, PierreSalignon,” “Point onthe North Korea Mission –Philippe D77 Minutes ofMSF according togeographic locationandthecategory ofthe times what we actually want to see. The situation varies we areshownwhattheywant ustoseeandonlysome- stricted evaluationsofthesituation. Visitsareorganised, seems chronic but there’s no way of carrying out unre- vated bytherecentnatural disasters.Themalnutrition undoubtedly started in the early ‘90s and has been aggra- food andmedicinesinthecountry.Thedropproduction We havethegeneralimpressionofaseriousshortage agencies are due to start up. Belgium, etc. Around another 10 NGOs and United Nations organisations suchasOxfam,HandicapInternational the Red Cross, United Nations agencies and various other tal): thosepresentincludeMSF,MDM,theFederationof (who don’t all have access to the areas outside the capi- North Korea, but there are now some 60/70 expatriates MSF isoneofthefirstorganisationstohavepenetrated nel inthe use ofmedicines. opening nutritionalcentres, and trainingmedical person- Our activitiesmainlyconsistofdistributingmedicines, MSF beganworkinginanadditionalprovincethenorth. The teamhaspassedfrom8expatriatesto13.InJanuary, MSF has been working in the field for 7/8 months now. around Pyongyang(programmecosting3millionECUs). drawn upforthesupplyofmedicinesinthreeprovinces tiations withtheauthoritiesledtoamemorandumbeing 1996 (seeddistribution)andin1997.InJuly1997,nego- MSF has run several missions in North Korea: in 1995, in The MSF mission and Pierre are soamazed.It’s the last of itskind… up forthelast20years,andthey’resurprisedthatPhilippe Jean-Luc andSergesaidthatwe’veknownaboutthisset Same Old Story around by foot. town areoftenbrokendownandmassesofpeoplemove no more machines, no more fuel. The metro and trams in that’s groundtoahalt.Everything’sdonebyhand.There’s affected andwehavetheimpressionofbeinginacountry with justaslittlethought.Allsectorsoftheeconomyare of trees,butthey’vebeentakenfromotherprovinces real ecologicaldisaster.They’renowplantingthousands been clearedcontrarytoallcommonsense,provokinga In anefforttoincreaseagriculturalproduction,landhas tion can be transformed into rationing. (food, clothes, etc.) and we saw how easily this distribu- no money.80%ofthepopulationlivesoffdistributions reserves. There’snothingtoeat,nomarkets,shops, vre, livinginextremely fragile conditions – canhaveany can’t seehowthepopulation–withnoroomformanoeu- (destroying harvests,landslides,etc.),drought…We hot summers and three years of natural disasters, floods blade ofgrass.Asevereclimate:harshwinters,excessively been ‘razedtotheground’,clinicallycleaned,withouta vive a longtime as itis;30 million people on alandthat’s Rouges inCambodia.It’sastrongsystem,anditcansur-

69 MSF and North Korea 1995-1998 MSF Speaks Out

people concerned. The authorities restrict us to a planned, into a role that’s not for us. The problem’s structural and global approach, which according to them is adequate requires other solutions. Donors are using us, because to deal with the problem. One NGO per province, such they want to be present, even if the work they’re paying and such a quantity per facility multiplied by the num- for is of little use. ber of facilities, that’s the essence of our ‘contract’. It’s The problem of quality: MSF carries out distributions over the ‘entry ticket’ to the country. MSF’s activities cover a 4 provinces and in masses of facilities, therefore multiply- population of 7 million people, some twenty hospitals and ing the errors by ten. We’re overwhelmed by the volume of more than a hundred health facilities. The work is thank- orders and we’re supplying bad quality material on a wide- less: it amounts to checking that the medicines arrive at scale basis. It’s serious that MSF is making this kind of their destination and noting on lists how many children error nowadays. We told the teams, the people around us have received milk. The motivated personnel in the MSF and the authorities exactly what we thought. Our contract teams are subjected to unacceptable working conditions. runs up to July, and we will not continue working like this beyond this date. Once this was said, we got locked into We cannot work correctly. Nothing other than superficial a dead-end dialogue. The officials responded by saying supervision is possible. Our work is reduced to distribution that they were happy with our work and wished to see us (even if it is medical and nutritional) and the teams are continuing in the same way, with the same volume. They not satisfied with this kind of intervention. In terms of pointed out to us that North Korea is a socialist regime, so collecting information, we don’t know what is and isn’t there are no rich and poor, everyone is treated in the same reliable. We carry out clinical work on paper, we can’t give way, and if we’ve seen some differences, they are only due any advice, and only a little medical discussion is allowed. to disruptions in distributions caused by transportation There’s no follow up possible, just a quick glimpse of dif- problems and imbalances in international aid. ferent situations. When we see a child, for example, we don’t know his history, where he comes from, and it’s It’s our responsibility to hold firm with the European practically impossible to see him again. They choose the Community donors. Even if there is no acute famine at the children they show us, who appear and disappear. We’re moment (this is not a statement), medicines and food are not sure we know all the facilities. The team has tried needed, but this isn’t the work of an NGO. Political agree- to focus on a few in particular, but the size of the pro- ments are required, addressing structural, economic and grammes doesn’t really make it possible. These working political problems. For example, re-starting the production conditions are imposed by the authorities and accepted by and importation of basic materials, re-planting forests, us. The situation has become even more complicated since installing drainage etc. we took on an additional province. Everything’s oversized.

Conclusions 1) There are differences between what we see via the access we have and the accounts collected from refugees I went with Pierre in spring 1998. We’d started on the Chinese border. This mystery needs solving: gen- receiving witness accounts from refugees, we’d cross- eralised fragile situation or big-scale human catastrophe? checked our information, and we’d taken up con- 2) Whilst the food shortage seems incontestable, it should tacts with experts on Korea who explained to us how the be placed in a context of general economic collapse. The regime worked. François Jean was beginning to have expla- natural disaster has just made things worse. nations for us on the way things were organised, collecting 3) It’s impossible to say if the aid provided by MSF saves information on the regime. Eric Goemaere had been there lives, how many or where. Aid is openly perceived as a shortly before us; he’d brought back some film and given a “support system” for avoiding the most serious problems. press conference in Hong Kong. And that’s when we started feeling uneasy about things, particularly with our Belgian In practise, we’re incapable of forming a clear definition and Dutch partners. Marie-Rose, the Head of Mission, was of the needs. Yet, without evaluation, it’s impossible to more inclined to communicate with Brussels than us. Pierre fix objectives, modify our activities, etc. We don’t know was saying: ‘We’re an active part of this mission, but I feel what impact our work has on patients’ health. Whatever more and more uncomfortable about it.’ But he was very the case, it’s not proportional to the amount of money involved due to his role as Programme Manager. I was new being spent. It’s costing too much and we can’t even be to it all, open-minded. I felt curiosity more than anything sure that this way of proceeding doesn’t harm the popu- else. lation. Philippe and Pierre didn’t see any famine, but no one can move around to check and we readily believe The teams were waiting for us without enthusiasm, par- that in certain areas the situation must be really serious ticularly Marie-Rose: ‘Why are they coming, these French – (e.g. gulag, re-education camps, closed off areas, etc.). they’re going to do another “I accuse” in the Libération5.’ Milk and medicines are useful because there aren’t any We received a rather frosty welcome, the atmosphere was in the country. There’s no diversion, but rather storage in anticipation of harder times. This situation transforms

MSF’s doctors into policemen, responsible for checking 5. See “Hunting and killings of Rwandan refugees in Zaïre-Congo 1996-1997” 70 that the medicines are used properly. We’ve got ourselves Laurence Binet – Médecins Sans Frontières (August 2004). nothing. We’ve drawnuplists;we’vecarried outvisitsto another facility ortogohome.Werealisethat we’vedone bows andleave.Wetaketothe roadagain,eithertovisit made anefforttoseasonit for us.Andthenwedothree when we’renothungry.It’sgood; wecanseethatthey’ve already 11h/12handwehave toeat.Theyfeeduseven etc… Andthenthere’satype ofsmallbanquetbecauseit’s Then weasktoseethechildren.We3childreninbeds an electrictorchtocheckthattheboxesarereallythere. main stock; we godown into a frozencellar where weuse clean andwhoshowsusthemedicines.Weasktosee of the pharmacy. We meet someone who’s very polite, very goes out,findsitandcomesback.Thenwedoarapidtour lists. Andwhenweaskforsomething,someonegetsup, We lookattwo or three registers containing handwritten the delivery arrived safely? ‘Yes, it arrived, here’s the list.’ cigarettes onthetable,sometea,afewnibbles.Weaskif all smiles.Asit’scold,wegotoaheatedroom.Thereare back. Whenwegosomewhere,there’saritual:arrive,it’s Which immediatelybecomesaweekandeverything’spushed or thecarbeingserviced,andwe’rerunningtwodayslate. every 45days.Itjusttakesonesmallthing,apuncture, the samehospitalmorethanonceamonth,sometimesit’s true, werunaroundlikeheadlesschickens,don’tvisit ing tohelp.Wemanaged to getthemrecognise this: ‘It’s sure thatthismoneywasreachingthepeopleweweretry- carried responsibilityforthismoney.Secondly,weweren’t blindly dumpingmillionsofdollarsintothecountry,andwe nonetheless aproblem.Theproblembeingthatwewere accept thatdespitetheprogressMSFhadmade,therewas We triedtodeveloptheir political analysis so theycould them fromrealisinghowseriousthesituationreallywas. that iftheywereforbiddentogoout,itwasprevent eat inthistownbutwasbeinghiddenfromthem,and was theirinvoluntaryjailors,thatnoonehadanythingto that theywerebeingkeptincustody,thehotelstaff just anissueofmaterialconditions,butpolitical needed abitoftimetohelpthemrealisethatthiswasnot water there was being frozen, the lack of food, etc. We lack of sleep, the lack of electricity, water shortages, what about howpainfultheworkwas,coldtheywere, in akindofenormous,emptyhotel.Theteamcomplained all. InWongjing,theteamhadbeenassignedtoaresidence life was for the teams, but there was no political analysis at At thebeginning,alldiscussionsfocusedonhowhard authorisation thatwasfinallygiventousinjusttwodays.’ and suchaplace,it’samazing,aftertwoweeks,withan every day: ‘Don’t you see, we managed to return to such all thetime,alittlemorehumanitarianspacewasopening was blockedbytheirclaimsthatthingsweregettingbetter sion wasunacceptable. At thebeginning,ourquestioning managing tovisitjustabouteverywhere,butthattheirmis- that theirlivesweren’tmuchfun,they’dbeensmartin ing ourtendaysvisit.Wetoldthemthey’dbeencourageous, with theteams.Weledthemtostartaskingquestionsdur- extraordinary experience;wewerereallypleasedtobethere, thing, howeverscandalousourdiscoverieswere.Itwasan tened, weaskedquestions;wantedtoknowaboutevery- strained, butPierreandIdidwhathadtobedone.Welis- right. It’s a prison.’ in Francetoo,youknow.’Andtheyreplied, ‘Yes, you’re really uncomfortable.Sowesaidtothem:‘Thereareprisons on guardduty. In the car, the guide and interpreter were realised itwasaprisonbecauseofthewatchtowerwithmen new building, with people working down below, and we Pyongyang. Atonepointwecaughtaglimpseofbrand route wetookbychancewithPhilippeonourreturnto were children,thenextdaythereweren’t.Therewas selves whatwasgoingon.Wecameandwent;onedaythere were the visits to the hospitals during which we asked our- the place,dedicatedtogloryofgreatleader.There out and see them. There were the weird monuments all over but weweren’tallowedtoleavethehotel,couldn’tgo sounds ofmilitaryexercisesatnightandinthemornings, were invitedto.Asortofparanoiaprevailed.Weheardthe we saidinourroomsandduringtheeveningbanquets box, beinglistenedtoandwatched.Wewerecarefulwhat travel bycar,thefurtiveimages,feelingofbeingina of thepopulation,whichweestimatedat10,15,and20%. participating intheorganiseddesertionofentiresections regime intermsofresourcestosavethesepeople,wewere the country’sstability.Overandabovecapacityof considered bytheregimeasuseless,possiblyharmfulto massive, planned destruction of a part of the population them totheideathattheywereperhapscontributing impression thattheysawthingsmoreclearly.Weintroduced are openingupalittle.’[...]Bythetimewelefthad whatever’s necessarytogiveyoutheimpressionthatthings the playthings of people who are smarter than you, who do they weren’tjustfrustratedwiththeirwork.Wesaid:‘You’re Our discussionswiththeteamshelpedthemrealisethat ing, it’s really frustrating.’ check thatthelistsaretickedoff,etc…We’vedonenoth- situation ormonitor theallocationofthis aidtothe in aprogramme whenitwasnotable to assessthe that MSF could not spend such a huge amount of money after theendofongoing MoU.Theywereconvinced MSF wouldnotcontinueits workonexistingterms the programmemanagerwarned theauthoritiesthat At theendoftheirvisit, MSFFrancepresidentand from October 1997 on, thenMSF France Executive went, whatwesawanddidn’tsee;the was goingonmyvisitwithPhilippe,howit For me,theeventthatreallymademerealisewhat Pierre Salignon, MSF France Programme manager, Dr. Philippe Biberson, President MSF France Director from January 2004 on (in

French).

71 MSF and North Korea 1995-1998 MSF Speaks Out

most vulnerable. For their part, some members of the level required by the enormous amount of money involved. MSF North Korea team remained convinced that step by My opinion is that MSF must not continue on this type of step they would be able to improve their access to the programme once we have satisfied the present contract most vulnerable people. Other executives within the (July 98). MSF must not extend another 6 months/5 MSF movement shared this opinion. A few days after million ECU type of programme. As for the general food the departure of the French executive team, Pim de availability, the drugs availability should be addressed Graaf, the Director of Operations of MSF Holland also by international, multi- or bilateral aid. Reinforcing local visited the North Korea programme. Several incidents production, imports and distribution capacities of this made him think that the North Korean authorities country. Emergency supply of medical items is not appro- manipulated the teams. priate for medium term solution. It is very expensive creating dependence and it is disrupting national channels of repartition. MSF should play a role in fostering this approach rather than the present. Due to the wideness of “Just a Few Words before Leaving, from Philippe,” this distribution programme, MSF doctors are unable to do Message from Philippe Biberson, MSF France to much more than investigative control on repartition and the MSF Team in North Korea, 17 March 1998 utilization. MSF has to inform and discuss with all partners (in French). D78 from now on to make this opinion discussed widely. For the 4 months lasting and in the 4 provinces we should Extract: strive to improve the execution of the present programme Dear all, with the experiences we gained in the past months and Thank you very much for this great moment we spent identify zones and/or populations where to concentrate together. My thanks go especially to MM Lee, Pak, Hong our action. Concentrate on people rather than on struc- and the others who have made my stay a very interesting tures. We should make proposals to the FDRC as often as experience. It has been a real pleasure to meet you indi- we come across specific situations. vidually and I have full confidence in the team you have built. Thanks Marie-Rose, I know our coming was expected If the answer is “NO,” just do as much and as wide as you with mixed feelings of hope and discomfort due to the are doing now (FDRC), then we have to say no as well. Be international mess as it is. You have a difficult task here it on a temporary basis, but they also need a clear position and I’m sure you are up to it. I’ll give you a few notes from us. If the answer is yes, then we have to prepare for before leaving; I know I’ll be very busy back in Europe. If many difficulties but then the challenge is up. As MSF, I can I’ll try to give you a more complete feedback. Sorry we have to show our compassion, our competence and for being too synthetic. our capacity to save lives, ordinary lives. The Koreans are 1) At this time, from what we can see, there is no longer quite open, frank and direct, let’s be the same. We have any nutritional emergency. Some areas, some populations nothing to loose. In one case or the other, it will necessi- remain in a more precarious condition but this doesn’t tate a lot of frankness between all MSF chains of decision. differ a lot from many other countries facing economic Good and strong decisions are required. They cannot be or development difficulties. The present equilibrium is taken if there is no factual, fluid information or if there is dependant on: a climate of lies or dissimulation. I will do my best to have - Continuing international food aid the HQ help you define clearer objectives for the future - Next harvests and be of a real support to the project. Thanks again for - Improvement of food production (irrigation, drainage, your ‘accueil’, [welcome] and good luck. erosion, fertilisers...) Avec mon amitié, Philippe. 17/03/98. In case of a new emergency MSF should be able to react again. The nutritional problems of the last years have benefited from our action but the problems we see now can no longer be addressed the same way. “A few remarks on Philippe Biberson’s Visit (in 2) At this time there is no medical emergency in this haste),” Message from Marie-Rose Pecchio, country. No epidemic, no acute crisis in terms of ‘public Coordinator North Korea, March 1998 (in health’ (except may be at the level of infant and child French). D79 nutrition). Entering in this country for the food emergency, we were presented with a real problem of shortage Extract: of essential drugs in the hospitals. Long-term declining SOME REMARKS ON THE VISIT OF PH. BIBERSON (in haste) productivity plus three years of disasters have led this sec- -Fixed ideas on the project before seeing anything at all: tor to a stand still. We decided to respond to this problem too expensive, not MSF’s job, not enough proximity to the by a general and standardized distribution programme: populations July 97-July 98. We have done our best thanks to the -For MSF F, the decision had already been taken: the teams but due to many problems (programme definition number of kits was reduced for ending the programme in and local constraints) we have not been up to our medical July and not a day over. Yet I believe that no decision has ethics. These drugs and equipment have been useful but been taken on an international level yet?? 72 we cannot evaluate the benefits for the populations at the -For them, it’s clear; they’re pulling out on the 1/8/98. With peoplelike this,Idon’teventryandfight mycorner; all whoarrived withpre-conceivedideason theproject. of the Great Leader who holds the MSF Truth and above talking. Ifeltreallyuneasy duringtheentirevisit -He saidthathehadcome to listen:hedid80%ofthe and Dominique. medical coordinator,whichrefutes alltheworkofJacques -A lotofdoubtsaroseonpastcoordinationwithout a to try something different. They’re not real MSF. party line,andnothingelse.Toobadforthosewhowant I don’tthinkhe’scapableofthis.ThetriedandtestedMSF MSF approachhere(rapidity,immediateresults,etc.),but in other MSF projects. We have to leave behind the classic -I don’tthinkwecangofastinthiscountry,likedo project. Which was far from being thecase. to talk about thefuture, but alsotohelpwith the current -I thinkthatwhen headquarters comestothefield, it’s on people,not structures, he said. tions), he didn’t even consider it. We should concentrate low up(morbidity,consummationofmedicines,prescrip- we cangointothingsmoreindepth:training,datafol- trate ononeparticulardistrictforaweekor15days,so that hastomakethingsconcrete.Iproposedconcen- -All hispropositionsarebasedonabigidea;it’sthefield then why did westart? -If MSFdoesnotdistributemedicines(FandHopinion), 4 monthsisabittight for setting something like this up. smooth exitwithahandovertosomeoneorsomethingelse. everything fromonedaytothenext???Weshouldplana our departure:wedistributein4provinces.Ifstop -Not oncedidweconsiderleavingsomethingbehindafter munism. riding roughshodoverthecontextand50yearsofcom- it thatbothersme:reallyquickly,withsuchimmediacy -No objectiontohisproposition,it’sthewayhemade in November ’97. nothing new:It’salreadyinWilliam’sreportafterhisvisit -His ideaofbeingclosetothevulnerablepopulationis nel should also bedifferentiated from the distribution. -The contactswe’veestablishedwiththemedicalperson- conforming to oneofhiscriteria. tact withthemostvulnerablepopulation,sowe’realready -We haveaccesstoorphanagesandtheTFCsgiveuscon- point for another approach. and wemustnotdropitnowbecauseit’sthedeparture sonnel inthefield,we’vebuiltupaclimateofconfidence, -We’re starting to have good contacts with medical per- results after 6months, so we’rethrowing in thetowel. ing thestateofhealthcareincountry.Stillnoreliable tify themeans.Themeans=distribution.endknow- of the country’s situation. Let’s just say that the ends jus- project, withadistributionofmedicinestogiveusanidea Conveniently forgot thatitwasMSFFwhostarted this we’ve got. could haveexplainedwherewe’vecomefromandhowfar who havebeenheresincetheprojectstartedand Didn’t takethetimetospeakwithDominiqueandBrigitte opinion aboutthe project. -Didn’t take the time to spend time with me and hear my All whilstremainingpoliteand puttingadateforJune/July. there wasnonegotiation,withdrawal shouldbeanoption. we wouldsaythatconditions required renegotiation. And if phase: ‘Shouldn’t we try stream-lining things first?’ Then ments pointingtoanenddistributions.Wewereinthe being raised,wehadtotryandsetoutthedifferentele - ing thisreport.Why?BecauseforMSF,giventhequestions I remember that I put a lot of time and energy into writ- take an objective look at the teams’difficulties.’ estimate what’sbeenachievedoverthelastsixmonths, what Isaidinmyvisitreport:‘Watchout,don’tunder- sands, we’reresponsible.Butwewerejustafoil.Whichis slamming thedoor,we’releavingpeopledyingintheirthou - be usedagainstMSFbythosewho’llsaywe’releavingand these people, we’re responsible. This is the argument that’ll the dynamicsinfieldattime.Ifweclose,ifdrop come backwiththeideaofclosing.And,thentherewere to: havetheycometoclosetheproject?Andwedidindeed but atthesametimefieldwonderedwhatwewereup ager toateamcoordinated by MSFBelgium was welcomed, the visitofMSFFrance’spresidentandaprogrammeman- Marie-Rose. soon realised it wasn’tworth it. and it’sovermyhead,hesays.Ireallytriedatfirst,but he neverlistens,whateverIsay.He’stheonewhoKNOWS outlook, amongst others, without reducing our assistance. in Belgium,shouldintegrateamorecritical and political work <->criticise).ButnonethelessI’mconvincedthatwe, patience, massive assistance <-> political negotiation, reaching itaresometimesradicallyopposed(rapidity<-> sections –havethesameobjective,butstrategiesfor far toogeneral.Ithinkthatweall–thecombinedMSF than the‘summary’sheetbecauseasMarie-Rosesays,it’s hope thatPhilippe’sreportwillgoabitfurtherintodetail /remarks and realise how he was perceived in the field. I Biberson’s ego–tohavehimreadMarie-Rose’sresponse I thinkthere’sarealproblem.Itwouldbegood–for I’ve readthetwomessages–Biberson-Pechioand Extract: didn’t hidetheirdoubts.Institutionallyspeaking, the time.Thedifferentmemberswereuneasy.They There weredebateswithintheNorthKoreanteamat from October1997 on,thenMSFFranceExecutive Pierre Salignon,MSFFranceprogramme manager, Message D80 Executive Director,25March,1998(inFrench). Belgium programmemanagerandEricGoemaere, Operations MSFBelgium,toWilliamClaus, from MarioGoethals,Directorof Director fromJanuary 2004on

73 MSF and North Korea 1995-1998 MSF Speaks Out

get used to this idea. I don’t want to be sensationalist, but I don’t think we’re reaching the standards, the prin- During out stay, we gave the people around us indi- ciples that MSF wants to abide by. We’re completely off- cations of our astonishment and unease when con- track, you say it yourself.’ She said, ‘Yes yes I agree.’ So fronted with different situations. I remember con- I replied: ‘So we have to do something about it.’ In fact, versations in the car, on leaving the hospital, conversations she was scared of getting her fingers tapped by Brussels or in French in front of people who understood French per- Amsterdam. ‘We’re an international mission etc.’ I said fectly – even if they were interpreting English into Korean to her: ’I’ll deal with that, I’m going to speak to Eric – conversations that were set up with Marie-Rose or Pierre: [Goemaere, Executive Director of MSF Belgium] when I ‘How would you cope with being a doctor and not being get back.’ I understand that Marie-Rose felt sidelined, dis- able to see a patient more than twice in a row? Personally turbed by our visit, by what we had to say. Maybe too much I find this a really difficult situation to work in …’ So we’d remained unsaid, both on her side and mine. already “worked” the people watching over us, letting them know of our unease, of MSF’s unease, by saying, ‘These Dr. Philippe Biberson, President MSF France working conditions are totally unsatisfactory, MSF can’t do (in French). its work properly.’

And then when we met the Flood Disaster Unit authorities – who were intelligent people, negotiating with MSF and the outside world, but who weren’t really the decision The visits were organized and manipulated from A to makers – we started saying to them: ‘We’ve had a really Z. You had to provide for a weekly visit programme. interesting time but our working conditions are becoming On Monday, we would go there to that hospital, on increasingly hard to accept, we’re not used to working like Tuesday there and so on. In general, that would be accepted this, we’re an independent organisation, we have a moral but in some cases they would say: ‘Your Wednesday pro- obligation of ensuring the impact of what we’re doing gramme cannot take place.’ They wouldn’t give a reason. with regards to our donors and the working conditions Another case: They had agreed, but upon arrival at the hos- imposed on us here mean we can’t be sure of anything. pital, their hospital director or the party boss, or I don’t know And then, we would like to use what’s left of our time who, would say: ‘We have a disaster exercise so you cannot before renewing our contract - we signed it for one year – visit us because today we have to evacuate all the patients to examine the possibilities of working completely differ- from the hospital as an exercise. So please go home. So it ently, in other words being fixed in one place, providing happened that people would be in a car for a couple of hours, care for children, and not just scattering aid around as we arrive at the hospital and then have to go back home without do at the moment.’ They looked astonished, they discussed any information. Also, during the visits, you could see it between them etc… and before the meeting ended, they patients being treated - I saw a few consultations myself - said to us: ‘You can’t just leave like that, when are you the dentist - the children in the children’s’ ward—but you leaving exactly, we have to meet again in two days to were never sure whether those were real patients. discuss what you’ve just said.’ And before leaving we had a meeting with the same group plus some extra people - they There are a few examples—concrete proofs of manipula- had obviously reported what was going on to their superi- tions. I remember one report that a MSF team had visited ors - it was a much more political discussion. We said to a hospital and seen a ward with children and women—the them: ‘You can take it or leave it. We’ll respect the current mothers of the children. Then they left. But because someone contract but you should know that we’re totally unsatis- had forgotten something at the hospital, after ? an hour or fied with the way our aid is being delivered, because we ? of an hour, they would return to the hospital unexpectedly have no guarantee that it’s really reaching the people. We and then they saw those mothers and children on their way wonder what’s going on when we see certain children in a home from the hospital. So obviously, they had been there to really bad state in hospitals that appear to work well. It show to the MSF people that the children were hospitalized makes us uncomfortable. Where are these children from? and their mothers were there. Why they would want to give We would like permission to work in certain facilities that this impression to MSF, I don’t know. But it was a proof of we’ve identified, but where - here, there, etc.?’ manipulation. So there were a few more of those incidents that gave us proof to confirm our suspicions effectively. Marie-Rose thought that I’d already taken a decision and was ready to impose it on her. She probably said some- Pim de Graaf, MSF Holland Executive Director thing along the lines of: ‘I hope you’re not going to doing (in English). anything stupid, because I have to stay here, dealing with the fall out whist you’re safe and sound in Paris.’ I must have replied to her: ‘I’ll write up a report of how I see things before I leave. We’ve spent ten days together, we’ve got on fine, we’ve worked well together and I think At the same time, during the two last weeks of March we’ve made a lot of progress. Now I think it’s nonetheless 1998, a team led by the coordinator of MSF France in 74 our responsibility to get things sorted out. You have to China collected testimonies of refugees with the help to earnthedenunciation bonus. Others justgetcaughtby Some refugees were denounced by the Chinese, who want Pyongyang, alltherefugeeswere sentbacktoNorthKorea. ’97). Afterafewweeksandsome threateningnoisesfrom authorities weretakentoa camp inHeilongjian(August so NorthKoreanswho’dbeen roundedupbytheChinese Last year,atthepeakof refugeeflow,ahundredor were inour premises: everything disappeared! numerous problemsoftheftlastyearwhenallthechildren blame peopleforshuttingtheirdoors.Wehadtodealwith to help. There was more and more theft: we can’t really night andwasmurderedbytheverypersonittrying weeks ago, in Baishan, a couple took in a refugee for the and 6000Rmbforanyonecaughthelpingarefugee.Afew nowadays. Especiallywhenthere’safineofbetween3000 pitying them.NooneopenstheirdoortoaNorthKorean hostility fromthelocalChinesepopulation,whostopped amongst them.Theincreasingnumbersgeneratedalotof during thesummerof1997,withmoreandchildren network. Thenumberofrefugeesincreaseddramatically a few hundred of these via the services offered by our crossed the border since 1996. We managed to support We estimatedthatsome50,000to70,000peoplehad aged between 12 and18inourown premises. is whythepreviousyearwehadtokeep30youngpeople all arrivedwithscabiesandvariousskindiseases.Which those tooyoungtowork,whichwasn’talwayseasy.They around 8000Rmb.Wetriedtofindfosterfamiliesfor Quingdao… SometimeswecouldevenbuyaHukoufor selves intheKoreancommunity:Yan,Shanyang,Dalian, them findworkinabigtownwheretheyburied- been treated,fedandputbackontheirfeet,wehelped premises rentedspecificallyforthem.Oncetheyhad were placedinfamiliessupportingournetwork,or Erdoubaihe, tonamethemostimportant.Therefugees in Mukekou,Liuhe,Tonghua,Baishan,SongjiangHeand border, wheretheyweremoresecure.Wehadoutposts triated toarearfront,inanareafurtherawayfromthe Changbai. Once inthe network, the refugees were repa- Korea, mainlyinthebordertownsofJi’an,Lanjiangand We’d receivetherefugeesastheycameoutofNorth Korea refugeesintheChangbaishanregionsince1996. We’d been running a little support network for North [Relief organisation operating on the border]: Extract: Korean border. Liaoning andHeilongjiangProvinces)neartheNorth China provinces (Yanbian Autonomous District, Jilin, were givingassistancetorefugeesinnortheastern of localundergroundaidworkersandactivists.They D81 Buissonnière, es,” March/April1998,MarcelRoux,Marine “Exploratory Mission,LiaoningandJilinprovinc- Report 7April,1998(inFrench). Yun Shanstopped more than 5years ago! was oneofthe betterofftowns.Distributions ofcerealsto It was the same everywhere, and Hui Shan, on the border, changed everything(tears).My situationisn’tatallunique. affect me. Then my 5-year-old son died of hunger too. That saw peopledyingofhungeraround me,butitdidn’treally managed tosurviveforawhile, forbetterworse.I had nothinglefttofeedmywifeandthreechildren.We absolutely nothinginHuiShanforovertwoyears,and I 1991 andhaddisappearedaltogetherby1995.Wereceived of cerealdistributedbythestatestartedtodwindlein I foundmyselfwithnosalary,alternatives.Therations When mycompanygraduallywounddownitsproduction, fications. Idon’tknowhowtodoanythinginparticular. in astate-runcompany;Idon’thaveanyparticularquali - the Yalu, which isn’t very deep, in July ‘97. I was employed from China.IgotovertheSino-Koreanborderbycrossing “I come from the town of Hui Shan, just over the border Man, HuiShan (Hyesan), 34 years old what to do anymore.” they contactmeforhelp.We’reoverwhelmed.Idon’tknow ning totrytheirluckinChina.Oncethey’reovertheborder, and mytelephonenumbercirculatesamongstpeopleplan- we’re reachedourlimits.Wecan’tdomore.Peopleknowme more foodthatthesituation’sgettingworsebyday.But asking for help. They all tell me that they can’t find any Over thelastfewweeksI’vereceivedmoreandletters but one thing’s for sure; itisn’t arriving in this region. hunger. Idon’tknowwheretheinternationalaidisgoing, Ji, awomanatehertwo-year-oldchildtoavoiddyingof ple weresplittingup;itwaseachoneforhimself.InJiang the land,notoolsforworking.Familieswereexploding:peo- was nofood,medicines,andfertiliserforcultivating where thedoorsremainedfirmlyshut.Itwasawful.There in thestreets.Isawpeoplegatheredaroundtrainstations, discoloured hair.Isawthebodiesofchildrenandoldpeople was critical.Isawchildrenwithbigbellies,headsand The lasttimeIwentwasinAugust1997.situation exchange, and everything goes fine.” to China, I buya symbolic cargo of wood to balance out the border withacommerciallicence,intruck.WhenIreturn ily framework, is not allowed by the Chinese. So I cross the clothes. Thiskindofdistribution,extendingbeyondthefam- taking cereals, essential medicines, milk for the children and made severalreturnjourneystomynativevillagethisyear, ily alllivesontheotherside,inareaofZhonJiang.I’ve country withmyparentswhenIwas9.Therestoffam- “I’m 46yearsold.IwasborninNorthKoreaandfledthe along by a rope.Andall this onChineseterritory. they havearingputthroughtheirnoseandarepulled them backtoKorealikebeasts.InTunenandChangbai, caught them,passedabitthroughtheircheeksandled couple was arrested in Jinan. The North Korean agents of responsibilitybeforedefecting.InSeptember1997,a activity, orwhowereinthemilitaryoccupiedposts pick upthoserefugeesinvolvedinimportantcommercial infiltrated intoChina.Butapparentlytheagentsonly the ChinesepoliceorinnetsofNorthKoreanagents

75 MSF and North Korea 1995-1998 MSF Speaks Out

Last June, a distribution of one kilo of rice per family came heads, and incredibly thin people. When I arrived in Hui out of the blue. I asked where the rice came from. I was Shan, I decided to cross the border. I’d heard there was told: just take it and mind your own business. I thought food on the other side. I crossed the river and knocked at it must have come from international aid. It was the only peoples’ doors, who told me where I could go to find help. time it happened. Most aid goes to the army’s officer ranks That’s how I found myself here. Here, Koreans look after and the government; it never reaches the common people. Koreans. In our country, no one’s interested in any one any Those who have a bit of money get rich and do business; more.“ the others die of cold, hunger and disease. There were epidemics of cholera in Hui Shan. The hospitals were empty and the medicines and food were no longer free of charge. Just as the factory workers dismantled state companies and sold the metal piece by piece, the doctors sold their working Marcel and I went up to the border for the first time tools too. Hospital medicines were sold in the market and in March 1998 with a South Korean friend who acted the hospital stocks were empty. Doctors have to survive like as a translator and introduced us to the network. We anyone else. went all over the North Korean border, practically from Yanji More and more people were leaving their towns to head for to Dandong [the length of the border]. Using contacts set the countryside in search of food. The train stations were up by the South Korean network, we met North Korean refu- packed and the dead were piling up, especially old people gees at various different points and places: some had just and children. To such an extent that the train stations in the arrived – once we were in a house when a group arrived. It area are now shut. Bodies in the streets are a daily sight. was people who had literally just crossed. Others had been Violence has become endemic: those who have nothing have there for several weeks, or even several months, and started to steal to survive; it’s the only way to get by. Honest people to tell us about an apocalyptic reality, which initially left die first. Since the death of our son, my wife has started us, like others, a bit sceptical. We asked ourselves what they up a little business on the border to survive. It’s what keeps were talking about. We heard descriptions of people so tired our other two children alive. She goes inland to sell clothes that they lay down by the side of the road and stayed there, from China, passed to her at the border by Chinese ethnic dying on the spot; we heard about children with oedemas, minorities. She sells all sorts of other stuff too.” kwashiorkor, de-pigmentation, on top of chronic malnutrition, because they were really really small. We also heard Man, Bei Qing (Buk Cheng), 23 years old. about this system of public distribution that had stopped “I come from the town of Bei Qing (Buk Cheng). I’m 23 functioning several years ago, according to the people we years old. We’re a family of 4 children. I’ve got two broth- met. These people dated the beginning of the famine to the ers and a sister. Last year, the situation in the town of Bei early ‘90s and not to the period of flooding in the middle of Qing became more and more difficult. There were deaths ‘95, and started to describe the system to us. from typhoid, cholera and then hunger, and the bodies were lying in the streets. We had nothing left to eat. The distribu- These accounts shed a completely different light on what tion of cereals in urban areas had stopped some three years was going on inside the country, on this famous class before and the prices on the free markets were exorbitant. system inside Korea. The refugees explained to us that We had nothing left to sell, no revenue, no money. So we all such and such, whose grandparents had fought alongside agreed to split up, to go our separate ways. The situation’s Kim II Song, had the right to live in Pyongyang, and had the same in most families now. It’s each to his own. My par- access to food, and as far as possible, universities, etc. On ents couldn’t look after us any more; they didn’t even have the other hand, the people we met had been sent to the enough for themselves. When I left, my father was already northern provinces long ago, to the mineral areas, because suffering from malnutrition. He was weak and thin. I think their grandparents were landowners or because they were he must be dead by now. I don’t know what’s become of my on the wrong side during the Korean War. They were the brothers and sisters. Our neighbours ate their own daughter first to suffer from this non-access to food resources. At so they wouldn’t die of hunger. It’s true. I saw it. the time, we also heard descriptions of public executions When the cereals stopped being distributed, people started for people arrested for selling human flesh in the markets. moving around. There were strict controls in the past and ‘Cannibalism in North Korea’, an expression taken up at will a valid travel pass was required to pass from one county to by journalists, was just part of what was going on at the another. Now there are so many people travelling round the time. We heard about people dying by the dozen. A priest country that population movements have become uncontrol- told us that one morning he went into a neighbour’s pigsty lable. So I decided to leave for the town of Hui Shan, where and saw 6 children frozen to death. He buried them. The I’d heard there was more food available due to the border population described scenes of horror. trade. I took the road to the North, managing bits of the journey by bus. But the bus, which was supposed to run And over and above the abandonment by the system – daily, only ran once a week and often broke down. It was because they’d been abandoned by the system for a long packed and couldn’t take everyone who wanted to board. time – they described how families were falling apart. They So I walked, like thousands of others. Bodies were lying on were obliged to separate to survive. Some decided to sell the roadside all the way from Bei Qing to Hui Shan. Adults, everything, including the house, share out the gains and 76 children, all ages. We saw children with big bellies and big leave in the hope of finding each other again in the future, direct contact would beprobably more useful). ment for access andreality (and notonly MSF for which a national communitytobemore pressingonthegovern- situation in DPRK. The objective would be: get the inter- Hereby howIwouldseeaplan ofcommunicationonthe William, Extract: with a coherent picture. Chagang) andcaredforbydifferentnetworks,weendedup from differentprovinces(NorthHamgyong,Hwanghaeand interviews woreon,conductedwithdifferentpeople,coming crepancy wassovastthatweweretakenaback.Butasthese via theteamsbasedinNorthKoreawasincredible.Thedis- them andthenewsweweregettingfrominsidecountry first heardtheseaccounts,becausethedifferencebetween stopped bytotryandfindhelp.Wewerescepticalwhenwe work in and selling the metal via markets in China. They in NorthKoreaweretakingapartthefactories they usedto decline thatnolongerworked.Itwasthetimewhenpeople tions pointedtoenormoussocialviolence,asystemin us heategrassandtreebarktosurvive.Allthesedescrip- when Koreanshadn’thadmaizetoeatforsolong.Hetold Korean beingscandalisedthatmaizewasgiventocattle This phrasecameupagainandagain.IrememberaNorth was foodinChina,that“eventhebeggarseatwhiterice”. luck, hopingtofindhelpbecausethey’dheardthatthere They’d crossed the river. They crossed in groups to try their children atthetime,andmanyofthemonChineseside. they could survive better apart. There were a lot of street depending onhowtheyfared.Theyhadtheimpressionthat not necessary. the field team concluded that the press release was ties haveagreedwiththe‘idea’ofanutritionalsurvey, Korean Buddhist statement and that the DPRK authori- this communicationwouldhappentoolateafterthe to prepareapressrelease.Eventually,considering that tion coordinatorstartedtogatherinformationinorder situation inDPRK,andMSF’sinternationalcommunica- MSF Belgiuminitiatedaplanofcommunicationonthe lected bytheKoreanBuddhistSharingMovement.Thus and askedtoreacttheaccountsofrefugeescol- In lateMarch1998,MSFwasapproachedbyjournalists China, December 1996 toJanuary 1999 (in French). Marine Buissonnière, administrator, MSF France in March, 1998 (in English). Belgium, DirectorofCommunications,24 gramme managerandDanielDeSchryver,MSF to Jean-MarcBiquet,MSFBelgiumDeputypro- Claus, MSFBelgiumprogrammemanager,copy MSF Belgium,ExecutiveDirectortoWilliam “North Korea Saga,” Email from Eric Goemaere, D82 of her most expensive relief operations. national communityisdeployingontheotherhandone on one hand about millions of death and that the inter- accordingly. We cannot accept that people are speaking in alltheprovinceswheretheyworkandadaptstrategies accurate diagnosisofthesituationbyaccessingvillages - Acoordinatedeffortofalltheaidcommunitytomakean adapted strategy. problem thepeoplefaceandbeabletoanswerwithan the provinceswhereweworkordertoassescorrectly - Anunlimitedaccesstothevillagesandhouseholdin We ask: CANNOT REACH THEM AT THIS STAGE DEATHS, PEOPLE ARE DYING AT HOME AND WE PROBABLY THIS WILLCAUSEOTHERUNNECESSARYTHOUSANDSOF For example: TFC are too farandaccess is discriminated do notanswer the realproblems of the people. 2. Wefearthattheactualstrategiesaremaladaptedand embarked in oneoftheirbiggest relief programmes l. TheinternationalcommunityandMSFparticularlyis 4. General conclusion structures. -On themedicalsituationandfrequentationofhealth ogy ...forbidden). tion asmadeinthedraftisagrossmistakeofmethodol- -On thegeneralmalnutrition(becareful:extrapola- the border. -On themillionofdeathsrecordedonotherside 3. Conclusion from what we see: number of patients(reality as far possible). -Lack ofmedicineandeffectthedistributionson distance, other barriers??). -Difficulty ofaccesstotheTFCforpeople(climate, measure). fact thatitwentupandnowdownwhichisacomparative -Number ofmalnourishedchildreninTFC(especiallythe 2. The situation werecord until now: centres and hospital. have mountedXXXTFCanddistributedkitstohealth l. MSFispresentsince...withexpatsin4provinces.We WC See you. pose acommunicationstrategy andadraftpressrelease. cerning thepressrelease.We agreedthatsheshouldpro- Yesterday I hadatelephone contact with Samantha con- Hello loves, [RE] From: William CLAUS Extract: D83 communication, 25March,1998(inEnglish). agers, directors of operations, and directors of MSF FranceandHollandprogrammeman- Belgium programmemanagertoMSFBelgium, “ Press Release,” Email fromWilliamClaus,MSF

77 MSF and North Korea 1995-1998 MSF Speaks Out

what we are given, but we do need to be credible to communicate! “Re: Press Release,” Email from Samantha Bolton, MSF International Communication CREDIBILITY - From a purely credible medical, communica- Coordinator to MSF network, 26 March, 1998 (in tions and operations point of view, we do need a minimum English). D84 of information to support any statement we make, even if it has been made public before. Basic health informa- Extract: tion or malnutrition indicators are not state secrets, and From: Samantha BOLTON it would be good if the teams could see what they think MESSAGE - After talking to the field and a couple of the is feasible or not to give some field credibility to what sections, it would seem that the aim of the communica- we are saying. The information doesn’t have to be too tion is to put pressure on the N Korean government or to much in detail (there were already some such details in request more access to the people in the provinces so that the press proposal sent to me), but it must be credible. we can conduct a scientific survey to establish how bad MSF needs to somehow show that we are actually seeing the malnutrition and food problems really are. This is a and working in the clinics and not just hanging out in the coherent message and we can do as much or as little as you capital which of course we are not - otherwise it looks like like, but we have to work out how we want to and where. we are not doing the basic job of collating and analysing basic medical data of who we see in the clinics etc. or that TIMING - The Buddhist monks and their death claims, were we are censored on our own medical data by the govern- actually made public on the 3rd of March, so there is no ment! […] Look forward to your feedback and will talk to emergency to issue a statement to disclaim this. The Red you all on Monday. Cross North Korea Appeal has been pushed forward from Have a good weekend. May to April, so soon North Korea will be on the agenda, and so we should try and time ourselves to just before FIELD – please advise how the talks with the North Korean their campaign - sometime in April (as you probably all authorities went. Also, don’t worry, comm will always send know, they are steering clear of the call for food, as there you everything for comment before anything goes out! We is no control over where the food is going or how much need you more than anyone else to comment! Kind regards gets through the WFP/Govt pipeline). Most of the relevant and have a good weekend. desks and directors who have been visiting the field will SB be back on Monday and in addition, all the press officers of the network are in a meeting until the end of the week, and won’t be back in their offices until Monday. For this reason, I suggest we leave any action planning and dis- “Re [2]: Press Release,” Email from MSF cussion until Monday that way we can also find out at this Pyongyang to Samantha Bolton, MSF meeting how much N Korea is being talked about already International Communication Coordinator, 29 around the world. March, 1998 (in English). D84

MEANWHILE - if the team in the field could continue to Extract: answer press questions related to the Buddhist statements From MSF-Pyongyang at MSF-Brussels as you already have and as you see fit, this is the best way Dear Samantha, to go forward until we have something more organised. We received your message concerning the press release. All the team agrees with your remarks and comments. OTHER COMMENTS - re replying to the Buddhist claims on 1. About the information: we don’t collect the data. They paper. By even mentioning them on our headed paper for are giving it to us by the health responsible of the coun- public distribution, we are giving them credibility. We ties. In NK, the data is secret of state and a very touchy have no way of knowing how they did their research and point. If this point is in the MoU, I think they asked for it. can get into trouble on paper talking about other agencies 2. Concerning the meeting with the authorities, Pim and unless they have directly attacked MSF and we need to do myself: it was on Tuesday 24/3. I had another one on a ‘disclaimer’. We should focus on what we know in the Friday 27/3. The main point has been the press release. field! The main problem is finding information that we can Pim explained what and why. He asked for more access, it give out which gives credibility to our opinion. MSF has means to do a survey among the population; like that we apparently signed some sort of agreement with the North will be able to adapt our projects according to the needs. Korean government, which stipulates that we are not For the FDRC, the press release is not a problem but they allowed to give out public health/medical information. repeat that they have not been happy by the previous one This is a rather surprising agreement for MSF to sign given and ‘the collapse of the health structures’. With a negative our charter and given that in most places, health informa- advice about the country (no free access, for example) we tion is to a degree public (govts always issue stats), and will scare the donors. About the nutritional survey, they if it is collected by us, then it is MSF, data, not Korean accept. The way to do it has to be discussed. It has not government data. This is an issue for operations and the been “NO” as previously. I spoke again during the next 78 field to sort out and communications have to work with meeting, it was the same answer. Then, as we are a bit Marie Rose already the purposei.e.to be allowedto do asurvey. release anymore.ThetalksaboutwithFDRCperformed We don’tthinkitwillbenecessarytodothiskindofpress vey. -The authoritiesagreewiththeideaofanutritionalsur- lion dead. late toansweraftertheKoreanBuddhistand2mil- 1) MSFwants to beabledoinitialresearch outofthe is because: I wouldrecommendthatMSF gofortheBoption-this RECOMMENDATIONS info was etc. consideration howmuchaccess wegot,howreliablethe to proveordisprovethereportsoffamine-takinginto 3. Workoutstrategyforgivingresultsofthestudy final use will be-on/off the record etc. for themselves).Needstobeaccuratenomatterwhatthe political conclusions/interpretations-asthefactsspeak 2. Producemedically/nutritionallyaccuratereport(no possible. 1. Dothenutritionalsurveyandcollateasmuchdata B) WAIT AND SEEBEFORE COMMUNICATING or tional levels in therelevant provinces 3. Thengiveouttheresultstoshedlightonnutri- final use will be-on/off the record etc. for themselves).Needstobeaccuratenomatterwhatthe political conclusions/interpretations-asthefactsspeak 2. Producemedically/nutritionallyaccuratereport(no to make sure wegetin. purpose), thusputtingindirectpressureontheauthorities nutritional survey(specifyingwhenandwhere,withwhat finally doanutritionalsurvey/announcethatMSFwill 1. ThanktheNKoreanGovtpubliclyforallowingusto A) COMMUNICATE UP FRONT FROM THESTART two possible strategies: From a communications point of view therefore there are or isnot evidence ofafamine. 2) do an analysis to see/prove where possible, if there is 1) dothe nutritional survey and the priority is to: where weareworking.Operationallyitwouldseemthat prove ordisprovewhetherthereisnota‘famine’ seems wenowhaveit),butthateventuallywantto the message should not be that we want access (as it Further tothenotebelow,plusPim’scommentsthat Dear all, Extract: (in English). Coordinator toMSFnetwork,30March,1998 Bolton, MSFInternationalCommunication “Re [3]:PressRelease,” D85

Email fromSamantha organisation can’t do what it would like to do in North his returnfrom aninvestigativetripofone week.“Our explained PhilippeBiberson, PresidentofMSF,following “It’s time to redefine our missions with the authorities,” its work in NorthKorea. the Libérationwhendescribing itsintentionsto‘question’ ent inthecountrysince1995,didn’tminceitswordswith being manipulated.MédecinssansFrontières(MSF),pres - unease withincertainNGOs,whohavetheimpressionof tude, skillfullymaintained,isstartingtoarouseprofound two, oreventhreemilliondeathssince1995.Thisincerti - fathom. Estimations range from several hundred to one, a foodshortage,orfamine,thescaleofwhichishardto were hardlyanyayearago.Thereasonfortheirpresence: tarian organisationscurrentlyliveinNorthKorea.There Some onehundredemployeesofinternationalhumani - Extract: and fromtheMSFNorthKoreateamwhofeltbetrayed. gave rise to heavy reactions within the MSF network did notprovetherewasnofamine.Thispublication ongoing famine. However he pointed out that it still to attractaidbutthattheteamshadnoevidenceofan nourished childrenwereshowntoMSFteamsinorder dispatch ofitsaid.Hesaidthathesuspectedmal- access tothemostvulnerableandinmonitoring difficulties encountered by the MSF teams in getting France President,PhilippeBiberson.Hedescribedthe One articlewasbased on aninterviewoftheMSF a three-pagedossieronthesituationinNorthKorea. On 1April1998,theFrenchdailyLibérationpublished SB regards That is all for now. Look forward to your feedback. Kind survey. the evidence–i.e.medical/nutritionaldatafrom The bestwaytoproveordisproverumoursisproduce matches” -terribleforourimageespeciallyattacking. would getusintolegalandother“aidagencyslagging ability’ ofotheragencies’data(i.e.themonks)-this We cannotpubliclyinastatementcommentonthe‘reli- OTHER COMMENTS matter what. pressure tocomeoutwithcoherentresultspubliclyno sional credibilityisonthelineaswewillthenbeunder 2) Ifweannouncethataredoingasurvey,ourprofes- people surveyed could bemore reserved with the info. spotlight, andifitisoutintheopenonagenda French). Franklin, “North Korea:AManipulatedFamine,”Romain D86 Libération, (France),1April,1998(in

79 MSF and North Korea 1995-1998 MSF Speaks Out

Korea,” he continued, “meaning work at a human level. Our places the number of victims between one and three mil- work is useful but could be judged condescending and open lion. The latter extrapolates from studies carried out with to political manipulation.” MSF, whose current programme 472 North Korean refugees in China and suggests a figure runs until August, spends nearly 30 million Francs distrib- of three million deaths from hunger since 1995 (out of uting medicines. “It’s an expensive programme,” remarked a population of some twenty two million inhabitants). the MSF President. Biberson’s response: “We have no medical information on the country, which is why it’s dishonest to extrapo- Since January 13, the global humanitarian assistance late from studies using such small sample numbers.” Yet provided to North Korea (via the UN, NGOs and bi-lateral certain diplomats, cited anonymously by the press, are assistance) has cost 415 million US dollars. This aid believed to consider this study one of the “most com- includes the 658,000 tonnes of food sent by the World plete” carried out on the question to date. Food Programme (WFP) – the biggest operation in the world. “The food shortage is such that we have no doubts Stimulating generosity about the usefulness of our presence,” moderated Biberson. On the other hand, is Pyongyang exaggerating the scale “But the constraints imposed on us are hard to accept. We of the malnutrition in an attempt to attract food aid can’t go to peoples’ homes, it’s forbidden. The role of our for plugging the gaps in its economy? Is the communist teams in the field is often reduced to policing, checking hos- regime creating this catastrophic, but non-verifiable pitals and dispensaries for diversion of our medicines. They information to stimulate generosity? That’s what MSF see children in bad shape in the hospitals, but they can’t seems to think. “The authorities want to show us just follow them up. Obviously this poses ethical problems.” enough to maintain the emotional involvement of the international community. We’re above all viewed as suppliers. We Under close surveillance provide large quantities of medicines, which enter into their MSF, the organisation with the biggest presence in what planned economic system. And we have the impression that is undoubtedly the most secret country in the world, has what they show us in terms of malnutrition serves to attract twelve expatriates in the field since last July. These teams, this aid.” At the same time, Biberson does not completely kept under close surveillance, are responsible for running exclude the possibility of a real, large-scale famine, given some forty ‘nutritional centres’ and supplying dozens of the sectored and hierarchical nature of the system where, hospitals and dispensaries in the three provinces situated even in normal times, the food rationing is differentiated around the capital, Pyongyang (Hwanghae, Kangwon and according to the categories of citizens and their loyalty to South Pyongan), and soon in a fourth, North Hangyoung, the regime. “In the areas I visited, I don’t think that people on the border with China. At the urging of UN agencies, were dying of hunger. But I don’t know what happened in such as the WFP, Philippe Biberson said he was incapable previous years and I don’t know what’s happening in the of drawing up a picture of the situation. In the absence of most affected regions. It’s not impossible that certain areas any other available term, it could be called a ‘humanitar- are even less well off.” ian enigma’. “We’ve seen children with chronic malnutrition, but we can’t extrapolate for the entire infantile population,” Patrick McCormick, spokesman for UNICEF in Geneva, explained the doctor. It’s obvious that the authorities stated that the teams in the field “have seen children on want to conceal what’s going on. Like other organisations, the verge of dying of hunger,” often from diseases linked MSF has asked to carry out a nutritional survey. This could to malnutrition, such as diarrhoea. A study carried out provide a more specific overview of the situation. The by UNICEF, published in November 1997, estimated some request was refused, without explanation. 800,000 children (33%) under the age of 5 are malnourished. Thanks to international aid, he continued, the Staging situation has improved slightly. For UNICEF, which can “During a visit to one of the hospitals, the patients had apparently confirm or deny the most alarmist reports, been installed in their beds just before my arrival,” he North Korea is well and truly in the grips of the “most explains, “but they were actually genuinely ill…” Some wide-spread famine raging in the world today.” staging go wrong. The statistic most often peddled by the authorities for hospitals or clinics is ‘10 to 15% of children malnourished’. But the figures get muddled at times, and don’t match the official percentages. The impossibility “ North Korea,” Email from Samantha Bolton of NGOs working in the country forming an idea of the MSF International Communication Coordinator disaster’s size on a national scale can also be explained to MSF Pyongyang, MSF programme managers, by the regime’s deliberate wish to conceal facts not just MSF presidents, MSF executive directors, MSF from visitors, but also from its population. director of operations, MSF press officers, 1 April, 1998 (in English). D87 Does this well-kept secret hide a minor human toll, or, on the contrary, wide-scale slaughter? Are the catastrophic Extract: estimations put forward by certain NGOs – the American Dear all, organisation World Vision, or South Korean’s Korean As a few of your have just come back from North Korea, 80 Buddhist Movement for Sharing – plausible? The former it would be good if we had some sort of an agreed verbal would seemthat forsometimenow,various journalists being attacked atalaterstageofbeingmanipulated. It controversial andareprotecting ourselvesinadvancefrom others ofbeingmanipulated, wearenotbeingparticularly cal pressurefromallsidesand thatweruntherisk,asdo OTHER COMMENTS-aslong wesaythatthereispoliti- MOH, andare unable toconfirm or notas yet. cal/ nutritionalpresenceinthecountry,workingwith prove ordisproveafamineasMSFhasthelargestmedi - try. Otherdatagivenoutbyotherorganizationscannot orphanages, butthereisnoproofontherestofcoun - -There are pockets of serious malnutrition e.g. in certain in themiddle, and risk being manipulated. agencies andothersworkinginthereliefsectorareoften within thecountrytoproveordisprovefamine.Aid -There isalotofpoliticalinterestfromoutsideand veys (access etc). until nowithasbeenverydifficulttodohouseholdsur- how widespreadorseriousthefamineisnotasup -There isnomedical/nutritionalproofinNKoreaabout lines of: have alreadysaidpubliclybefore,thiscouldbealongthe SUGGESTED BRIEFINGLINE-Inkeepingwithwhatwe that itseemsthesectionsagreeandisastartingpoint! actually a relatively fair and neutral article), so at least on in theLiberationarticle(whichapartfromtitlewas Claus hassaidsoinarticlesandBibersontoday ine- EricGoemaere said soin press conferences, William MSF ashavingreservationsabout-theseverityofthefam- been avarietyofarticlesoverthepastfewweeks,quoting RE STATEMENTSALREADYMADE-FYI,therehavealready a message is evenifit just inverbal interviews. make sense if the desks could clarify what our priority as questions, astheyaredoing.Forthisreason,itwould are being) and that they be expected to answer simple contacted by their local press upon their return (as they couple ofmonthsago,BibersonnoworPim),thattheybe returns fromatriptoNorthKorea(beitEricGoemaere fectly normalandexpectedthatwhenadirector/president occasional calling journalists as they see fit. It is also per- to all.Meanwhile,theteamsareansweringpresscalls facing up to etc, but it would be best if this was clear we aredoing,thebasicproblems/positivethings tions andgiveoutsimplepublicinformationaboutwhat are workingin,wehavetobeableanswerbasicques- field orbythedesks/directors.Aswithallcountrieswe give direction to any interviews being done either in the all sections,nottobegivenoutinwriting,butjust of paragraphs‘guidelines’onwhatourbasiclineisfrom of tripreport,butitwouldbeusefultohaveacouple BASIC VERBALPOSITION-Pierreiscompletinghisend clear for the network! while, sothebasicpointsMSFwantstomakeneedbe famine questions is an ongoing issue, which will last for a that itisclearwhatlinewearetakingwiththepress.The position. Doesn’thavetobefixedinstone,butjustso Pim to FDRC. different inLaLiberationthanwhatwehavebeensaying Rose whowillhavetoexplainwhyyousaysomething we canonlyhopeforthebestandburdenisMarie ward. Thisarticlemayhavefrustratedthisprogress.Now Rose since. Getting access is a matter of slow steps for- a meetingwithFDRCandhasbeenfollowedupbyMarie has beenadvocatedfor by MarieRoseandmyself during concerning nutritionalsurveystobedonebyMSF.This at themomentthereareseriousnegotiationsgoingon this message as well. They might react against MSF, while Pyongyang? The authoritiesin Pyongyang will receive communicate with the other sections or the mission in are busy,youfollowyourownpath,whydidnot with SamanthaBolton,whoactsasanadviser.Whilewe We arebusyformulatingaPRstrategyforNKoreatogether Liberation for2 reasons: I donotappreciatethemessageyouspreadinLa Bonjour Philippe, Extract: inform the restof network. clarify whatourpositionis-withcomm,sothatwecan conference call tomorrow between the relevant desks, to expected to give out basic info.Maybe there could be a we cannotstopthepresscallingandasitisnormal Meanwhile, weneedsomesortofongoingpositionas can definitelyconfirmwithMSFdataornotthe‘famine’. nutritional surveyasmuchpossible,andthenseeifwe access wasscrapped.MSFisgoingtogoaheadwiththe initial ideaofputtingoutapressreleaseaskingfor As farasIcangatherfromyourvariousresponses,the RECOMMENDATIONS not accusing anyone inparticular. manipulated, wearebeinghonestaboutthesituationand the country(MSFHsource).Byadmittingthatwemaybe and RedCrossaremanipulated, as we can’t getaround and WorldVision,etc.aresayingthatinanycaseMSF 1 April, 1998 (inEnglish). MSF internationalcommunicationcoordinator, France andMSFBelgiumprogrammemanagers, Biberson, MSF France President, copy to MSF Holland DirectorofOperationstoPhilippe “ La Libération,” Email fromPimDeGraaf,MSF D88

81 MSF and North Korea 1995-1998 MSF Speaks Out

“Re[5] !AM! Meeting in Bxls,” Message from “To Marie-Rose and Team,” Email from Pierre Pierre Salignon, MSF France Programme Manager Salignon, MSF France Programme Manager to to William Claus, MSF Belgium Programme MSF Pyongyang, copy to MSF Belgium pro- Manager; Message from Mario Goethals, MSF gramme managers and MSF Holland director of Belgium, Director of Operations to MSF Belgium operations, 2 April, 1998 (in English). D90 Programme Manager, executive director and director of communication, MSF France presi- Extract: dent, executive director, director of communi- I hope you are fine. After yesterday’s call from Marie rose, cation, 1 April, 1998 (in English). D89 I would like first to come back on the interview given by Philippe to Liberation and give you some explanations. As Extract: I said during my visit, lots of journalists called us before From Pierre Salignon: we came to NK and wanted to know our position about the […] There is no matter in this article to create a problem. ‘so called’ famine in this country. In fact, when Philippe I spoke already with Mario this morning and he agreed. On went back to Paris, one of them called him. Romain the other hand, all what is written in the article (problem Franklin (Liberation) in fact already planned to write an with the authorities for example) was said during our visit article on NK’s situation. So Philippe answered to some to the authorities. We really hope it will be possible to of his questions and Liberation, decided to publish part open negotiations with them in the future. Anyway, there of this interview yesterday with other information and are lots of things to discuss next week. I will send you end their own analysis. As you can see, the interview is soft of this week my field visit report. and mainly focused on “is there a famine or not in NK?” I spoke with Mario yesterday and he didn’t see any problem From Mario Goethals with what is written. OK my friends, When Pierre Salignon spoke to me about this article, I On the other hand, I understand also Marie Rose’s reac- hadn’t yet read it, and when Pierre told me that it didn’t tion. I agree with her on one point: you were not informed pose too many problems, I said that in that case, it didn’t directly by us about this interview. Sorry for that. We cause me too many problems either. Nonetheless, now I’ve didn’t know when Liberation was going to write the article. read it, I think that there are actually some really serious But it’s not a reason. Next time, I will inform William and problems, and I’m a bit lost, but perhaps someone could you directly before. Anyway, I feel we must be careful explain to me: not to give too much importance to this article. Philippe 1. The aim of this ‘denunciation’, what’s our objective? didn’t do a press conference and will not do it. But it’s 2. If there was an objective? With agreement on the mainly impossible after a visit in NK not to answer to objective? Perhaps even with a decision taken by head- questions on the current situation in this so closed coun- quarters to denounce? Or at least with an appropriation of try. More and more people are asking questions and as MSF this initiative by the head of mission and the desk? is one of the biggest NGOs in the country, it’s difficult to 3. Why an article in the Libé, why not a larger campaign say no we don’t want to answer. I spoke with Samantha if there was indeed a concerted strategy? yesterday and she agreed. This is the reason why she did a proposal some days ago we need to discuss with William And I don’t find the basis of the message very coherent, and Pim. You are right to say we must be careful. You because we say that we’re being manipulated, that we already started the negotiation with the authorities. But know we are (so who’s manipulating who?), that we’re that’s not the reason why it’s impossible to speak about doing programmes that we don’t really want to do but we our action in North Korea and the problem we are facing. do them anyway, that they’re costing us a lot of money This could reinforce also our position. but we do them anyway, that there’s no famine but we can’t prove what’s being said is false… In short, I’m not Anyway, don’t hesitate to tell us what you think. But too impressed and I hope the teams in the field won’t please don’t make this article an international problem suffer too many consequences. At the same time, I find between sections. It’s not the case. For your information, it a shame that we haven’t had a serious discussion on we plan with William and Pim to meet in Brussels next our projects in North Korea yet following the visits of week (9th of April) to discuss the MSF programmes in NK. Philippe, Pierre and Pim. This strikes me as essential. It There are lots of points to speak about. And as I said, I seems a date’s now been fixed, but can everyone come? really hope we will find a common approach. NK is not This discussion seems more important to me than the a country easy to deal with (you said this several times article in the Libé. I question if we should always be during our visit), but MSF is confronted with ethical ques- assuming that field teams “have nothing to say,” it’s such tions we need to discuss. I’m sure we will also speak about a demotivating message to send out and we shouldn’t be MSF position regarding media/lobby. allowing it to happen. I’m tired of all this, my friends, tired of it, because we’ve seen it all before. 82 Mario could influence our buildingcapacity for thefuture.” we aredoingnow wehaveachievedalready alotandit direct accesstoourcounterparts. Ifwecompareittowhat the mission,nolibertyofmovement, longprocedures,no one yearago, there werealot of constraintsto set up the last6months.WhenMSF openedthemissionalmost First ofall,itisclearthatMSF hasachievedalotduring Comments: all over the 3provinces we visited.[...] it waspossibletoseepeopleinsocalled‘militaryuniform ’ of ourfieldvisitswerecancelledatthelastminute,and war mobilisation”duringallourstayinthecountry.Some try. Thisgaveusastrongandstrangefeelingof“virtual exercises, whichbeganonMarch12thalloverthecoun - Remark -Thevisitcorrespondedwithnation-widemilitary Extract: the way we haveoneavailable. enced nutritionistassoonthereisasmallopening-by that as well. That is why we need to send a very experi- example longitudinaldatacollection)weshouldinsiston relevant datacollectiononthenutritionalsituation(for by nutritional surveys. When we find other options for was thatwewantbetterinformation,AMONGSTOTHERS So, inthediscussionwithFDRClastweekourmessage these peopleyouhavetofightforeverysquareinch. small nutritionalsurveysandthatistheendofit.With The pitfallisthatweareallowedtodooneortwolousy ask to be abletodosurveys, AMONGST OTHERS. by others,soweneedtohavebetterinformation, see, wedonotonlyaskourselvesbutarealsopressed extremely importantistoaddthemessagethat,you Maybe ourinterlocutor now feelsmanipulated... What is we didnotsaythatwouldusethetermmanipulated. to avoidthewords‘nofreeaccess’.Youcanimaginethat we willspreadapublicmessageinwhichwouldtry not more.Beawareofthefactthatwealreadytold use thetermconditionalaccessorsomethinglikethat, our interlocutorofFDRCgotextremelyannoyed.Wecan - whenwetalkedlastweekaboutourlackof;freeaccess’- are awareofthesenistivitiesthatsomeauthoritieshave and theyhavereadthat in thenewspapers. Probably you tells themthatothersthinkwearebeingmanipulated- it istheshortestwayofleavingcountry.AtbestMSF are (orIrisktobe)manipulated.Theywillnottakethat; It isnooptiontotelltheNorth Korean authoritiesthat we Extract: D92 Programme Manager, March 1998 (inEnglish). “Field VisitReport,”PierreSalignon,MSFFrance work, 2 April,1998(inEnglish). Belgium, France and Holland North Korea net- MSF HollandDirectorofOperationsto “Re: NorthKorea,” Email fromPimDeGraaf, D91 of thelatearrivaldrugsfromEurope.IDA -Another bigproblemisdelayinthedistributionbecause those children not beingseenin our centres. tinuing this way. Steps need to be taken quickly to reach continue tofall,itmaybecomedifficultjustifycon- losing effectivenessandifnumbersinthefeedingcentres -Today, teamsalsoagreedthatournutritionprogrammeis is notgood. not enough)todoclinicalwork.Thequalityofouraction on meaningfultopics.Infact,thereisnotimeleft(or and thereislittletimetotrain medical staffefficiently takes about3-4weekstocompleteeachtrainingsession to visitmorethanonecountyeachday.Thismeansit and training.Withlongdistancestotravel,itisdifficult one. Thetimeissharedbetweendrug/milkmonitoring teams tomanageavastdistributionprogrammelikethis problems forMSFteams.Itisimpossiblethecurrent -The wayweworkiscreatingmajor-technical/ethical of ‘drug dumping’. tainable oriftheyarejustinNorthKoreafordistribution unclear. Theydon’tknowiftheyaredoingsomethingsus- objectives andthestrategyofmissionarestill -For mostoftheMSFexpatriatesinNorthKorea, programme in NorthKorea. ficulties MSFteamsarefacingduethedimensionofour Anyway, itwouldbeamistaketounderestimatethedif- bers attending the hospitals are currently reducing). the severecasesofmalnutritionhavebeentreated(num- improvements madeinseveralhealthstructuresandthat ning ofourprogramme,therehavebeensignificant -Today, somehospitalstaffreportthatsincethebegin- schedule one weekinadvance. Teams can‘freely’visitclinics.Forhospitals,theyneedto it seemsMSFhasoneofthebestaccessestofield. -Among allNGOsandUNagenciesworkingintheDPRK, greater accessibility of healthcaresuppliesindevelopingcountries. 1972 inAmsterdamby agroupofpharmacistscommittedtocontribute towards 6. IDAFoundationisanindependentnot-for-profit organization,establishedin medium term,theinternational communityneedstogive ing nationalchannelsofrepartition. That iswhy, inthe is very expensive, creating dependence and it isdisrupt- items isnotappropriateforamediumtermsolution.It capacities ofthiscountry.Anemergencysupplymedical aid, reinforcinglocalproduction,importsanddistribution should beaddressedbyinternationalmulti-orbilateral for thegeneralfoodavailability,drugsavailability munity might address with the authorities directly. As kind oflong-term answer, whichtheinternationalcom- future. Theneedsaretoovastandappealtoanother involved anymoreinthisdistributionprogrammethe we hadachoice.ButIamconvincedMSFmustnotbe any substituteorganizationforthefuture.I’mnotsure curative medicineinvastareasandwedon’thaveyet We must recognise that MSF is creating a dependence on quality of severalitems). refugees’, brokensurgicalmaterialsuchasscissors,poor of thematerialsupplied is notalwaysgood(‘blanketsfor North Koreatakestime.Becauseofthehurry,quality handle NGOs’bigorders(MSF,MDM,IFRC)andshipmentto 6 cannot

83 MSF and North Korea 1995-1998 MSF Speaks Out

structural replies to the difficulties the health care system specially the local population, live and work in a country is facing. It is not a job for MSF, but more for UN agencies where everything is carefully orchestrated and controlled. and foreign governments through bi- and multilateral aid Furthermore, it is important to understand that this is an (under conditions). east Asiatic country with a different mentality than we westerners are used to. Showing you the worst things is Conclusion: simply loosing face. Being here a longer time MSF learned Needless to say MSF must stop its distribution programme how to cope with this situation, and slowly but steadily we or, at least, must reduce drastically the number of struc- manage to go further then any journalist can go (or new tures/provinces it is supporting. Stopping/reducing ‘dras- NGO’s, or directors, on indeed strict orchestrated visits). tically’ drugs supply, doesn’t mean, MSF would leave the If the pace is quick enough is still a point of discussion. country: however certain conditions must exist, which do not exist today. MSF cannot continue working without Indeed we, like all others, are only tolerated in this coun- being able to assess the real needs and having access to try, if we bring in considerable amounts of goods and the population. Ethically, it is no longer acceptable. That money and draft a MoU in accordance with those in power. is why we need to (renegotiate with the North Korean At the same time we are not forced to bribe, or render authorities the modalities of our intervention in the coun- goods or services to officials like in many other places in try. We are in a position to do so, and we must accept to this world. Contrary to Pierre’s last remark in his annex to take risks. After the talks we had with FDRC representa- his report I would say that there is a quite a good coordi- tives during our visit, I am convinced that we can work in nation between the humanitarian actors. All have the same agreement with our principles: practical and ethical problems and this is something which - Need to have direct access to the population/villages/ is frequently and openly discussed. Free access, and the houses/institutions need for correct and independent data is high on every- - Need to organise nutritional/medical assessments body’s agenda (a suggested name for the newly formed - Necessity to focus on vulnerable groups (children, ‘social club’ is ‘the random access club’). [...] A nutritional orphans?), institutions (children’s centres for example) survey is hard to accept for the authorities because food is - Necessity to develop a medical approach close to the regarded to be a strategic i.e. military commodity. Health patients. MSF is a medical organization and not a supply isn’t and therefore the co-ordination will be done by agency. UNICEF and it will be called a health survey. In case there is no space for negotiation, MSF will have to take decisions regarding its involvement in this country. Back to food: All those bringing in food are pressed to We must be clear (all MSF -B/F/H- and coordination in speed up operations and to use food stocks for 6 months North Korea) that our withdrawal could be an option. This in one month by enlarging the target group. This would should be explained again to the FDRC. Negotiations are indicate that they have serious shortages. It is as well now open and a definitive decision must be taken before understood by all that monitoring food distribution here June 98 (our MoU ends in July 98). Lastly, it is important is shear impossible and in a way useless. Normally we have to inform (in Europe/USA or on the field) all NGOs work- clearly defined target populations (refugees, displaced, ing in North Korea of our position and see if it is possible disaster victims, etc.) Monitoring is merely locating these to develop a common approach in relation to the North people and checking if they got the food. Target groups Korean authorities. MSF must also address this issue with here like under five’s etc. are nation wide thus making donors and foreign governments involved in the current more or less the whole population the target population. North Korea crisis. For that purpose, there is a need to Because of the national food distribution scheme here, discuss the way the co-ordination between the sections is food allocated to a specific target will be deducted from currently working. the normal food allocated to that target. So what is monitored is a replacement of food.

“Re[3]: North Korea,” Email from MSF Pyongyang to Samantha Bolton MSF International “Press Release North Korea,” Email from Marie- Communication Coordinator, 4 April, 1998 (in Rose Pecchio, MSF coordinator in DPRK to MSF English). D93 Belgium Programme Manager, MSF Holland director of operations, MSF France President, 7 Extract: April, 1998 (in English). D94 Further for a good understanding. MANIPULATION: “control or influence cleverly or by unfair Extract: means” (Oxford dictionary). We do not have the idea that After the press article appearing in the Libé, I think the we are manipulated in the negative sense of the word. field itself might have some remarks to make. Or course there are attempts to steer us like at any other 1. On leaving, Philippe Biberson promised to let us know place in the world. But we are not puppets on a string. if there was a press conference or something similar. It For a better understanding it is necessary to know the would have taken 5 or 10 minutes to type a mail or make 84 system here and understand that we, and all others, and a quick phone call to Pyongyang. No time, too expensive, our workingrelationship! It didn’thelp tocreateaclimate of having diverted humanitarian aid, it doesn’t facilitate it -butwhenwetreatthem as cannibalsandaccusethem making outrageousremarks- whicharetrue,Idon’t deny when we put themonthe front page of the‘Libération’by We hadquiteafewproblems with theauthorities.Obviously the front page of the ‘Libération!’Iwasso upset. anything without warning us. Threedays later, there was because onleaving,Philippehadsaidthathewouldn’tdo I reallyhadtheimpressionofbeingknifedinback, forewarned. Which is not to say that we would have agreed. caused arealstorm.Weweren’thappythatwehadn’tbeen aware ofanythisinthefield.Wetookitreallybadly, malnourished children.Theydidthislikeso.Weweren’t described thehospitalconditions,conditionsof tion problembecausewedidn’thaveaccesstopeople;he He saidthatwehadn’tmanagedtoevaluatethemalnutri - carefully consideredattackagainstatotalitariancountry. tion. Hesaidthatwedidn’thaveaccesstopeople.Itwasa working conditions,andthelivingconditionsforpopula- page ofthe‘Libération.’Hespokeaboutregime,MSF’s returned, heheldapressconference,whichmadethefront pretty mucheverywhere with them,andwhenPhilippe Marie-Rose neh na”because that really would bethe end. school, “you did it in December, I’m doingit in April, na na in intersectionalsquabbles.Ihopeit’snotlikeatnursery story lamentable.Onceagain,thefield’sbecomeastake sensibilities thatarehardtomatchup.Ifindthiswhole our problemsatinternationallevelandthediffering 5. Thisarticleisnotconstructive.Itexposes,onceagain, position, when opinions divergesomuch. I doubtit.It’sgoingtobetrickypresentingauniqueMSF tions. Ihopethatthe2articlesfollowsameline,but going toreact.Pimhasalsoansweredjournalists’ques- 4. Idon’thavetheslightestideahowauthoritiesare French are waiting untilJuly to pull out ofthecountry. in thefield–includingMSFFexpatsIwonderwhy mission, thelowopiniontheyhaveofworkpeople 3. InviewofthelowopinionFrenchhaveKorea not beencompletely overlooked. the uniqueMSFschoolofthought.Ihopethispointhas rather, thatoftheGreatLeader,Marxist,andLeninist well. This article only reflects the position of MSF F, or me, MSFinKoreaisF+BH,ifmymemoryservesme the teams.ThearticlecitesMSFonseveraloccasions.For the followupofdiscussionsbetweenPierreS,Pimand 2. Certainpositionstakendonotcorrespondatallwith of MSF’s presidents. lack ofrespectforapromise,andthisonthepartone ever therewasone.”Inaword,wefeelbetrayedbythe or perhaps“it’sjustthefield,anunimportantelementif April. TheycametoKoreafortendays,wewent Biberson andPierreSalignoninMarchearly Everything kickedoffwiththevisitofPhilippe mate of confidence. depends on being friendly with people, creating a real cli- of confidence.Yetit’sthesortcountrywheresuccess was muchmoreinfavourof a compromise.Iwasn’t. people inthefield.Iknow that Ericspoke to Parisandhe let itdrop,becauseIwashavingenoughproblemskeeping ters andIputmyfrustrationsdowninwriting.Afterwards, beforehand. Hedidn’t.IraisedthisintheBrusselsheadquar- have hadenoughrespectforthefieldteamtoinformit with theothersections,that’snotParis’style,butheshould sion withtheteam.Iunderstandthathedidn’tdiscussit radios are forbidden, so they don’t give a damn. radios areforbidden, so they don’t givea damn. really sobothered.There’snopressinthecountry,foreign has suchabadimage,thatI’mnotconvincedtheywere ness accountsdeliveredabroad.Butthecountry’ssofaraway, North Koreanauthoritiesweredispleasedandannoyedbywit- tionship withthem.Atbestwewantedtoavoidexpulsion.The the authorities. But we weren’t aimingto have agood rela- harder fortheteamoverthere.Marie-Rosewassummonedby ities abitangry,makingthecontextanddailylifeeven Goemare haddone.Sotherewas indeedadifference. have accessandtobeopentowards us-moreclearly than Eric the NorthKoreanauthoritiesand theirunwillingnesstoletus Philippe Bibersonmoreclearly pointed totheresponsibilityof different thingsfromwhichPhilippeBibersonsaidlater.But had madeapress conference in Hong Kong,saying not very couple of monthsearlier, EricGoemaerefromMSF Belgian also Marie-Rose Pecchio, Coordinator, MSF Programmein Dr. Eric Goemaere, Executive Director MSF Belgium quotes in the ‘Libération’ must have made the author - say whosewordcountsformore.IthinkthatPhilippe’s wasinthefield,Iwasn’t,it’sdifficultto Marie-Rose rebound effect from the North Koreans. In fact, a rebound effectfrom the NorthKoreans.Infact,a Biberson, which,wewereafraid,wouldcreatea Then, therewasanunexpectedstatementofPhilippe Philippe couldhaveatleasthadalittlepriordiscus- thing, evenifit’ssomeonehighlyplacedinMSF. It givestheimpressionthatanybodycansayany- William Claus, MSFBelgium programme manager, Pim DeGraaf, MSF Holland Executive Director DPRK, November 1997 toSeptember 1998. (in English). (in French). (in

French).

85 MSF and North Korea 1995-1998 MSF Speaks Out

France president in Libération, were angered to have not been informed of the release of the report to the What really worried me was that there were still press. They expressed their disagreement with the MSF some senior people in MSF who were saying that all China coordinator statements. Several MSF executives this was a fuss about nothing; it was just publicity also reacted strongly to what they perceived as an or yet another demonstration of how the French go about unprofessional move. things, saying one thing and doing the opposite, treachery of some sort. It really proved to me that they hadn’t got it The Executive Director of MSF Belgium sent a letter to yet. We didn’t just take a decision like that, out of the blue, the FDRC General Director stating that this report did saying: ‘We’ll go back and go public.’ But as time went on not represent MSF’s official position. In the meantime, it became obvious to us that we should: all the contacts the head of the World Food Programme threatened to taken up before we left, the incredible privilege we’d had of reduce WFP aid delivery to North Korea if there was observing, understanding and being able to summarise the no improvement in the monitoring of the aid’s final situation, all this practically obliged us to deliver our con- destination. clusions, at the risk of being a bit sensational. There was effectively a bit of sensationalism in these articles. But it was more the fault of Romain Franklin, the journalist, who relied on our good will. Nonetheless, our thoughts gradually Message from Pierre Salignon, MSF France became clearer on the issue. We considered that we couldn’t Programme Manager, to Marcel Roux and Marine just stand by and say nothing, that we had to come back Buissonnière, MSF France in China, 7 April, saying: ‘We’re almost certain that this country is doing 1998 (in French). D95 really badly, that there’s big shortages.’ I think that’s’ exactly what we said: ‘There’s really big shortages that Extract: affect all levels of society.’ I returned for a board of direc- Hi Marcel and Marine tors’ meeting. Then I spoke to Brussels on the phone and we Thanks a lot for your visit report. It’s really interesting… soon agreed that we had to go public with the question or should I say horrifying. posed to the Korean authorities: ’Do we have the right or Several remarks: not to save people in Korea or is our aid going elsewhere?’ 1. Here are the main points I’ve retained from the docu- Brussels agreed with this. At the time Eric had already rec- ment: ognised to an extent that the message he’d passed during -The collected accounts mainly cover the ’97 period (April/ the Hong Kong press conference was beside the point. August/December) and the end of last year (with the exception of the Chinese priest whose last visit goes back Dr. Philippe Biberson, President MSF France, to January ’98). (in French). So little recent info even if certain witnesses say nothing’s changed for the better, on the contrary (they receive let- ters, for example). Which seems logical. For info: the MSF programme started in September ’97 in the three southern provinces. The MSF B team only arrived in the northern On 8 April, 1998, back from its trip to the border province in early February and have barely started work. V4 , the MSF Beijing team transmitted the report to So there’s been no expatriate presence in the area up until the MSF France programme manager. The programme now and no support with medicines (it’s different for food). manager then forwarded the report to their MSF -Your accounts confirm information already made public Belgium and MSF Holland colleagues. The issue was put by others sources (NGOs or journalists like Jasper Becker, on the agenda of the next programme managers meet- whom you’ve spoken to me about and who for you informa- ing that would take place the day after. During this tion has just published a book in French called “Famine in meeting on 9 April, the programme managers decided North Korea. 1998: a Murdered People” (L’esprit Frappeur) that MSF should stop its distribution programme in with the same information on the lack of food, families North Korea and renegotiate its modes of intervention breaking up, death, developing violence, the black mar- with the authorities. MSF would carry on explaining its ket, inequality in the population when confronted with position regarding North Korea, and the accounts, com- this tragedy, the ‘madness’ of the system, the privileges piled by MSF Beijing would no longer be given to jour- of the system. nalists. However, in the meantime, the MSF France in -In your report I can distinguish direct witness accounts China report had already been given to 5 selected press made by ‘refugees’ and Chinese/members of the Korean correspondents in Beijing. The team had also given community in China who can travel to North Korea, and some interviews and several newspapers had already ‘indirect’ witness accounts of other people involved in the published articles. Some of these articles focused par- reception of individuals who have fled. ticularly on stories of cannibalism that were reported -The description of the population’s living conditions is by some refugees. The MSF North Korea team as well as terrible and completes the questions/interrogations raised the MSF Belgium and MSF Holland programme managers by certain of our observations during our North Korean 86 and executives, already annoyed by the quotes of MSF visit. to collect a bitofdata? eases. Whatnutritional statearetheyin?Did youmanage talk aboutsores,woundscaused bythecoldorskindis- details onthestateofnewarrivals’ health?Thewitnesses provided for‘themostserious cases’.Doyouhavemore -A memberofthenetworktalked aboutthemedicalcare with regards to theregime in placeNorth Korea. ishing. Theyraisequestionsonthestatusofthesepeople closed offasNorthKorea,thesemovementsseemaston - of thecountryandtravellingaroundit.Inaas those whostillhavethepossibilityofgettinginandout don’t neednames)whogavetheseaccounts.Particularly -We wouldlike to know more about thepeopleyoumet (I may be able toanswer: 2. Reading this report raises several questions, which you understood things correctly, and leftnothing out. of informationIdon’treferto.PleaseletmeknowifI’ve your visitreport(withoutforgettingalltheothermines So that’smysummaryofthemainpointsIretainedfrom doesn’t detractanythingfromthegravityofsituation. 1997 (AugusttoDecember’97+January’98),which separating the2countriesalsocorrespondtoyear the on streets, edges oftheroadsoronChinesebanksriver the in bodies saw who witnesses The • away locations. covers bothbordertownswithChinaandother,further and large relatively is about talk witnesses the area The • precise figures. It’s not the mostimportant issue). shouldn’t expect this type of witness account to produce 90 (definitive?)permonth.Butwhateverthecase,we persons since 1996 or several dozens of passages - 30 to despite someaccountstalkingabout50,000/70,000 passages overtheborder(difficulttoestablishafigure the North Koreaauthorities)forlimitingthe‘refugee’flow/ with collusion (in policy authorities’ Chinese The • population. us without China knowing iftheymanagetoimprovethedailylotof with exchanges some Nonetheless • tions. population movementsdespitetheadministrativerestric- wide-spread food, for search constant population’s The • zero. to reduced activity industrial Economic • regarding the empty hospitals). ’97 whichconfirmsthewitnessaccountsinyourreport order the blackmarket(refEricGoemaere’svisitinDecember working in structures health and thediversionoffewmedicinesstillavailableto of absence The • concerned. which doesn’treach,orhardlyreaches,thepopulations national aid/absenceofdistribution(foodinparticular) inter- of diversion the regarding presumptions Strong • information). the witnesses,butit’soneofimportantelements years agoelsewhere(itseemsveryvariabledependingon ties ayearagointhemostfavouredareasandseveral • The end of cereal distributions by North Korean authori- put forward by certain witnesses). to extrapolateonthenumberofdeathsdespitefigures • A situation of food shortage/famine (without being able To summarise, I was struck bythe following: information strategy and MSF’sposition. to havealltheelementsonhandbeforediscussingan can readitbeforethemeetingonThursday.It’simportant and MSFH(PimdeGraef)tomorrow(Wednesday),sothey -I wouldalsoliketocirculateyourreportMSFB(William) communications levels. discussions anddecisionstakenonbothoperations -Conclusion: OnTuesday,we’lldotheminutesof there are disagreements. see ifeveryonereallyisonthesametrackornotewhere an overviewoftheDesks’meeting.Whichwillallowusto Operations Directorsofthethreesections(B/F/H),giving -On Friday,stillinBrussels,we’llgooveritallwiththe communication + lobbyingwith regard todonors/NGOs. be discussingMSF’soperationalstrategyandparticularly the 9thinBrussels.I’llsendyouagenda,andwe’ll -A meetingbetweentheDesksisplannedforThursday position). point of view on the operationsin this country and MSF’s visit report,whichwillalreadygiveyoumyandPhilippe’s Korea, Iproposethefollowing(Ihopeyoureceivedmy course tobeheldbyMSFandthefutureofinNorth 3. Concerningtheuseofthesewitnessaccounts,dis- refugee question? Thanks in advance. -Do you know if the UNHCR in Beijing is interested in this send everything through due to lackoftime. who arrivedafterthebeginningof’98.Unlessyoudidn’t -We would also like to know why there are no witnesses the mailasend toMarcelandMarinewithsome comments NK inJanuary 98). Ialsoenclosedinthismessage copyof period of April/December 97 (onlyone ists. Peoplespeakingaremainly givinginformationonthe observations already done by other organizations/journal- the informationenclosedare interestingandconfirming in French.ButIknowanyway youcanreadit.Youwillsee Chinese movinginanoutNorthKorea.Sorrythereportis local organizations,‘refugees’comingfromNorthKoreaor The teamspent10daysinthisareameetingwithdifferent visit wasdecidedwhenIinChinagoingtoPyongyang. Liaoning andJilinprovincesborderingNorthKorea.This ing areportofthefieldvisitourteam(inChina)in other hand,I’msendingbyfaxtobothofyouthismorn - do now.William,thankyoutokeepmeinformed.Onthe coming tomorrow,Iwouldliketoknowhowyouwant the reasonwhyIfeelwemightmeetsoon.WithPimnot week onNorthKorea.Weneedtimetodiscuss.That’s I hopeyouarefineandwewillorganizeameetingthis Extract: April 1998(in English). Vasset, MSFFranceDirectorofOperations,8 MSF Belgium Director of Operations and Brigitte Programme ManagercopytoMarioGoethals, Programme Manager, Pim de Graaf, MSF Holland Manager toWilliamClaus,MSFBelgium from PierreSalignon, MSF FranceProgramme “DPRK MeetingTomorroworFriday!?” D96

person visited Email

87 MSF and North Korea 1995-1998 MSF Speaks Out

on their report. I’m waiting their reactions. I feel it would real needs and having access to the population. Ethically, be important to speak about this report during our meet- it is no longer acceptable and practically the distribution ing. If you have comments, please send me a message. I programme is too vast (number of structures... etc.). will send it to Beijing. William, could you send this report -That’s why our priority is currently to assess as soon as to Pyongyang. I would like to have their comments too. possible the nutritional situation in North Korea. That’s all for me. Sincerely, speak to you soon. Pierre -For that purpose, it was decided that William B would go back to NK end of April to negotiate again with the North Korean authorities the modalities of our intervention in the country. [...] Letter from Dr Eric Goemare, MSF Belgium -In case there is no space for negotiation, MSF will have Executive Director to Mr Lee, FDRC General to take decisions regarding its involvement in this coun- Director, 9 April, 1998 (in English). D97 try. It is clear for Brussels, Paris and Amsterdam that our withdrawal could be an option. This should be explained Extract: to the FDRC. Dear Mr. Lee, -Negotiations are now open and a definitive decision must You heard certainly last week news forwarded by the be taken in June 98 (our MoU ends in July 98 for the 3 international press that MSF had made declarations about provinces of the south and in September for the Northern an alarming food situation and misuse of food aid. We Province in which MSF started to work in February 98). would like to stress that these news are not produced by We will decide then what to do, how to continue, if we any official MSF press release but have been extracted continue working in the country, until when, under which from interviews of Korean refugees made by MSF teams in conditions. Sure, the last statements done by MSF Beijing China, part of their ongoing work with every kind of refu- could provoke reactions of the NK authorities. We will see gees in the country. Those interviews are not new, and are in the coming days. But we must stay strong on our prin- form the same source as different NGO’s in the past. We ciples and the way we want to work in NK, and be clear would like to stress that it was a totally personal initiative with the authorities on the problems MSF is facing in-the to release those information, initiative that is not backed country and the consequences in terms of the quality on by the headquarters, neither in Brussels, neither in Paris. our work. We must explain too why we spoke out in the About the content, it represents the refugees’ point of media (be careful not to apologise because of that). [...] view but is in no way confirmed by the MSF teams pres- -It’s clear for all of us that it is important to inform (in ent in the field neither by our mission last December in Europe/USA or on the field) all NGOs working in North North Hamyong. We have launched that message to all the Korea of our position and see if it is possible to develop a journalists that contacted us here in Europe. common approach in relation to the North Korean authori- We would ask you to consider keeping the meeting with ties. MSF must also address this issue with donors and Dr P. Biberson, President of MSF- France and our meet- foreign governments involved in the current North Korea ing in December as the official point of view of MSF on crisis. that subject. We will take this opportunity to reaffirm the -It was decided to organise several meetings with donors importance for our team to have free access to the popula- and humanitarian actors working in North Korea in the tion, including at village level, to have a clearer view as coming weeks. an independent observer of the food situation and be able to put a definitive end to all kinds of rumours. Sincerely yours Reuters dispatch Beijing, 11 April, 1998 (in English).

Minutes of DPRK meeting MSF B/F/H, Brussels, Extract: 9 April, 1998 (in English). D98 Starving North Koreans are resorting to violence and cannibalism to stay alive as army and government officials Extract: pilfer emergency relief supplies, said a report by Médecins Present - William Claus, Pierre Salignon, and Pim de Graaf. Sans Frontières (MSF) seen in Beijing on Saturday. A bare A debriefing with the directors of operations was done on minimum of food and medical supplies sent by interna- Friday morning. tional aid agencies to the famine-stricken nation had OPERATIONS reached the sick and dying, the group said. Refugees and -MSF must stop its distribution programme or, at least, Chinese travellers interviewed by MSF on the Chinese side must reduce drastically the number of structures/provinc- of the North Korean border described bodies lying in the es it is supporting. It is no longer possible to continue the streets, widespread violence and disease, and even cases way we do (cf. field visit report and constraints MSF teams of cannibalism. are facing). Stopping/reducing ‘drastically’ drugs supply, doesn’t mean MSF would leave the country. However, cer- Most supplies had been consumed or sold by the army tain conditions must exist, which do not exist today. MSF despite efforts by aid groups to monitor distribution, they 88 cannot continue working without being able to assess the said. “Foreigners came to check that the grain had been dis- set asidefor children underage6.But she cautioned have pouredinto thecountry,mostofwhich hasbeen She creditedthealmost1million tonsoffoodaidthat and emaciated than those she saw on a visit a year ago. schools andday-carecentres weregenerallyfarlesssickly North Korea, she emphasized that children she saw in Bertini said that a serious food shortage continues in stockpiled byofficialsandthearmy.[…]AlthoughMs aid earmarked for the general public is being eaten or group DoctorsWithoutBorders,havesuggestedthatfood Several reports,includingoneissuedSaturdaybythe used. more widespreadmonitoringofhowdonatedfoodwas tions wouldbescaledbackifNorthKoreadidnotallow people. IncommentsSunday,shesaidthatfooddona - distributes mostoftheaidtonation23million ing tocooperatefullywithheragency,which solicits and Catherine Bertini,criticizedNorthKoreanofficialsforfail- day trip to that hunger-stricken nation. But the director, director oftheUNWorldFoodProgrammesaidafterafour ably asaresultofinternationalfoodaid,theexecutive ably betternourishedthantheydidayearago,presum- BEJING -YoungchildreninNorthKoreaappearconsider Extract: across the border since1996. mated thatbetween50,000and70,000peoplehadfled a supportgroupforNorthKoreanrefugeesinChinaesti- stations astheywaitedtoescapestarvation.Amemberof movement aroundNorthKorea.Manyhaddiedatrailway 34-year-old man.Otherstalkedoflarge-scalepopulation sold onthemarketandhospitalstocksareempty,”saidone and medicalsuppliesscarce.“Hospitals’medicinehasbeen Witnesses saidtuberculosis;typhoidandcholerawererife who makesregular food deliverytrips over the border. anything aboutinternationalaid,”saidaChinesedriver has notdistributedgrainsince1994andIneverheard grain rationsatleastthreeyearsago.“Thegovernment […] Mostintervieweessaidthestatehadstoppedissuing quoted one18-year-old orphan as saying. and ateanorphanwhonobodycaredabout,”thereport place, theintervieweessaid.“Ourneighbourkilled,salted old child to save herself from starvation were common- Horror storieslikethatofawomanwhoatehertwo-year- 34-year-old former NorthKoreanstateenterpriseworker. ment cadresbutneverreachesthecommonpeople,”saida aid again.” “The majority of aid goes to army and govern- government collectedthesacksandnevermentioned border townofTumen.“Aftertheforeignershadleft, tributed to thepopulation,”saidateacher in theChinese 1998 (inEnglish). Tribune/The NewYorkTimes,Beijing,11April, Elisabeth Rosenthal,InternationalHerald – “Food AidSeemstoHelpChildreninNorthKorea but a UN Director Cites Distribution Flaws,” by D99 we have to becareful.” who hasworkedintheregion.“Butwereallydon’tknow; say there’sjustastateofbadnutrition”saidoneaidexpert or experienced.“Somesaythereare3milliondead,other rumours insteadofthingstheyhavepersonallywitnessed believe thattherefugeesexaggerateproblemsorreport what we’vereadinthenewspapers”.Somefoodexperts said theagency’smonitors“havenotseenanythinglike papers, were a source of concern to her agency. But she have received front-page coverage in some Asian news- Ms. Bettinasaidthattherefugees’statements,which sive starvation as well. malnutrition, thequestionremainswhetherthereismas- While noonedoubtsthatthereiswidespreadhungerand North Korea, possibly the world’s most secretive nation. the debateaboutseriousnessoffoodsituationin parate accounts, within just 24 hours, further confused parents eatingtheirchildrenindesperation.Thesedis- grisly talesofvillageroadslinedwithcorpsesandhungry who hadcrossedintoChina.Thedoctors’reportincluded which wasbasedon interviews with North Korean refugees with thefardirerreportSaturdaybydoctors’group, Her soberassessmentwithitshintsofprogresscontrasted unable tosupply. [...] their witsforwhatgovernmentfooddistributionhasbeen serious fortherestofpopulation-whomustrelyon children. And she said that nutrition problems remain that therewerestillmanycasesofmalnutritionamong nibalism. in camps for vagrants. Many North Koreans spoke of can- the countryinlargenumbers andsomewerebeingheld malnutrition andfreshgraves. Peopleweremovingaround up adentalsurgeryintheNorth reportedseeingchronic never to the people.’ A South Korean who had tried to set Most oftheaidgoestoarmyandgovernmentcadresbut aid. Thisistheonlytimesomethinglikethishappened. said, ‘Take it and don’t ask.’ I think it was international rice lastJune.‘Iaskedwhereitcamefrom,’hesaid.‘They starved todeathsaidhisfamilyreceivedonekilogramof some places.AmanfromHyesanwhosefive-year-oldson rations in1995.Rationswerehaltedfiveyearsago North Koreansinterviewedsaidthestatestoppedissuing ing thosedyingofdiseaseandstarvation.[…]Most Chinese sideofthebordersaysalmostnothingisreach - Frontières reportbasedoninterviewswithpeoplethe officials andtheArmy,witnessessay.AMédecinsSans in NorthKoreaarebeingtricked,asmostaidisgoingto International reliefagenciessendingfoodtothestarving Extract: 11 April, 1998 (inEnglish). Becker, “Food forHungryStolenbyArmy,” South ChinaMorningPost,(Beijing), Jasper

89 MSF and North Korea 1995-1998 MSF Speaks Out

We would therefore like to carry out a nutritional survey and increase our proximity with the most affected Koreans “Info,” Email from Pierre- Pascal Vandini, MSF to be sure they are benefiting from our aid. Obviously, we France Programme Manager to Marcel Roux, can say all this to western journalists. But I have no idea Coordinator MSF France in Beijing, copied to how to deal with the fall out in the field … (the very day Programme Managers, operations directors and a North Korean delegation arrives in Beijing). executive directors of MSF France and MSF Belgium and the president of MSF France, 11 April, 1998 (in English). D100 “’According to Witness Accounts Collected by Extract: MSF,’ North Korea: the Newly Damned of Asia,” Hi Marcel Jean Leclerc of Sablon, Beijing, Le Figaro I’m writing this message to facilitate discussions. We have (France), 11-12 April, 1998 (in French). two problems: D101 - The risk of MSF’s expulsion from the DPRK. - The loss of credibility with journalists right at a time Extract: when we want to talk about the situation in North Korea. In North Korea, an entire population is dying of hunger, We owe this situation to you, and I’ll explain why. The cold, exhaustion and violence. “Life was too hard, we were info you passed to the press is of course known to MSF, eating grass and roots. Children, orphaned or abandoned particularly the DPRK team, Pierre and myself, Philippe, by their parents, were grappling with danger for survival. Brigitte, Karim, the board and the desks in Brussels and There’s no pity. Our neighbour killed, salted and ate an Amsterdam. So widely circulated within MSF. Nobody orphan that no one had taken in …” So say two escapees questions the witness accounts you’ve collected. The only from the tragedy of Asia’s newly damned, a young 18 question is how to use them. We all made a decision year old girl and her 8 year old brother, originally from together - and that’s sufficiently rare that it deserves Hambung in the south east coastal region, and taken in a mention - we all decided together on the strategy to by an orphanage in Yanji, a town in North West China at adopt for North Korea during the international meet- the limits of North Korea and Siberia. ings of Thursday and Friday = firm negotiations with the Korean government in order to have direct access to the “At a guess, 15% to 20% of the population is dying of population. This is the only way we can respond to their hunger, 5% is doing fine and the rest is trying to survive, needs (evaluation of nutritional status in the villages, but it’s exhausted. I saw the bodies of seven half naked chil- active research for malnourished children, correct case dren in January, all huddled up against each other. Nobody management) and maybe eventually denounce the diver- wanted to take them in. They took shelter in a pig sty before sion of aid (document it, circulate info). succumbing to the cold” relates a Chinese priest of Korean origins, who has family on the other side of the border. I think that you agree with these objectives: help and The UN is trying to put perspective on these two accounts denounce. Unfortunately you’ve just pulled the rug out amongst dozens of other odysseys of horror listened to from under our feet and it seems unlikely that we’ll and carefully recorded by a team from Médecins sans manage anything except leaving Korea. What you’ve Frontières (MSF), who has just spent twelve days going up done weakens MSF in negotiations and alienates us from and down the Sino-North Korean border. They heard the Koreans. It weakens MSF, the Koreans are reinforced by accounts of some thirty North Korean refugees, smugglers your dramatic declarations, will have a great time pushing and volunteers, Sino-Korean, South Korean or Chinese. on the quantitative aspects (still more food, more seeds) These stories, coming from twelve different towns or prov- whilst we want to focus on getting food to the beneficia- inces in the north of the peninsula, inhabited (in 1994) by ries, i.e. the qualitative ones. I don’t know if you’re aware 22 million people, tie in and tally with each other on the of how difficult it is to negotiate with them in normal ‘details’, suggest that one of the biggest tragedies unfold- times. You alienate us from Koreans, meaning both the ing this century is taking place in the ‘earthly paradise’ authorities and the people themselves. Your declarations created by the Stalinist regime of the dictator Kim II-Sung on cannibalism are seriously insulting for the people. It’s and his son and successor Kim Jong-II. an inhuman act and you accuse Koreans of having committed it. And then your declarations also specify that aid is “Disinformation! It’s all manipulated by the American partially diverted by the army. Our interlocutors, who are secret services”, cry diplomats from the European Union, seriously paranoid, will lap up this kind of phrase. who claim to have dispatched a dozen specialists in the field who didn’t see anything of this tragedy. The UN and We’re attempting damage control in Europe by circulating numerous other humanitarian organisations have around a MSF’s real line, which is: numerous witness accounts col- hundred representatives between them based in the capi- lected over the years raise fears of serious food problems. tal, Pyongyang, who also said, when questioned on their MSF, which works in Korea, has not yet been able to con- return to Beijing:, “We shouldn’t dramatise things.” “The firm the extent of the catastrophe. None of the witness food situation isn’t desperate yet,” stated a World Food 90 accounts have been confirmed by the MSF teams in Korea. Programme representative recently. The problem is that Roux really said. newspaper thatcalled,butitwouldbegoodtoKNOWwhat of NorthKoreaandcouldbalancethestoryabitfor to haveadoctorhere(RikardLjung)whojustcameout that. Iguesshemustbemisquoted.wasluckyenough a bitincrediblethatRouxwouldhavesaidanythinglike way. IthinkitcameviaAFPafewdaysagoandsounds credited to MSF F coordinator Marcel Roux in some vague new rumoursaboutcannibalisminNorthKorea,apparently I justwantto ask you ifyouknow anything aboutthese Hello, Extract: witnesses to MSF. steal bread from the mouths of adults,” confided another our possessionsistosleeponthem–I’veseenchildren everything wecangetourhandson,theonlywaytoprotect year oldsondiedofhunger.“Wekillforfood,westeal an unemployed34yearoldmanfromHyesan,whose5 for survival:“It’stheonlywaytobringsomethingin”said become endemic,thosewhohavenothingtosteal share oflife”explainedatraderfromTumen.Violencehas lived longenoughandpreferredtoleavetheyoungtheir 72 andeducatedinRussia,letherselfdie,sayingthatshe’d misery initsmostextremeforms.“Mygreataunt,whowas Chinese peasants,cannibalism:the‘Frenchdoctors’picture at night,childrensoldfor5,000Yuan(3,500Francs)to last hopeofsalvation,bodiescollectedbyarmytrucks and youngcollectedtherefortheirlastgasporinthe skin cracked.[...]Railwaystationsclosedbecausetheold children withswollenbellies,facesblackenedcold, an exodusofpoorwretches,barelyclothedorshod, “You didn’trealise?”[...]ThepeopleMSFmetdescribe Are weonceagaingoingtohear,whenit’stoolate: famine!” ters haveledtodifficulties,forsure,butthere’snoreal returned with‘reassuring’information:“Thenaturaldisas- of deathsinChina,yetthewesternersinvitedtoBeijing of MaoZedong’scommunistpartyleadersledtomillions During the ‘60s, a famine caused by the lies and cheating officially decided itineraries. outside thecapitalunderstrictsurveillanceandfollowing most ofthese“humanitariancivilservants”canonlytravel (in English). to MSF North Korea network, 12 April, 1998 Janne Gustafsson,MSFSwedenPressOfficer “ Cannibalism RumoursNKorea,” D102 Email from

not verify -when we were noteveninformed ourselves?? why distributethissuddeninformation-whichwecould cult toassessandthereforeweneedbeverycareful.So acknowledged ourselvesthatthesituationwasverydiffi- the seriousnessoffoodsituationinNorthKorea;we ress andMSF’sreport)furtherconfusedthedebateabout (between Bertini’ssoberassessmentwithitshintsofprog- the NYTarticlementionedtoday,thesedisparateaccounts well on MSF and we are loosing some credibility here. As the waythatthisnewshasbeenpublisheddoesnotreflect have no access there). I am sorry to say but I think that some proofofit(whichweknowit’simpossiblesince refugees withoutverifyingtheirstories,oratleasttoget rely on-andthereforepublishaccounts/interviewsof in previous circumstances, we agreed that we could not to answercorrectlyforlackofinformation.Ithoughtthat both byjournalistsandcolleagues,towhichweareunable We arereceivinganumberofquestions/inquiriesraised our colleagues (including those of WorldVision). we couldnotconfirmthedramaticfiguresusedbysomeof ous meetingshereattheUN,MSFusuallyrepeatedthat statements, andistakingusbysurprise.Infact,invari- the NYToftoday,isquitecontradictoryearlierMSF on it.NowMSF’squoteinvariousnewspapers,including we expectedtobeinformedsometimelater(thisweek?) day to define MSF’s position vis-à-vis DPRK, and therefore was thatthereameetingtakingplaceinBrussels ism. FromwhatIunderstood(aslateasThursdaynight), report onthesituationinDPRK,withmention of cannibal- I wasquitesurprisedtohearonFridaynight,CNN,MSF Hello everyone! Extract: Radio tooknote ofthe“graveworriesabout thewayfood ted thatthesituation has worsened. Last week Pyongyang ed population.TheNorthKorean authoritieshaveadmit- roadside, andthatdiseaseis rampant amongthedebilitat- It isreportedthatcorpseshave beenabandonedbythe have alsobeeninvolvedin acts ofviolenceandlooting. report, publishedinBeijingon April11,starvingcivilians under wayagaininBeijing.[...]AccordingtotheMSF der withChina,talksbetweenNorthandSouthKoreagot of alarmingfoodshortagesinNorthKoreanearthebor - to Médecins Sans Frontières (MSF) had reported evidence On April11,justafterateamofFrenchdoctorsbelonging Extract: 1998 (inEnglish). York toMSFNorthKoreanetwork,13April, Catherine Harper,MSFUNLiaisonOfficer,New “MSF StatementonNorthKorea,” 1998 (inEnglish). Pons, “Food CrisisOvershadowsKoreaTalks,” The GuardianWeekly(Tokyo),14April, D103 D104 Email from Philippe

91 MSF and North Korea 1995-1998 MSF Speaks Out

reserves are running out” that have been expressed by the possibility of asking us to leave the country. With the head of the United Nations World Food Programme (WFP), national holidays going on in Korea, I won’t be able to Catherine Bertini, who has just visited North Korea. [...] see them before Friday. Maybe we’ll be thrown out. Even if we’re not, it comes to the same thing, the damage is In January the WFP launched its biggest emergency aid done, and in the name of MSF. Our good relationship operation for North Korea and called for 650,000 tonnes with the authorities, the climate of confidence built up of foodstuffs to be contributed in 1998. The United States between MSF and its partners, the little bit of ground responded to the appeal by promising 200,000 tonnes. At we’ve made (which is a lot compared to where we started the end of March, in the course of talks between Red Cross from): it’s all finished. We’ll have to start again from organisations in the two Koreas, South Korea pledged to scratch, spending huge amounts of time trying to re-build supply 50,000 tonnes. The first consignments of that aid confidence, if we ever manage. And all this for facts that are due to arrive this week. But the great unknown factor, haven’t been checked and which others have been spread- which could put off donors and delay deliveries, is the ing about for a while, always without proof. We in Korea question of who the beneficiaries of that aid should be. still haven’t received the dossier handed over to the press. Will it go to the population at large, or be given first to Which is a bit of a joke, considering that the FDRC has it. the regime’s elite and the army? Refugees questioned by So for once I’d like MSF to recognise that someone in our MSF doctors have said that only a strict minimum of food- organisation, even if he’s super-protected by the nomen- stuffs and medicines are reaching the civilian population. clature MSF F, has screwed up big time. And only MSF F can do this. He works for MSF F.

Marcel Roux, to name no names, which I spoke to yester- “Sick and Tired of North Korea,” Letter from day on the telephone, considers that he will save more Marie-Rose Pecchio, Coordinator DPRK to the Korean lives with his report than we do in the field with North Korea Programme Manager in MSF our medicines. He can think what he likes. But I want you Belgium, 14 April, 1998 (in French). D105 to know that enough’s enough. The Korean mission is sick and tired of all this. We’ve called on the International Extract: Office or Committee (I don’t know who does what) to take I read somewhere in ’97 that new rules over ‘témoignage’ rapid measures against such acts that achieve nothing for had been decided by all the MSF sections and approved anyone, other than trouble for people in the field who by the international office. These new controls have been are just trying to do their job. Can we accept that such disrespected twice in 11 days, both times in relation to people, who don’t respect MSF’s internal rules, continue the same mission, being North Korea. Remarks on the first working for MSF? Humanitarian work is about helping occasion have already been circulated and copied around people, but it starts with respecting them. And for us, all the sections and persons involved, so I won’t go back accusing someone without proof lacks respect. over it. The second occasion, more serious in my opinion, Marie-Rose and the North Korean team. involves some people describing what they’ve heard other people say. Not one fact has been checked or really seen by the person who passed these accounts to the press. Can we really talk about witnessing?? And not any old facts “For Your Info,” Email from Pierre Salignon, either, but really serious accusations: cannibalism, diver- MSF France Programme Manager, to Patrick de sion of humanitarian aid to the army and higher echelons Briey, MSF Belgium Programme Manager, 22 of the regime. And these accounts weren’t even passed April,1998 (in French). D106 on to the press with the normal reserves, used by others before him on the same subject. Extract: Hi Patrick, I hope you’re well. And who’s witnessing? MSF! Or at least someone who I would just like to react to the little messages sent by calls himself MSF. What right does he have to talk in the Marie Rose with the ‘savoury’ references to MSF France. name of MSF, about a mission that’s not his own, without I would be grateful if you could let her know that the consulting the people responsible in Paris, Amsterdam and decisions taken during the meeting in Brussels didn’t Brussels? The 3 headquarters concerned, I believe: we’re just come from Paris, but were accepted by all sections an international mission. What right does someone have intervening in Korea. If I wrote up the minutes of the to omit informing a mission when he’s going to bring meeting, it was because William and Pim asked me to. I serious accusations against the country it’s trying to work don’t want to send her a mail about this, as it’s not worth in? I don’t even use the word ‘consult’, we’re way beyond fanning the flames. I’m relying on your powers of persua- that … I’m not going to give another overview of Korea: sion when you have her on the phone. For sure, there was a closed off country, completely paranoid blah blah blah. the Libération episode (the problem wasn’t that Philippe This was sufficiently covered in Brussels during the meet- gave this interview, it was that the field wasn’t informed, ings between desks and operations directors. which we regret. And we’ve said so).

92 For my part, the FDRC is furious. It’s not excluding the There was the episode with Marcel Roux in China (regard- FIELD STAFF IS EQUALLY PROFESSIONAL. tological rules, SURELY MSF OUGHT TO ENSURE THAT ITS in theprocess).Ifevenjournalists canhavebasicdeon- from a field colleague (and looking like a bunch of clowns the lastfewdays,whiletrying nottodistanceourselves not easytolimitthedamage donetoourreputationover ers and journalists against the use of such material. It was Great Lakescrisis.TheBBC,forinstance,warnsitsproduc - completely discreditedintheUK-asadirectresultof reports. Theuseof‘interviews’withrefugeeshasbeen enquiries andpassthemoffasfact-findingmission situation. WeCANNOTAFFORDtoconductsub-journalistic field andourabilitytoprovidefirst-handaccounts of a A. MSF’scredibilityisbasedonourpresenceinthe disastrous because: need tobeconductedASAP).Marcel’smediastuntis what is going on, so 2/ ‘free and fair’ nutritional surveys highlight therealissues(i.e.1/wedonotknowexactly individual wasallowedtoderailourcontinuingefforts North Koreanstocannibalism.”Itisagreatshamethatone reported overtheEasterweekend:“Thatfaminedrove smacked tohear(fromaBBCproducer)thatMSFhad Like manyothersaroundtheMSFnetwork,Iwasgob- Dear all, Extract: with the authorities aboutall this. his visa. It’s so important because we need to be clear sections. It’snotthecase.IreallyhopethatWilliamgets fundamental problembeinterpretedasanissueamongst have confidence in Marie-Rose, but we shouldn’t let a let youknowofmyconcerns about thecoordination.I There yougo,justalittlewordforandWilliamto being kicked out. or refusetoraiseitwiththeauthoritiesthroughfearof ethics andthequalityofourwork.Weshouldn’thidethis position inthecountryposesarealproblemtermsof authorities (andthere’salotofthingstodiscuss).MSF’s on themostimportantone,beingnegotiationswith that she’s confusing the issue, and not concentrating of MSFdirectorswhocometoplaypolitics,I’mconcerned lem forMSF.WhenIseeherlittleremarksonthevisits are tensions,it’sbecausethismissionposesarealprob- responsible foranycurrenttensionswiththem.Ifthere on negotiationswiththeauthoritieswithoutfindingParis like hertoadoptamorepositiveattitudeandconcentrate ‘Marie-Rose annoyedwithParis’episode,andIwouldreally Paris, therewasn’tany,andyouknowit).Nowthere’sthe less ofwhatPyongyangthinksabout‘manipulation’from April, 1998 (in English). Briey, MSFBelgiumprogrammemanager),15 Belgium Programme Manager toPatrickde network, (forwardedbyWilliamClaus,MSF MSF UKExecutiveDirectortoNorthKorea “ North Korea,” Letter fromAnne-MarieHuby, D107 them: JasperBecker, whowasstillworking fortheSouth events inNorth Koreaforawhile.Thereweren’t manyof with journalistsbasedinBeijing who’dbeenfollowing exactly howithappened,but wehadcontactsatthetime these storiesout,onewayor another.Idon’tremember everything wasfine.Wesaidto ourselvesthatwehadtoget Koreas weretalkingabouta returntonormality,saying was takingplaceintotalsilence.Onthecontrary,North was sufferinganunimaginabledegreeofviolenceandyetit were inanincredibleperiodduringwhichthispopulation being askedaboutapossible famine inNorthKorea. We talking aboutallthis,becauseitwaswhenquestionswere ried, I shall notcirculate it further... easier andFAXITplease?Thanks.Incaseyouwerewor- except me.Couldonecharitablesoulmakemydayalittle Everyone hasseenit,includingthemedia–everyone LAST BUTNOTLEAST:Ineedtoseeacopyofthereport. I look forward toyour comments on this. prospects tobesomewhatcurtailed–andquiterightlyso. this shitinthesameway,wewouldexpectourMSFcareer If someone fromLondon or New York had landed you in rather than go off and wage their own personal crusades? planning todoensurethatourfieldstaffplayball other) fiasco.Myquestionnowis:whatareyouguys or moreimportantly,nolessonslearntafteramedia(or and allthat,buttoooftentherearenosanctions, MSF’s informality and ‘room for initiative’ is all wonderful WHO ISRESPONSIBLE? done. Which brings metoa final point... only onesleftoffthehookareNorthKoreans-well bashes MSFreport’-boringandwhollyunnecessary.The Herald Tribune).Insteadoftherealissue,wehave‘UN week, nowhastodiscreditourtestimonies(seetoday’s Bertini, whohadineffectralliedroundourpositionlast C. Thestorynowlookslikeaninter-agencyfeud.Catherine teurs we reallyare. medical agency.Itpainsmetoseewhatabunchofama- supporting evidence,ratherthanasthegospelfroma to telljournosaboutthesetestimonies,asANECDOTAL, May Ipointoutthatitwouldhavebeenperfectlypossible with suchemotiveissuesascannibalism).Takeyourpick. expect journaliststoprintyourfinerpointswhendealing which is probably even worse), or PLAIN STUPID (you can’t answer, MSFwaseitherIRRESPONSIBLE(andmisleading, subtle issueofthelackmonitoring?Whatever KIDS” -typestories?Ordidtheywanttoraisethemore whatever) aimtoget“NORTHKOREANSEATTHEIROWN we shoulddoanotherjob!).DidMSF(HongKong,Beijing, a clearideaofwhichcoverageweactuallywant(ifnot, B. Every time we prepare to speak to the press, we have the refugees.Wewereastonishedthatnobodywas write everythingup,typeoutalltheinterviewswith When we returned to Beijing, we felt that we had to

93 MSF and North Korea 1995-1998 MSF Speaks Out

China Morning Post, was the first to write up stories of before, using the same sources. But MSF wasn’t the one North Korean refugees in 1997; Jean Leclerc du Sablon, denouncing, even if in Marcel Roux’s article, MSF was cited. working for Le Figaro at the time, John Pomfret of The Washington Post, Francis Deron of Le Monde and Alain Marie-Rose Pecchio, Head of mission, MSF Programme Extramiana of The AFP. We shared the contents of these in DPRK, November 1997 to September 1998. witness accounts with them, as we were convinced that they should become public knowledge.

We didn’t go through the programme managers, but directly via Philippe Biberson [President MSF France]. I remember Marcel Roux started circulating reports on state- a phone call between Marcel [Roux, Coordinator MSF France ments that had been made before, claiming that in China] and Philippe Biberson. Marcel said he was going there was cannibalism in North Korea, which didn’t to make the witness accounts public and Philippe didn’t tell help matters much. On one hand, you’re trying to negotiate him not to. This interpretation of things caused a storm. I to stay in the country and have more access and on the don’t have Philippe’s version, just Marcel’s. So we gave the other, you have someone saying such things without proof. accounts to journalists a few days after our return from the It’s serious, saying there’s cannibalism in the country. border, explaining what we’d seen and heard. Which led to They’d interviewed people on the Chinese border who were the publication of articles at the beginning of April. Jean being sheltered by religious Buddhist “sects”. The Buddhists Leclerc du Sablon took a whole page in Le Figaro, using had brought out a report; they brought out the same report the following extracts: ‘The newly damned in Asia according shortly afterwards. It was the same people, some one hun- to witness accounts collected by MSF.’ Jasper also did an dred refugees.7 The people being questioned knew exactly article, we were in The Financial Times, the AFP published a what message they had to pass. It was Buddhists opposed story and Elisabeth Rosendale of The New York Times wrote to North Korea who’d been trying for years to pass the mes- a piece for The International Herald Tribune. I think that sage that North Korea was going to be “Christianised” Eric Goemaere then distanced himself from us by writing a [sic!] and wanted to build up a really negative image. We letter to the North Korean authorities. And I remember a never had any proof. There was a river border between South row between Pierre Salignon (Programme Manager MSFF) China and North Korea, and that winter the river was dry. If and Marcel. Pierre was mad at shim because our dossier was there’d been a famine, nothing would have stopped people ill prepared; it was missing sufficient solid elements to sup- from crossing, everyone would have done it. But this border port the circulation of such information. I remember some was heavily controlled by the military. People always move really heated discussions. when they’re hungry, whatever the context.

Marine Buissonnière, administrator, MSF France in Paris always said that it was not aware of Marcel’s inten- China, December 1996 to January 1999 (in French). tions. But I’ve worked with MSF for long enough to know that at least a few people knew about it. Marcel wasn’t mad enough to do something like that on his own; he must have had the back up of Pécoul [Bernard, General Director of MSF France] or someone else. It was once again an article Things continued with Marcel Roux, the head of mis- aiming to shock without being capable of proving anything. sion for MSF France in China. We often talked about North Korean refugees who crossed the border with William Claus, MSF Belgium programme manager, China. Marcel went to the border, and on his return, there (in French). was an article in The South China Morning Post, a Chinese newspaper published in English, which talked about the diversion of humanitarian aid and cannibalism. This didn’t help relations with the authorities, which were getting worse and worse. They’d questioned some refugees and a Buddhist Marcel was in China, so he was interested in Korea. organisation looking after Koreans who’d slipped across the He and his team had a lot of freedom in their work. Chinese border. A whole dossier had been built up from We were questioning MSF’s presence in North Korea. these witness accounts. Amongst others, these refugees said We were wondering what was going on in the country. Marcel there was cannibalism in North Korea. There were interviews was convinced that what we were seeing was not what was with some 40 refugees. Can this be extrapolated across an actually happening and he started digging for information entire country? They couldn’t be tallied up with anyone or on the border. I can’t put a date on it, but he said to us: anything. They only took the opinion of one side. And as for ‘You’re kidding yourselves, it’s the worst regime in existence, cannibalism, it completely contradicts Korean culture. the criteria used to select people receiving food are not what Nobody knew about releasing this dossier to the press and it caused a real stink in Paris and Brussels. There were several articles on North Korea every year. Stories of refugees 7. Actually, from the beginning, the MSF team had difficulties to work with the Buddhist organisations and coordinated mainly with the Protestant network. Thus, and cannibalism, which the Buddhists had already had the refugees they interviewed were not the same as those interviewed by the 94 published in the South China Morning Post a few months Buddhists. There’s atendency tofunctionasfollows:‘Wehaveanidea Latin country, intention ismoreimportant than discipline. I oftenhavetheimpression that inFrance,atraditionally this account. It can’t be denied. But Idon’t know for sure. cruelly. It’spossiblethathedrawparticularattentionto to drawpeople’sattentionbysayingthingssimplyand ing ahorrifyingsituation.Andhe’sknownforhiscapacity media jumpedonthispointatthetime.Marcelwasdepict- again fromotherrefugees I met. Certain elementsofthe witness accounts, which referred to cannibalism. I heard it on thispoint…that’sanotherissue.Therewasoneofthe a bittoofaronthecannibalism,andthatpressjumped Marcel didn’tactalone.Weallagreed.Afterwards,hewent rich discussions,leadbyMarcel,whowasasfeistyever. this methodhasitsusesattimes.Irememberaperiodof a full-frontalapproachtohiswork...buthavingsaidthat, effect, insideandoutside.Theproblemwasthathehadsuch of communicating or the necessity of having this mirror went aboutit.Buttherewasneverdisagreementontheidea information. OfcourseIhadsomerowswithhimonhowhe agreed withMarcelfromtheoutsetthatheshoulddigfor external pointofviewtohelpuskeepperspective.Andwe that whenwe’rebusyinsideacountry,wealsoneedan to theborder,wehadalreadyformedanidea.Butknow you think.’ And it was confirmed. I think that before hisvisit believe us? holding rehearsalsandasking ourselves:aretheygoingto witness, wehavetoprepare things asifit’sastageshow, about things-it’sdangerous.Ithinkthatbeforebearing in China,eatingyournoodleseveryeveningandthinking Hysteria’s OKwhenyou’veseenityourself.Butyou’re as hystericalandanti-communist,it’sjustnotcredible. witness isalsoabouttellingastoryandwhenitcomesacross I wasconvincedthatotherpeoplesharedmydoubts.Bearing well. ButIfoundthisdeclarationonNorthKoreapointless. because I’doftendeliveredargumentsthatdidn’tgodown I feltprettyateasemakingpersonnelchoicestimes courage thatwecouldspeakout,holdunpopularpositions. think we’ddemonstratedoftenenoughthatwehadpolitical doesn’t standuptotests.Weknowwhowe’retargeting.’I with thedifferentsectionswhenteamheresaid:‘It information, Iwouldn’tbelieveit.’Weoftenhad friction a journalistatmyprogrammemanagerandIreceivedthis refused. Isaidtothem:‘Itdoesn’tcutthemustard.Ifwas game. If there’switnessing, you have to passiton.’I they saidtous:‘You’recensoring,you’renotplayingthe to thisreport.TherewastensionwithMSFFrancebecause T credible. I admitthat didn’t want to draw attention things downabit.Ididn’tfindMarcel’sdeclaration from October 1997 on,thenMSF France Executive his storybrokeinAsia.Theycalledus.Wecalmed Pierre Salignon, MSFFrance programme manager, Director from January 2004 on

sense in relation toourmission.’ ing totheirlives.Butitdoesn’tnecessarilymakeany totalitarianism continuestoexistbecauseitgivesmean- this story.Somepeoplearesohappythatevilcommunist about myrefusal,Isaid:‘Doasyoulike.Butdon’tbelieve the plotabit.Sowhenpeople in MSFgavemeahardtime prove theexistenceofevilsowehaveatendencytoloose MSF, weattractenormousnumbersofpeoplewhowantto people haveaproblemofproofwithregardstoevil.In of socialism,theexperiencessocialists.Icanseewhich evil linkedtopoliticalissues.Theyarethesetup issue. I know about the neurosis concerning revelations of I can’thelpthinkingthatthere’salotofneurosisonthis to the crimes being carried out ona daily basis. totalitarian regime,asifallhumanitarianagenciesareblind North Korea. As if no one was aware that North Korea is a certain peoplehaveverymessianicpositionswithregardsto we havealarmingfactualelements.AndthenIthinkthat have toproof,andinitsabsenceweshowthat the RwandanrefugeesinZaire1996. cerned that a situation will deteriorate, as wasthe case for when youhavetangibleprooforyou’rereallycon- and we look for proof to support it.’ This is acceptable Laurence Binet–Médecins SansFrontières(August2004). 8. See“Huntingand Killings ofRwandanRefugeesinZaïre-Congo 1996-1997,” could beissued. regard totheauthorities(meaning thearmy)sovisas -The FDRChasgivenitssupport todirectors’visitswith politics. Here’s theessence of theirmessage: cake -butBiberson’sarticle,whichquestionsthecountry’s so muchRoux’sfoolishness-that’sjusttheicingon noon (Saturday).Infacttherealboneofcontentionisnot met MrLee,theActingDirectorofFDRC,thisafter - Here’s thelatestnews in theMSFDPRK and FDRCsaga. I Extract: a nutritional survey. and ECHO were negotiating authorisation to implement tives inNorthKorea.Atthesametime,WFP,UNICEF MSF, whichwascopiedtotheEUandUNrepresenta- the coordinator.TheyalsosentaletteronApril24to their disagreementwiththeMSFstatementsdirectlyto In Pyongyang,theNorthKoreanauthoritiesexpressed D108 programme manager,19April,1998(inFrench). MSF NorthKoreatoWilliamClaus,Belgium Email Anne-Marie Huby, Executive Director, MSF UK from Marie-RosePecchio,HeadofMission 8 ButIthinkthatwe (inFrench).

95 MSF and North Korea 1995-1998 MSF Speaks Out

-Every time someone from headquarters has visited, there time. I received a letter, which is attached to this fax. are subsequent press releases that attack the regime. Eric, -It’s not addressed to me because the errors in question Philippe. come from outside the country. -The FDRC is in a very uncomfortable position and doesn’t -If such things happen again, it could be catastrophic for know what decisions to take regarding MSF. MSF and for him personally. -The FDRC is well aware of the work accomplished for the -MSF has to take measures to ensure that such things do Korean population by MSF, but observes with regret all not happen again. the problems generated by the different directors. These -They are very positive with regards to MSF and hope that types of problems don’t happen with the directors of other our work will continue. At this stage I explained that if we organisations, NGOs or the UN. So why with MSF? had more access, this sort of incident could be avoided. -We’ve been able to do everything specified in our MoU. -It should be born in mind that this is the first time The nutritional survey was never included, so why ask for they’ve worked with humanitarian organisations and they it? need time to digest our requests and come up with posi- -The FDRC doesn’t really understand why MSF sends out tive responses. And that hostile forces use the press to political messages when we’re humanitarian workers. denigrate the country. -They’ll keep me posted about the decisions taken. End. So -That our good collaboration will continue in an attempt that’s how things stand. to satisfy our demands. -That they’re aware of the problems raised and they’ll try Re the nutritional survey, WFP + UNICEF + ECHO are in to respond if possible. the process of getting permission for one because it is -That it’s MSF’s directors who cause problems following included in their MOU. Michel of ECHO thinks it can be their visits to the country. carried out by the end of May, beginning of June. Let’s -In the future, until indicated otherwise, the hierarchical see. Whatever the case, it’s for the whole country and authorities refuse to issue visas to senior headquarters the NGOs present in the field will be associated with it. I staff. See my cc mail, sent this morning: it’s not just MSF, suppose you’ve guessed that your visa’s not looking good. all agencies are concerned. I explained that the people in Sorry, but given the current glacial atmosphere, I’m not headquarters are our bosses and they come to evaluate sure I’ll get it. You can scream and stamp your foot, it our work. won’t change a thing. I’d have liked you to come so you -The FDRC cannot push for visas at the moment. could feel the atmosphere with the authorities for your- - The next time that something like this happens, they self. Too bad … I read the minutes of the desk meeting won’t be able to stop us getting thrown out. End of meet- with great interest. So the French position wins, with their ing. “everything, right now, or we leave.” I think it’s time to get our bags ready for July because the way we intend to I continue to defend MSF’s position to the FDRC, other go about things with the authorities will get us nowhere. agencies present here and MSF’s teams. I’m setting things I’ve never felt such a division between headquarters and out this way because this message is internal. Following the field as I did when I read these minutes, especially this letter and my meeting, the MSF Hierarchy, as Patrick when Salignon’s seen how the authorities work here for calls it, can react in 2 ways: himself, and spoken to people in the field. Has MSF B -Either we scream with rage and decide that it’s inadmis- already merged with MSF F or is this just planned for the sible, blah blah blah. next general assembly? -Or we lie low because, in my opinion, we’ve got away with it lightly. This also conforms to my point of view that using strong-arm tactics, banging our fists on the table, wanting everything right away, will get us nowhere. We can easily obtain more access without figuring on a full Email from Marie-Rose Pecchio, coordinator, page of the Libération. If we want to continue trying to MSF DPRK to William Claus, MSF Belgium pro- do something in this country, we must choose the sec- gramme manager, 24 April, 1998 (in French). ond option this time. But it’s up to you because it’s the D109 hierarchy that decides. A final word, totally treacherous, I know, but I can’t help myself: I would like the decision Extract: to be taken by MSF B, who’s the leading section. If we I’ve just come out of a meeting with FDRC, which was ask the French’s opinion, such as I know them; they’re postponed 3 times. I was dealing with one of the acting capable of holding a press conference for denouncing such directors, amongst others. The main points were: an outrage … -This type of thing is regrettable for the FDRC who has to Marie Rose account to its hierarchical superiors. -The same authorities have pushed the FDRC to take serious measures on our account. -Thanks to the explanations given, the FDRC managed to reduce the sanctions. 96 -The dialogue with the hierarchical superiors lasted a long with youand we willnotkeepourdisagreement toour- there -together withMarie-Rose-andIsaid, ‘wedisagree have done.Irememberadiscussion withourcounterpart and thewaythatitwaspublished wasmorethanIwould will publicisethat.Butthewords thatPhilippehadused, and saidwellwearenotsatisfied withthesituationandwe so Iwasjustinbetween.had alsogonetotheauthorities - afterBibersonbutbeforeMSFwascalledtoexplainitself, were out. was real Dante stuff) and the next time it happened, we all consequences arising thereafter. repeated, then MSF would be held wholly responsible for and makesitclearthatincasesuchamatterwouldbe ing thereality.TheFDRCcallsMSF’sattentiontofact either slingingmudatusonthepretext of aidordistort- disasters, butshouldnotremainindifferenttoanyactof to ourpeople,intemporarydifficultiescausedbynatural humanitarian aidofferedbyinternationalorganizations the humanitarianprinciples.Weareappreciativeof to us,insteadofstandingitsaimproceedaidworkfrom est elementsfortheirdirtypoliticalpurposeofdoingharm ous apprehensionabouttheMSFbeingmisusedbydishon- Such beingthecase,FDRCcannotbutexpressitsseri- from our country. public health system this way and that, after his return the MSFBelgium,too,spokeofsomethingcontrarytoour December lastyear,MrEricGoemaere.GeneralDirectorof our countryandthedistributionworkofgoods-in-aid.In are notconsistentatallwiththepresentsituationof providing themwithsome ill-founded materials which papers fordefilingandthrowingmudatourcountryby the ugly purpose of some media including UK and French try lastMarch,andtheMSFteammembersinChinaserved of theMSF-France,whoreturnedfromavisittoourcoun- It hasbeenreportedthatMr.PhilippeBiberson-President Extract: selves bemanipulatedbythereactionarypress(it we receivedalettersayingthatwerelettingour- They didn’twanttoseeusforawholeweek.Then ing there toexplainwhyMSFhadmadesuchanaccus- And indeed, November 1997 toSeptember 1998 (inFrench). 24 April 1998 (inEnglish). Korea toMédecinsSansFrontières, Pyongyang Committee, DemocraticPeople’sRepublicof Letter statement. I went there also shortly afterwards Marie-Rose Pecchio, CoordinatorDPRK, from theFloodDamageRehabilitation

Marie-Rose wascalledbytheauthorities D110

continue. side, ledtothedecisionthatMSFwouldnotbeallowed that Philippehadchosen,triggeredmorecriticismfromtheir their side.Butthen-thisismyunderstandingthewords - okthat’syourdecision.’Thatwasakindreactionfrom selves.’ Andtheysaidontheirside,‘well,wedon’tlikethat centres 9-27. tres andmakesomeprogresswithaccessingthechildrenin they couldgainsomeworkingspaceinthenutritionalcen- particularly at a time when Marie-Rose and Dominique felt Koreans riskedendangeringMSF’spresenceinNorthKorea, presentation ofthesituationasdescribedtousbyNorth North Koreaatrisk.ForMarie-Rose,ourstatementsand mad andwewereputtingMSF’spossibilityofworkingin phoned Marcel.Shewasfurious,tellinghimthathe coordinating theMSFteaminNorthKoreaattime,tele- create adramawithinMSF.Marie-RosePecchio,whowas depth work with the refugees. On the other hand, it did our capacitytoreturntheborderandcarryoutmorein- have anyrepercussions on eithertheChinese programme or choice ofwordsbeingemployedatthetime.Thisdidn’t come unstuckoverouroperationaldemands,notthe circles –orinChina.NegotiationswithNorthKoreahad eyes’ we’d always been killjoys about running around in anyway. the pressreleasesbutmaybe itwouldhavegonewrong enced thefutureofproject.Ithoughtitwasbecause also togetBelgiumandFranceononeline.Ithasinflu - management teamwentintorestoringthisrelationshipand these statements,butIsawhowmuchenergyfromthe me inthefieldbecausewedidn’tknowwerehaving press statementsharmedthecooperation.Anditwasnotfor offices. Ithinkthetrusthasbeendamaged.that with theFDRC,repairingwhathadbeenbrokenbyhead and inmymemory,themanagementteamwasonlybusy Dr. Corien Swann, physician, MSF Programme in DPRK, China, December 1996 toJanuary 1999 (in French). North Korea-evenifintheKoreanauthorities consequences, eitherinoperationaltermsforMSF I don’tthinkthisperiodoftensionhadanydirect had tonegotiateanewMoU,seehowgoon, very negative for us on the field. In June/July we The influenceofthosecontactswiththepresswere Marine Buissonnière, administrator, MSF France in Pim DeGraaf, MSF Holland Director of Operations January to September1998 (in English). (in English).

97 MSF and North Korea 1995-1998 MSF Speaks Out

In New York, the MSF USA team intensified its efforts I get any feedback of such meetings in Europe or in NK? to explain the MSF position to the United Nations, 5. NK is an extremely sensitive issue among my US NGO the US Congress, the US State department and the colleagues, can I get some quick feedback from our field American NGOs. team members on their perception of the US NGOs’ work in NK. 6. Any advocacy campaign developed in the States at different levels of the Administration and the Congress “North Korea Working Group Meeting, Washington should be coupled to similar work in Europe. Refugees D.C, April 23, 1998,” Message from Antoine International is pleased to address a letter of concern to Gérard, MSF USA Programme Officer to MSF Tony Hall, who can easily address it to Madeleine Albright. North Korea network, 5 May 1998 (in English). But it will be more significant if we can have some similar D111 actions taken in Europe (Letter to Ema Bonino, to WFP etc.). Extract: 7. I don’t share at all the view of my US colleagues that I- InterAction Meeting: the North Korean authorities have no western culture MSF USA has been requested to provide information therefore they can’t fulfil and understand the require- regarding the testimonies collected among the refugees at ments of the International NGOs as MSF. Believe me or the Chinese-North Korean border. I clarified our position not, Ambassador Kim Su Man of FDRC has a better under- and the concern we have about the situation in the coun- standing of American policy and culture that many of us try. Then I provided some information on MSF activity in at MSF. We should not cultivate the naive idea, which North Korea and the conclusions of the latest visit of the is shared among US NGO rep. and more UN agency rep. desk and the President. As comments, some US organiza- that we should give time to the North Korean authori- tions expressed their wishes to operate in NK and are not ties to understand the Western requirements of action favourable on speaking out about the difficulties the NGOs for implementing relief program for the NK population. It are facing in term of monitoring their activities. is amazing that FDRC, which is the negotiating body for the NGOs, is pretending not to have control of the North The US organizations have been questioning MSF in Korean decision making process... It reminds of me when term of financial independence in NK. Some of the rep. I was in Khartoum (Sudan) and we had to swing between expressed strongly that MSF may have a need now to re- the different Sudanese relief governmental departments assess its activities knowing that European Union wishes and Ministry of Health officers... This is an old strategy to reduce it support to the International NGOs involved in and MSF has a long experience of such Governmental-No- NK. (I wasn’t aware of the EU NGO financing policy in NK, I Decision-Taking-Bodies... End stated that MSF has enough financial independence to run programs with or without the support of any donors...).

InterAction and Mercy Corps expressed their concern on the lack of coordination among International NGOs, spe- Pierre and above all Philippe wanted me to get on cifically when concerns expressed on the operational dif- top of the North Korea dossier as soon as possible. ficulties. “MSF is free to re assess its program but should They asked me to take part in the Paris board of coordinate with the others, should associate its efforts to directors’ meeting in March so I could start working on the the others.” issue in the United States. I remember that Pierre gave his presentation and Maurice [Nègre, member of MSF France’s […] III- Reception at the Congress Hunger Center board of directors] said to him: ‘a communist regime is Congressman Tony Hall organized a welcome drink for the always a communist regime; you’re not saying anything FDRC delegation. It was a chance to raise some concerns new. We didn’t need to go there to discover all this.’ I to a congressman on the negative effects of large uncon- started raising North Korea during American NGO meetings trolled unmonitored food aid to NK. Some further contact in April. They were attended by a certain Deborah Deyang, will be developed with this congressman. Tony Halls’ assistant. I said to them: ‘we’re carrying out an evaluation in MSF at the moment. We have the impression IV- Questions and Suggestions: Briefly, I would like to that access to the population doesn’t exist. We’re in a share with you some points. phase of renegotiation with the Korean government. We’ve 1. What is MSF position towards the nutritional assess- set down a number of demands. If they’re not taken into ment, which should take place in the coming weeks by account, we’ll start pulling out.’ Tony Hall and his assistant WFP/UNICEF and EU? were livid at the idea of us upsetting the apple cart. 2. How far MSF is independent financially from ECHO? Is there any plan of action to diverse our funds? Antoine Gérard, Head of Programmes Department, 3. Should we rely on gov. funds for such a country, due to MSF USA (in French). the heavily interests of the major donors? 4. Did we develop a strong advocacy to the different UN 98 agencies involved in NK as UNICEF and WFP? If yes, can (Marcel Roux) Exploratory missiontotheChinese/NorthKoreanborder Extract: or electricity...The socialviolenceisextreme. Peoplekillto al aid.Peopledon’tfarm,there arenoseedsleft,fuel given upallhope,andknownothing ofalltheinternation- the reflextorevolt,complain orevenspeakout.They’ve rest oftheworldisinsame boat.Sotheydon’thave population initsclutches.The Koreansbelievethatthe pushing itsbeliefstothelimit whilstholdingahelpless tion istrappedwithnopossibilitiesofescape.Likeasect a majorcrisis:it’smadcountry,closedoff.Thepopula - they containconfirmsthatNorthKoreahasfallenvictimto journalist) hasbeenforwardedtoParis.Theinformation A collectionoftestimoniesdrawnupbyJasperBecker(a of cannibalism…Thesituationisappalling,acatastrophe. are takingtotheroads;apparentlytherefrequentcases hospitals areempty.Familyunitshavecollapsed,people are completely unaffordable, no access to healthcare: the from disease,hunger,etc.),noaccesstomedicineswhich where (allthepeoplequestionedhadlostfamilymembers: distribution for at least three years; people dying every- probably only serves to bolster those in power: no food secret. Humanitarianaiddoesn’treachthepopulationand mental famine going on, which has been kept completely description ofthesituation.There’sprobablyamonu- All thewitnessaccountscoincidedintheirnightmarish - North Korean refugees, etc. - Chineseliving on theborder. ily in Korea). - MembersofKoreanminoritieslivinginChina(withfam years. - Religiousnetworksactiveintheregionforlast2 Korean refugeesinthenortheasternprovincesofChina: collect some testimonies from people involved with North with andtreatpeople…Amonthago,Marcelmanagedto al, noaccesstothepopulation,impossiblecommunicate work inthismission:onlydeliveringmedicinesandmateri- B andPierresharedtheirdoubtsaboutthequalityofMSF’s Following theirvisittoNorthKoreaamonthago,Philippe pressure on theauthorities. the otherhumanitarianplayersinordertoincrease raised bytherefugees’testimonies,andactivelylobby Korea, supportthefieldteam,followupissue and decidedthatMSFwoulddoitsbesttostayinNorth On 29April1998,theMSFProgrammeManagersmet speak out. Korea, theboardconcludedthatMSFshouldstayand debate abouttherelevanceofMSFoperationsinNorth border totheMSFFranceboard.Afteranextensive reported onhismissiontotheChina-NorthKorea On 24April1998,theMSFFrancecoordinatorinChina 24 April Minutes ofMSFFrance’sBoardMeeting, 1998 (inFrench). D112

depends ona distribution system,sowecan easilyimag- the population sufferingtheconsequences. Thecountry across theboardwithatotal collapseoftheeconomyand For PhilippeB,it’smorethan justafamine;it’sshortage The collapse of apolitical system The North Koreans are undoubtedly in serious difficulties. etrable duringexternalvisits andhidehugecatastrophes. become malnourished!Totalitarianregimescanbeimpen - a nutritionalsurveytoprovethatifpeopleeatless,they the WFP’sproblem,forexample,whenithastocarryout shouldn’t succumbtoneedingmethodsforproof,whichis ity would be enormous. Jean-Hervé pointed out that we Korea. Ifnewsofthefaminegetsout,losscredibil - lions ofdollarsareinvestedinhumanitarianaidNorth not sharingalltheinformationithas.Hundredsofmil - to thegeneralpopulation.TheWorldFoodProgrammeis arrives inthecountry,itgoestothosepowerandnot tonnes of food a year. In any event, however much food ably insufficient,fallingshortofaround2.5to3million deaths fromstarvation.Theaidbeingdeliveredisprob- bottom linehaslongbeen:nofooddistributionandmany Such anevaluationcanonlybeempirical,saidMarcel.The sible, when we thinkabout it. (PhilippeB). to 4 to 5 million deaths in three years. It’s absolutely pos- camps) amountsto1.5milliondeathsayear.Thiscomes A mortalityof2/10,000/day(alertthresholdforrefugee per 10,000 per year amounts to around 500,000 deaths. to saythatfor23millioninhabitants,amortalityof20 come up with percentages. But it is nonetheless possible coincide intermsoftimeandgeography.It’sdifficultto measure thedevelopments.Mostofwitnessaccounts if wecouldestablishsomequantitativebenchmarksand mate thenumberofpeoplehidingthere.Odysséasasked border isthicklywooded,makingitimpossibletoesti- and childrencanbebought…TheChinesesideofthe offered tothosedenouncingclandestinearrivals.Women caught takingtheminarepunishedwithfines.Abonusis are oftenpickedupbytheNorthKoreans.AnyChinese months oftheyear.Peopleattemptingtocrossborder and China?It’saSiberianregioncoldforatleast8 What’s the situation on the border between North Korea a complete nightmare. food. Butaround50%ofthepopulationarelivingthrough and demonstrateaccesstohealthcare,medication, are usedtomountthe‘setups’savenation’sface live decently.Thesystemissoperversethatthesepeople replied thatprobablyonly15to20%ofthepopulation the populationarestrugglingmorethanothers.Marcel definitely moreaffectedthanothers,andsomelayersof production, no more commerce, but some regions are with everythingMarcelsaid.It’struethatthere’snomore set upwithamasterlytouch,hestillcouldn’tgoalong North Korea,anddespitehisfeelingthateverythingwas Philippe B.pointedoutthatafterspending10daysin Is this picture over-dramatised? have probablybeenbetween 1 and3million deaths… sion onlyconfirmedwhatothershavealreadysaid.There represent food…).Marcelthinksthattheexploratorymis- steal. Thepopulation’sgoingmad.Childrenarekilled(they

99 MSF and North Korea 1995-1998 MSF Speaks Out

ine how serious the situation becomes if this distribution - Send a new mission to SOUTHERN CHINA and/or stops… The regime is worn-out, absurd, and starving its VLADIVOSTOK for the collection of more recent accounts people. Why does the international community give it to increase the credibility of the existing accounts and such support? For Jean-Hervé, the real issue is why the for crosschecking with access/or not to international aid. European community and the United States support this - At the same time, in North Korea, try and regroup the dictatorship. The subject seems ultra-sensitive politically. data in an attempt to draw up a ‘humanitarian aid’ map The issues at stake: which gives us clear answers on WHERE, SINCE WHEN and -Collective security, with regard to the nuclear question. HOW MUCH aid has been distributed. -Economic security, with regard to the economic collapse - Active lobbying with other humanitarian actors: ECHO/ in Asia and particularly South Korea. WFP/UNICEF/ICRC/MDM/ACF /OXFAM; contacts, sharing China, South Korea and Japan are the main providers our reflections, enhancing mutual experiences, etc. with of humanitarian aid to North Korea. They circulate no the aim of increasing pressure on the authorities in terms information on the situation in the country and we can of access. Avoid taking all these steps/witnessing alone. imagine that they don’t want their Korean brothers to - At communications level: put reigns on Marcel regard- loose face. Everything is done to avoid the regime col- ing all declarations/communications linked to his ‘report’; lapsing and a move towards the catastrophic scenario of if there’s any sort of info or important event, obligatory reunification. China is obviously keen to avoid millions of agreement required from headquarters and field for all refugees pouring over its borders. What position should decisions on communications. MSF take in all this? For Jean-Hervé the decision is vital. - Marcel and Marie-Rose to meet in Beijing before MSF F’s We should not get it wrong tonight during the board of coordinators’ week to go over things. directors’ meeting. Everyone agrees that it is impossible to continue like this, with no control over what we do. MSF should remain in the country and speak out. This is the most powerful strategy (Jean-Hervé, Marc, etc.). We Email from Pierre Salignon, MSF France should say that we don’t have access to information and Programme Manager to Marie-Christine Ferrir, we can’t do our work (Christiane). After some resistance, Director of Operations MSF Belgium, 30 April doubts and the normal questioning, MSF France, Holland, 1998 (in French). D114 and Belgium all agreed on the evaluation of the situation (Pierre). Why not ask for an enquiry commission at the Extract: UN? (Odile)? Would it be useful to speak to a group of On the USA side, Antoine Gérard […] will write up an deputies or senators and encourage journalistic enquiries overview during the next few days of all the meetings he’s in the field (Jean-Luc)? Philippe B and Jean-Hervé think had with the UN (UNDP, UNICEF, WFP), US NGOs, people it should be possible to ask for a team of journalists to from Congress and the State department. He’s done a accompany us for a visit. great job of lobbying and explaining MSF’s position/the questions we’re asking ourselves. Conclusion: MSF will stay in North Korea and speak out. We have every On the FDRC side, do you agree that we should reply to the reason to fight against the Korean authorities and those letter received last week? Not for throwing another punch who support them. Our presence would be harmful if we but for re-stating the urgency of discussing our future kept silent, pretending that our aid was effective. We will collaboration after July ‘98 on the following principles: say – in full knowledge of the cause – that we’ve reached reducing the distribution of medicines, access to the an impasse. population, freedom to evaluate, targeting our actions. We could take the opportunity to insist on the importance of William’s visa (or someone else’s if he’s not available). This letter would not prevent Marie-Rose from having dis- ”Summary Conclusions North Korea Meeting,” cussions with the authorities as of now on the problems Email from Patrick de Briey, MSF Belgium encountered by the teams and MSF doctors having access Programme Manager, to Programme Managers to people’s homes and accompanying local doctors dur- and operations directors of MSF Belgium, MSF ing their home visits. On the Chinese border front, you France and MSF Holland, 30 April 1998 (in went over this yesterday and Marcel explained the cau- French). D113 tion required for follow up. If I’ve understood properly, we agree to go further in depth in our reflections on the Extract: subject, returning to the border to collect recent testimo- Conclusions: nies and matching the information up with data from the - MSF is in North Korea and doesn’t want to get expelled; field teams in North Korea (I’ll look at the dossier Marcel this should be born in mind at all times. brought back with him. There’s a detailed map of where - Give active support to teams in the field: to be provided the refugees come from that I’ll send to you ASAP). through increased transparency, circulation of all info. - Carry out deeper investigations of the issues raised by Could you let me know if you agree with all this? […] 100 the witness accounts collected in China. Last point: I’m working with François Jean to establish terms of referencefor this mission. right andproper way.Forus,itisimportant tohaveclear else who will havethe right competences to doitina - Wearesurethattheheadquarters canfindsomebody North Korea mission. North Korea.Hewillbethe ‘SwordofDamocles’forthe China andbethereferralperson forthejournalistsabout - Wedon’tunderstandhowheisallowedtogobackin and solitary. - Wedon’ttrust,atallhispromise.Heactsout-of-control return. will go.Wedon’tthinkhebeabletoshutupathis - The journalistsknow him and they will know when he want to prove hewas right. the bigmessafterhispreviousmissionbecausehewill - Webelievethathecannotbeobjectiveanymoreafter THIS NEW ASSESSMENT. 4. WE WILL NEVER AGREE THAT MARCEL ROUX WILL DO we, asMSF should dothis assessment. not suppliedbyus.Weneedtohaveclearobjectiveswhy, not responsibleforinvestigationthe‘re-routing’ofgoods work, infourprovinces,notattheborder.Second,weare responsible fortémoignageintheareas/fieldwherewe the fieldandnofooddistribution.[…]Firstofall,weare interesting, nodoubt.Wearedoingdrugsdistributionon 3. Wecanagreewithanewassessment on theborder, it is regret its decision. authorities, ...)itisuptoMSFF.WehopeFwillnot destruction of months of building good relations with the see thepoint(norespectofinternationalMSFrules, of MSFFtokeephimasamember.Ifdoesn’t 2. MarcelRoux:weunderstoodthatithasbeenadecision discussion. For the others, they havebeen discussed. the samelocally.Thisfirstpointhasbeenagreedwithout have informationaboutwhatwillbetold,toablesay - Activelobbyingwith ECHO-WFP-UNICEF- [...] We ask to too much on theoperationsin the field. quarters. We hope these are solved because they interfere with that.Itseemsthereareonlyproblemsbetweenhead - The international mission. We have no problems at all 1. Weagree completely with thedecisions taken about: Patrick de Briey. meeting M. Roux, E. Goemaere, P. Biberson, M.C. Ferrir, points, wediscussedabouttheresolutionstaken,after We hadateammeeting,thisSunday,whereamongothers Extract: explored in Parisnext week. I’llkeep you informed. context etc.Therearesomecontactsandavenuestobe Korea inordertoobtainmoreinformationonthecurrent contacts with academics and others familiar with North er, 4May 1998 (inEnglish). Pyongyang toMSFBelgiumprogrammemanag- “The Voice of the Field,” D115 Email from MSF proactive and document it. totalitarian regimeandweknewthathadtobemore a feelingforhowtheassistancesystemoperatedinthis these thingsatalaterstage,butwe’dalreadystartedtoget political loyalty.Wewouldbuildaclearerunderstandingof against thepopulationaccordingtoitssocialutilityand through thepublicdistributionsystem,whichdiscriminates ing toclassandthechannellingofinternationalassistance the country.Meaninghowassistanceisdistributedaccord- refugee accountsregardingtheorganisationofassistancein we also needed to study the information gathered from country andwhatourteamwassayingfromwithinit,but the discrepancies between statements collected outside the going oninNorthKorea.Obviouslyweneededtolookinto my translator also gotabitenthusiasticand shestarted you saywhenthey aregiven?? In my third orfourth month, Then thenextphasecame;ok thedrugsaregonebutcan we checkedhowtheywereused, howtheywereprescribed. were storedinadryplace,and then,inthesecondphase pharmacy, firsttoseehowthe drugswerestored,ifthey that manypatients.Sowestarted checkingthingsinthe by everybody. that thedecisionstakenatthismeetingwillbefollowed chance. This has been made very clear to us. We hope have somemomentsofpersonalglorythatwegotourlast to succeed.Wewantremindeverybodywhowants the wayofMSFrules.Wewillonlytry.arenotsure it isfinishednow.Wewanttotrydosomework,in releases, interviews,fightingsandinsults.[...]Wehope sion isabig‘bordel’.Visitsofpresident,desks,press In conclusion,wecantellthatsince2months,thismis- want to trust that... parency andtransmissionofinformationtothefield.We 5. Weactonthewill,fromH.Q.,andtrans- drugs in case ofapossible MSF withdrawal. out thattheNorthKoreandoctorsweresavingthese MSF werebeingusedtotreatthepatients.Theyfigured more evidencethatnotallofthedrugsprovidedby At that time, some members of the MSF team received China, December 1996 toJanuary 1999 (in French). explore andimproveourunderstandingofwhatwas a visitbyFrançois[Jean],whichwouldallowusto We started spreading the net. We wanted to prepare lot ofcountries!Butontheotherhandwedidn’tsee used. It’snotonlytypicalforNorthKoreabuta When we arrived, the drugs were always all gone, all Marine Buissonnière, administrator, MSF France in 101 MSF and North Korea 1995-1998 MSF Speaks Out

also checking things and she said: ‘Corien, it’s not true, it always ended up seeing them. We never saw medicines can’t be.’ I was already thinking that, but after three being given to the army. Things were very clear in that months I also got [motivated] her on the job! Which was a respect. The message denouncing the diversion of humani- bit funny because there isn’t much trust, everything is fil- tarian aid was sometimes issued outside the country – it tered, her reaction should be filtered as well. She was pro- became the diversion of humanitarian aid – but we never ideology, and she was perfect example of a daughter of really talked about the diversion of medicines, because this Kim-Il-Sung. When I heard her translate, ‘where are the was never proven. Once we’d gone, who knows if these drugs?’ I could also hear in her voice, ‘how can it be like medicines were put to bad use? But whilst we were there, that?’ we were strict on the issue, which meant that we almost always knew where they were. In the fourth or fifth month, they started saying in the pharmacy that they had saved a bit, so I said, ‘ok, it’s not Dominique Lafontaine, physician, MSF programme in a big problem, we just have to be informed for ordering DPRK, August 1997 to September 1998 (in French). new drugs.’ To keep a good relationship, we weren’t crosschecking everything because we would have problems then, it would spoil your relationships. It was not easy for them to explain because it wasn’t something they were proud of. They said that they hadn’t had drugs for a long time and In May 1998, the WFP team started to organize a that they just wanted to save them because they didn’t nutritional survey in North Korea together with UNICEF know how long MSF would stay, how the supplies would go and ECHO. No NGO was involved in this project and the on. I could only imagine. I could understand them. Herbert, target population of the survey was chosen so that it my predecessor, wrote that when he arrived there wasn’t could justify the WFP programme. On 19 May the WFP anything in the hospital. They were built 30 or 40 years programme director announced that the agency would before and everything was re-used and re-used. There were cut its aid to North Korea because it had no access to no bandages; everything was old and broken but re-fixed. the entire country. And suddenly, they received 50 boxes of medicines. It’s just a normal attitude after 30 or 40 of having nothing, and re-using, and re-using. You don’t start using everything; you store it and start little by little using it. That’s what “Nutritional Survey in the DPRK,” Email from my predecessor had told me, ‘they’re using only tiny bits at Sonia de Meyere, MSF DPRK, to MSF Belgium, the time.’ You have to say, ‘please use it, it’s for the people France and Holland Programme Managers, 11 here. If they have pneumonia use the entire antibiotic May 1998 (in English). D116 course and don’t stop after two days because they are feeling better, we will re supply.’ So we really had to push them Extract: to use but it was very understandable. When given so many The WFP nutritionist called for a meeting with all the boxes, of course they’d want to keep them! NGO’s present in the country to discuss this draft protocol, as they have no experience with nutritional surveys and But the other part was that I was not able to be a real pri- have little information about what is happening in the vate investigator to count all the boxes and compare with field. what was missing. And I couldn’t be sure that boxes that were there today were not transported that evening to the Collaboration with the NGO’s: next county. And at the end, they were right, we stopped in It was an agreement with the government to conduct this August, there was no re-supply after August. But easily the survey with 3 organisations: UNICEF, WFP and ECHO, no ministries in Pyongyang could have said, ‘ok, these boxes, other agencies will be allowed to assist in the data col- tomorrow they go to the military.’ Yes, there was a conflict lection in the field, they will maybe discuss if the other of interest. UN agencies (WHO and FAO) can participate, but the government wants as few foreigners as possible involved Dr. Corien Swan, Physician, MSF North DPRK, in this, the expatriates will even not be allowed to weigh January to August 1998 (in English). or measure, this will be done by people from the ICN (Institute for Child Nutrition ), the expatriate is allowed to record the data. Input from the NGO’s: to discuss about the protocol, to obtain practical information about health structures in the counties. Week after week, relations were increasingly straightforward and direct. There were a few issues with Timetable: hidden medicines from time to time. Medicines were June is the month!!! Collection of data is expected to be diverted. But I’ve always maintained that even if the medi- done the second half of June, the analysis beginning of cines weren’t used where we wanted them to be used, they July, however negotiations with the government might were in a room next door. If we insisted, saying that we take some time especially where the household visits 102 wouldn’t leave without looking over the medicines, we come into the picture. second most important actor on thefield. nobody wasaware ofthelatesteventsand thisisthe call totheRedCrossFederation inGenevataughtmethat or position of the other actors involved in NK. A phone Another alarmingphenomenon isthattherenoreaction not involvedintheimplementation onthefielditself. up toUNagenciesmake nutsurveyswhentheyare another nut survey, which will be nonsense. It is not or influencethepoliticaldecisionmakerstoavoidthat must intensify our lobbying strategy and try to convince discussed duringthelastinter-deskmeeting.Ithinkwe less foreseenandisgoingtoblockourstrategyasitwas the plannednutritionalsurvey.Thisscenariowasmoreor I hope everybody saw the message from Sonja concerning Extract: interpret the results. * Tobeawareoftheirmethodologytoablelater * Totry at leastto have areasonable draft protocol. gathering meeting is: - Theimportanceforustobepresentattheirinformation- go onwith the authoritiesto obtain access at random. - Itwillbeveryinterestingtoseehowthediscussions survey. - It is rather clear that we will not participate in this Remarks: Saturday). update thisFriday(thenutritionistleavesthecountryon Conclusion: thedraftwillberewritten;wegetan pitals or at home? bias ofthechildrennotpresentatschoolbutinhos- form couldincludethedataneeded).-Howtoavoid - How to select pregnant women? (The food monitoring not accessible because ofsecurity. - Choose counties at random when about 20% of them are resolve: has beendonebeforewillnotberepeated.Problems to They allagreethatascreening of 4,000children as At random survey: pling expert will beasked for. under five should also be included in the survey, a sam- this needstobejustified.Itwasfinallyagreedthatthe lactating women,thesearenewtargetgroupsforthem, tion forthechildreninprimaryschools,pregnant,and would liketohaveajustificationfortheirfooddistribu- survey? ThisquestionclarifiedtheobjectiveofWFP:they fives wouldbealmostexcluded,sowhereisthenutritional included inthissurvey,followingprotocoltheunder A lotofdiscussionsaboutthegroupchildrentobe Target population: English). and toMSFPyongyang,19May1998(in France andMSFHollandProgrammeManagers Claus, MSFBelgiumProgrammeManagerto “ The NutritionalSurvey,” D117 Email fromWilliam agreed uponduring the lastmeeting). which areactiveonthefield(wecanuselistaswe Therefore, Iproposethatwecontacttheorganisations, get aclearpictureofthehealthstatuspopulation. and the importance of having access to the population to So theseareenoughreasonstore-explainourposition able to evaluate oneyear of TFCprogrammes. 5. ThepositionofMSFwillbeverydifficultifwearenot field. which isunacceptableastheyarethemainactorson implement asurvey.NGOsarecompletelyoutofthegame, 4. OnlyUNagenciesareallowedbythegovernmentto again abias on thechoiceof sample. done bytheKoreans.Soagain,noaccesstohouseholds, unacceptable isthatallthemeasuringonfieldwillbe 3. Themethodologyisunclearasitwasbeforebutwhat is illogical and mustbeavoided. action without knowing what was happening in the past 2. To use atool such asa nut survey to justify the next they will have abetter opinion orview on it. survey butbyusingtoolslikefoodbasketmonitoringthat angle forWFPtodoanevaluation.Itisnotthroughanut. tion ornot.Thisshouldbethefirst(andmostimportant) nobody hastheslightest idea iffoodreached the popula- sibility tothedistribution was correct or not.Untilnow questioned; is/wasthereafamineornotandiftheacces- beginning ofthisoperation,thewholeoperationwas 1. WFPisresponsibleforthefooddistribution. Since the What we have toproposeor to explain. North Korea. detail thechallenges anddilemmasmet byMSFin Assembly, thepresidentof MSFFrancereportedin On 16 May 1998, in his annual message to the General whom it was intended. not monitorwhether the foodwasreachingpeoplefor expressed concernaboutlackofaccessbecauseitcould cally sought to enter, Ms. Bertini said. The agency had and hasbeenrefusedentryto39countiesthatitspecifi - However, theagencyhasbeengrantedonlypartialaccess reasons, saidCatherineBertini,theprogram’sdirector. areas thatithaddesignatedasoff-limitsforsecurity based World Food Program into all 210 counties, including cials last monththat it would let workers with the Rome- said today.NorthKoreaassuredUnitedNationsreliefoffi- vide accesstotheentirecountry,program’sdirector to NorthKoreabecauseitrenegedonitspromisepro- The UnitedNationsWorldFoodProgramwillcutbackaid Extract: English). New YorkTimes(USA),19May1998(in “UN AgencytoCutNorthKoreaFoodAid,” D118 The 103 MSF and North Korea 1995-1998 MSF Speaks Out

For the first time, in 1995, the North Korean government called upon international aid, but fixed conditions whilst “President’s Annual Report,” Philippe Biberson, doing so: no evaluation of needs, no serious control over 16 May 1998 (in French). D119 the destination of aid, selection and drastic discipline demanded of aid organisations. No opening up, no ques- Extract: tioning of the system: a take it or leave it situation. Using North Korea a combination of persuasion, candour, high operational This mission poses several problems, and I will try to capacity and a volume of aid representing several million explain why. Famine or no famine? Since 1995, North ECUs, Médecins Sans Frontières managed to set up a mis- Korea has not been feeding all of its population. This is a sion in North Korea, supplying the majority of medicines fact. The collapse of its agricultural production combined and specialised food needed for four provinces. Which is with an end to the aid provided by ‘sympathetic countries’ remarkable in itself, but we know that if we do not try and has bought the country to its knees. Three years of natu- narrow the gap between our work and our intentions and ral disasters appear to have completed the catastrophe. place all this in context, we can go badly wrong. It should be borne in mind that, in the North Korean system, the State, the cooperative or a production unit, Several questions need to be asked: including in rural areas, feeds the population. People are 1. Does this aid save North Koreans or, rather, those dying clothed, lodged, educated, treated etc. in the same way. of starvation and deprivation? Ordinary North Koreans don’t have the option of produc- There are some real doubts. It saves a few, but we don’t ing anything for themselves, or building up reserves. They have the means to know how many. Without wanting to are subjected to central planning and are completely get into cost/efficiency considerations, as you know as dependant on what is redistributed. There is practically no well as I do that we are not too keen on applying this money in circulation and practically no market. criteria in humanitarian action, we nonetheless have to assume our responsibilities in this matter. How many Why draw attention to all its population? Because appar- deaths did we avoid in one year by providing aid evalu- ently, not everybody is suffering to the same degree. All ated at costing 50 million francs? It is currently impos- populations contain marked variations in the individual sible to reply to this question. In other words, we don’t capacity to resist deprivation and a lack of health care, know if this aid is loosening the famine’s stranglehold on and it is not really possible to specify which geographic those suffering from starvation or not. Moreover, because areas and categories of the population in North Korea are this aid does not give rise to questions on the cause of at risk. Yet considering that this system is supposed to be the disaster, we may be reinforcing the very system that equal, there are nonetheless some striking contradictions starves and enslaves a part of the population. between what we see when we are moving around inside the country and what is described in the witness state- 2. Is the aid delivered by Médecins Sans Frontières an ments collected from people who have escaped it. expression of solidarity and humanity with regards to - From our work on the inside, we can see the country is those suffering so unjustly? Despite the devotion of the in the grips of severe shortages but there are no indica- teams (and I want to be clear that they are not in questions of a classic famine: no people wandering about, no tion and deserve all our support), I regret to say that it bodies, no riots at distribution points etc. We come across is not, or at least not nearly enough. Because we are in a cases of malnutrition, often-serious ones, but only in the totalitarian country and because we are obliged to cover institutions we’re allowed to visit: hospitals, orphanages. areas and a number of facilities that do not allow us to The rest of the population seems to be going about its think otherwise. This was the government’s aim, of course: business. authorising us to spread out and distribute as much as - The testimonies collected in the area on the border possible without allowing us more than a few minutes with China, however, describe a nightmarish situation: contact with anybody anywhere. This aid is also an inad- decimated families, distributions stopped months ago – equate expression of our solidarity because until recently or even years ago – (and no traces of international aid), we haven’t known how to communicate in our own coun- streams of people moving around in search of food, people tries about the profound distress of the North Koreans and dying of starvation, cold, disease, cases of cannibalism, the nightmare their regime represents. And besides a few traffic in women and children, crowds gathering at train digs made by us and reciprocated by them, we haven’t stations, violence, repression and corruption. known how to show our indignation to the North Korean authorities either. As contradictory as these two images might seem, we believe that they nonetheless amount to two descriptions 3. Is the aid provided by Médecins Sans Frontières infring- of the same country, North Korea, and we’re talking about ing upon our standards of quality, which is just one way its inhabitants in both of them. Famine is difficult to quan- of showing the respect we have for others? It is, unfor- tify, but it is likely, if not certain, that food and general tunately, with its mass coverage, little errors, and the shortages are affecting a large number of North Koreans, approximations made here and there that are transformed has killed some of them and continues to kill them still. into massive waste and large-scale inadequacies. That is 104 What aid can we propose to the population of North Korea? how, if we are not extremely careful, a gesture of good ations thatrequire understanding–andthe openingof Sans Frontières, wedeliberatelyplaceourselves insitu- in asituationofwitnessing something.InMédecins est bystander,asifwehave accidentallyfoundourselves Médecins SansFrontières,it is notenoughtobeanhon- and heard, what should we do next? In the case of Once we have seen and heard all that we have seen disease. fight forimprovedaccesstothosedyingofstarvationand I amnotlookingtohaveusexpelled,butwant the impressionthatwearenotaskingenoughquestions. are nothappywithit.Iremaincriticalaslonghave inspired theyhavebeenwhilstrunningit.However,we territory. AndIcanseehowintelligent,sensitiveand the explorerswhomappedoutthismissioninsuchhostile set footinNorthKorea.Onthecontrary,Icongratulate thinks thatMédecinsSansFrontièresshouldneverhave debate ratherthansetusapart.Iamnotoneofthosewho of theMédecinsSansFrontièresfamilytojoinusinthis that giveusrealcredibility,andIinviteothermembers tangible resultsyetbutwe’regettingstuckintotheissues I sayyes,andthat’swhatwe’vestartedtodo,withno 3. Totake a position? 2. Tobearwitnessonwhattheyseeandisbeensaid. 1. Toquestion and tryto understand. lated incertain contexts? Should theirrole not be: question nonetheless:istheworkofNGOsbeingmanipu- 5. OverandabovetheNorthKoreans,butanimportant so-called soft landing. is notpartofacoverupforslaughterinthenamethis ing.’ WehavetomakesurethatMédecinsSansFrontières prevention, andthispolicywouldbeknownasa‘softland- greater causecouldbecalledregionalstability,evencrisis subject, whateradication?InthecaseofNorthKorea,this according tocertainstrategies!Andwhileweareonthe worth thesacrificeofsometensthousandrefugees, called eradication of genocidal nests in Kivu was well We have seen this for ourselves in Eastern Zaire: the so- of leavingpeopletodieinthenamea‘greatercause.’ option, whilstcallingitselfhumanitarian,carriestherisk be explicit and held accountable. Why? Because such an sible onaninternationallevel.Butinthatcase,itshould in sendingaid.Andindeedperhapsnootherpolicyispos- that theresponsetothislastquestionresidesexclusively how can it be brought to an end? Everything indicates famine or no famine? On what scale? What caused it? And international aidgivenbystatestoanswerthequestion: compromise. There is a huge effortto make in terms of be insufficient)all the appearances of being a political give this massive aid effort (which paradoxically might their silenceandrenouncementofagreedprinciples Koreans tosuffer.Thatisobviouslynotthecase.But Which isnottosaythattheyaretheonescausingNorth to bemoreprecise,havearesponsibilityinallthis?Yes. 4. Doestheinternationalcommunity,oraidorganisations along, into a gestureofcondescension or even scorn. will canbetransformed,withvolumehelpingtheprocess Korea. Shewas wellawarethatshewould beparaded Ms Boninowondered whethershecould pay avisitto of aidproviders. problem andweareveryuncomfortable withthemererole of beingtheonlyonestrying tohaveaglobalviewofthe become thesubjectofderision. Wehavetheimpression MSF sections in securing a common position should not approach. Thedifficultiesencounteredbythedifferent to allorganisations.WerequestedECHO’ssupportforthis the Korean authorities. The same intimidation is applied proximity) onlygaverisetoaletterofintimidationfrom cerning theformofouraidinfuture(targetingand expelled, inaword).Ourpositionandpropositionscon - We presentedthefragilityofMSF’ssituation(riskbeing with slaughter. Concerns thatthismassiveaidco-existssimultaneously - Aidisdeliveredblindlyandcontrarytoallprinciples[…] ing withinformation.Pseudo‘openingup’,pseudoaccess. - Manipulationbytheauthorities:concealmentalternat the country and thoseonthe Chinese border. Contradictions exist between observations made inside - Theshortagesareprobablyreal,seriousandnotnew. our analysis: harvests; thefocusshouldbeonstructuralaid.Wegave The situation requires evaluationafterthe forthcoming seems to be over but ECHO needs to remain in the country. Korea. Themainpointsofthereportwere:famine (parliamentary pluscommission)hadjustreturnedfrom Mr Navarro,directorofECHO.AEuropeanUnionmission er someimportantpeopleforthemeeting,including Commission on the 25th May. She had gathered togeth- Goemaere, DorisandImetEmmaBoninooftheEuropean to convincethem,andaskthemfortheirsupport.Eric involved inaidKoreatoshareouranalysis,attempt Philippe Biberson:We’vedecidedtomeetallthepeople Extract: North Korea. strategy tobeappliedregardingtheMSFpresencein On 29May1998,theMSFFranceboarddiscussed out amongNorthKoreanrefugeesinChinaandRussia. actors. Severalroundsofinvestigationswerecarried MSF officials paid a round of visit to donors and aid people indistress. a consequenceofchoosingtoplaceourselvesamongst depending onthecircumstances.Bearingwitnessisalso guilty ofmerevoyeurismrightuptocomplicityinmurder, and understood.Ifwedonotfollowthiscourse,are our eyesandears–thenwesaywhathaveseen 29 Minutes oftheMSFFranceBoardMeeting,

April 1998(in French). D120

105 MSF and North Korea 1995-1998 MSF Speaks Out

around like everyone else; that she would end up mak- entourage around her, including Navarro who was following ing highly critical remarks, which she feared, could be Korea. In reality, she knew little about the country, depend- counter-productive. She was lucid about her impotence. ing up until then on certain members of her staff who were We drew attention to the importance of gathering all specialists, who had been over there or who were managing the information available and circulating it to the people the programme. In short, she received us with a mildly involved. We suggested that ECHO should be able to amused air, saying [Philippe imitates Emma Bonino and her obtain detailed information on food production and the accent to perfection], ‘so, which MSF is here today. The economic crisis. Given that the blind delivery of aid is at Dutch? The French? Which one? MSF’s in Korea, so which the heart of the problem, there should be an active search one is it? MSF International?’ She was playing with us a bit to shed light on the issue. We didn’t have the impression on this point. Whilst sipping her tea and nibbling her bis- that the EU has a real policy for Korea, other than being cuits. But she wasn’t daft. It’s true that North Korea wasn’t present. François Jean thinks that the EU should, on the her thing. That’s exactly what we wanted to say to her: that contrary, have a detailed policy but E. Bonino was not the she was dumping millions of euros [ECUs] into a situation person to discuss it with. without having all the informationat hand. ‘So what’s the problem in North Korea?’ she asked us. The discussion Pierre: The American NGOs are ready to go to North Korea. began and she understood right away that we hadn’t come Médecins du Monde shares our policy and the impression for fun, that whether the French, Belgian and Dutch sections that the Koreans want to shut the door on European NGOs. of MSF agreed or not, we had things to say. Eric added his As the offer of services exists, ‘humanitarian dumping’ bit, and she started questioning her team, ‘are you aware could become rife. We need to arrange more visits to try of this? Who’s in charge? Is there a report on it? Well I and see what’s going on, try and gain information from certainly hadn’t understood things were like this!’ And we surrounding countries, network in Japan etc. There are really laid it on thick. plans to return to the Chinese side and visit the border She said, ‘oK, I’ve understood, and it’s outrageous. So with Russia. what now? What should I do? Should I try and go there?’ François B: How long do we have to wait before taking a So I told her, ‘it would be a very good idea to go, Madame. clear decision? Even if we explain what’s going on in one You have to go!’ And she said, ‘Yes, but if I go I’ll cause board meeting after another, at some point we must draw a scandal!’ At the time she was always kicking up trouble, up limits. We need an external view before July, how much in Afghanistan, Sierra Leone, saying, ‘why are things such progress can we make? a mess? It’s unacceptable, the European Union is going to Jean-Hervé: We’re very pessimistic but we need to contin- do this, going to do that!’ I said to her, ‘yes I’m sure you’ll ue gathering information based on concrete action. Visits cause a scandal if you go because you’re not going to to China and the ex-USSR can be doubled with the help of believe what the European Union is contributing to.’ She a support network. Francois is working on Korea and we said, ‘is that so? Maybe it’s not such a good idea to go!’ are planning on organising an international conference We laughed a bit then, but I think that from that moment after the holiday period. on, she understood. And within MSF, even if there was still Xavier: Shouldn’t we be moving on this before July? huge reticence in the field – from Marie-Rose and maybe the Jean-Hervé: Just moving on it won’t have much impact Programme Manager in Brussels – Eric had no doubts at all. if we don’t back up our statements with more concrete elements... Dr. Philippe Biberson, President MSF France, Odysséas: The political outlook probably amounts to (in French). simply maintaining a presence in Korea without worrying about what happens to aid, that’s irrelevant. The humanitarian outlook must be different. We must check that the aid’s being useful, insist that it saves lives and we should not be scared of being expelled. The European Union has this strategy that was Rony Brauman: Humanitarian and political interests can- known by some as soft landing, meaning gradually not be confused, but politics are often played off the cuff changing the situation from within North Korea. MSF and seem to lack clarity. was against it. So we went to see Emma Bonino, to ask her straight out to impose more conditions on the European Union’s food aid. She said that she would take what we had to say into account. Unfortunately she had also asked the EU’s local representative for North Korea to attend, the one We divided up tasks and I went with Eric Goemaere, who usually dealt with MSF in the field. Obviously he the Executive Director of MSF Belgium, to meet the defended his corner, saying there was no problem; he con- European Union representative in Brussels. I think it trolled all the aid being delivered. For me, there was no was because the European Union was giving massive fund- contradiction, we were using EU funding and trying to apply ing to MSF and other NGOs over there. We had a meeting international criteria: direct access and control of distribu- with Ms Bonino. Eric and I had made a good duo and we tion. It should also be borne in mind that the funding we built up the picture so well that Bonino was really attentive. received from the EU represented a tiny amount compared 106 We shifted her opinion around completely. She had all her to the overall amount given in international aid. It was Refugees. the foodshortagesinNorthKoreaandonKorean ried on his researching work on the structural causes of to the most vulnerable populations. François Jean, car- encountering increasingdifficultiesingainingaccess MSFers andsomejournalists.Inthefield,teamwas who hadlivedinNorthKoreadiscussedtheissuewith famine inNorthKorea.Researchersandexpatriates its monthlyconferencedebatetothequestionof On 9June1998,theMSFFranceFoundationdedicated in North Korea. outrageous. TheWFP’sbiggestfoodoperationinhistorywas François Take care, and suggestionsyoucansendme.Speaktosoon. other countries.Thanksinadvanceforanyinformation ers workingintheUnitedStates,KoreanRepublicor ward, atthisstage,isgettingintouchwithKoreawatch - the foodsituation,etc.)?Ithinkthatonlywayfor - regime, thewaysocietyisrun,itsagriculturalpolicies, even journalistsworkingonthissubject(thenatureofthe if you’veheardofotherresearchers,researchcentres,or could yousendthemtome?Andletmeknow If youhavecontactinformationfortheseinstitutions, University - StephenLinton,CenterforKoreanResearch,Columbia for Peace - ScottSnyderandStanleyRoh,UnitedStatesInstitute - Marcus Noland, Institute of International Economics - Nicholas Eberstadt, American Enterprise Institute names of a fewresearchers: pretty impenetrable[…]NonethelessI’vecollectedthe The contrarywouldhavebeensurprising:thecountryis there areveryfewseriousstudiesofthesituationaround. doing someinitialgroundwork–andatfirstglance-- I’ve started working on North Korea – or rather started Dear Barney, Extract: Dr. Eric Goemaere, Executive Director MSF Belgium MSF FranceFoundation,toBarneyRuben, Email fromFrançoisJean,ResearchDirector, Researcher, 5 May1998(inFrench). D122 France Foundation,9June 1998 (inFrench). Stake andtheProblems,” ” Famine inKorea?TheHistory, theIssuesat

Invitation, MSF (in French). D121

rights on a dailybasis,etc… was pouredblindlyintoacountrythatviolateshuman that historywilleventuallyrevealthisfloodofaid attitude and particularly the Americans = Clinton. He says critical oftheinternationalhumanitariancommunity’s sation with its president, Mr Lee Chul-Seung. He’s very Prize committee.I’vejusthadaveryinterestingconver- to takeupcontactwiththepeopleonSeoulPeace trip organisedtoSouthKoreathissummer,it’simperative Just areminderforallthreeofyou.Ifthere’sresearch Extract: increase thecircle ofpeoplewecanquestion aboutthe with PierreRigoulot andP.Biberson.It allowed usto The Foundationorganiseda conferenceonNorthKorea, tions but a deadlinehasbeen drawn upforJuly/August. information first.We’llseehow thingsgowiththenegotia- to stopourworkaltogether but weneedtocollectmore ing moreandunacceptablethere.Wecoulddecide what’s goingon.WilliamPéréasaysthatthingsarebecom - Marie-Rose, thecoordinator,willvisitprovincetosee iting thehospitals,thereareveryfewpeoplearound. the fieldsinFebruary1998,whichposesaproblemforvis - involved in,thewholepopulationwascalleduptoworkin problem intheNorth.Inthislatestprovincewe’vebecome phase, willstopinJune.ForMSF,there’sapotential Médecins duMonde,whichisstillinthenegotiations of visasandlimitationsonthenumberexpatriates. In thefield,wearecurrentlybattlingwithaproblem what, particularlytheAmerican and EuropeanNGOsetc. October withthepeopleinvolved,tofindoutwhothinks should gototheUnitedStatesprepareforameetingin same time,whenhegetsbackfromMoscow,FrançoisJean which providesuswithafairamountofinformation.Atthe on NorthKorea. We’re startingto build up a little network, these peopleastherearenumerousresearchersworking people inJuly.Theywouldliketotakethetimeassess rently preparingavisittoSouthKoreameetwithvarious in JulyorAugust.SophieDelaunayandFrançoisarecur- tion. There’s a plan to visit the region bordering with Korea two persons to work withMSFon the collectionofinforma- various fronts.FrançoisJeanhasleftforMoscowtoidentify Pierre Salignondescribedtheprogressbeingmadeon Extract: Meet Minutes oftheMSFFranceBoardDirectors’ D120 D123 Delaunay, Epicentre, 12 June 1998 (in French). MSF FranceProgrammeManager,andSophie of Research,MSFFoundation,PierreSalignon, President MSF France, to François Jean, Director ” Korea, ing, 19 April/June 1998 (in French). ”

Email fromPhilippeBiberson,

107 MSF and North Korea 1995-1998 MSF Speaks Out

nature and pertinence of aid in North Korea. The confer- ordinator, a supply officer and a water-sanitation expert. ence was followed by a debate and allowed us to meet No reason was given, just the assurance that they will people familiar with Korea, especially one person who be replaced ASAP. A programme will be set up to assist spent a year in Pyongyang as a teacher. She had really the production of ORS in the country. The country asks interesting things to say. She’s still got friends there, more and more raw material to be imported instead of and didn’t want to put them at risk by saying too much. drugs. UNICEF can only assist in the production of ORS But her contribution made a strong impression on us. She as stated in their mandate. For the next three months lived in a wealthy environment, amongst teachers, and UNICEF guarantees us a monthly supply of 15 MT of HEM was constantly watched over and surrounded by people, for the feeding centres in the three southern provinces. drivers, translators etc. She realised right away that UNICEF received the demand for funding the printing of people were hungry. The best thing she could do to give the Korean translation of the MSF nutritional guidelines. them some relief, help them out, was to spend part of her Nobody was aware that this guideline was under transla- monthly salary organising meals at her home. She gave us tion. UNICEF asks MSF for authorisation. a lot of information on the underground system set up by the people, which is witness to the total shortage of food MDM: The surgical program in South Hamgyong province and everything else, access to health care, hospitals, med- was put to an end earlier than planned. The team found the icines, and an open form of corruption. Access to a doctor, working conditions no longer acceptable: no access to the which should be fairly straightforward, has to be paid for patients before and after the operations, difficulties with with a carton of cigarettes, etc. People were reluctant to the translations of technical terms, the low level of knowl- talk about the situation, but she soon understood what edge and operation techniques used are so archaic that a nightmare their lives were. And she left North Korea in further collaboration was impossible. The drugs programme December, so fairly recently. continues until the end of the month and by the first week of July the whole MDM team will have left the country. [...] Pierre Salignon: her words chilled us to the bone and confirmed everything we’d heard in the refugee camps. North Hamgyong Province Her analysis of the system, the mode of social stratifica- The working conditions for the team in Chongjin did not tion, was telling. People received 100 grams of food in improve this month, with the excuse of the planting sea- Pyongyang. The aid system and aid distribution posed son, travelling to the different hospitals was restricted: problems. only one county per day, the members of the team have to stay together. This is diminishing the efficiency of the program as the hospitals can only be visited once a month and travelling time makes the visits rather short. As we Monthly Report, MSF DPRK, June 1998 (in have now doctors in this province the situation will have English). D125 to improve, the doctors should be able to travel in different directions otherwise it does not make much sense to Extract: have a second doctor. Discussions about the plans with It is felt that the general situation in the country improved the provincial and central authorities resulted in the with continuous inflow of food and medicines. It is how- changing of one of the translators (he should have better ever possible that situation will worsen again during the explained the conditions of the country). This situation lean period of July and August. Despite the improvements improved after the visit of Marie Rose to Chongjin, dur- in the situation in the country and the prospect of more ing some days in the week the provincial FDRC is willing active involvement of the international community in to accept the team to go in different directions. Also the agricultural recovery, the international relief organisa- living conditions for the team are difficult: walking into tions present in the country have started to experience town is limited, use of bicycle only permitted outside new and increased restrictions on the implementation town and always accompanied by translators. The team of their programmes with the possibility of more limited stays there during six weeks before coming to Pyongyang. operating conditions on their future activities. [...] [...]

The nutritional survey is still on the table, talks are being North Hwangae Province [...] held with the implementing partners about the protocol Stock keeping in most places ‘correct’, but unreliable... to follow, but little information is given to the NGO’s. The local authorities more and more give information It seems that UNICEF will be the major counterpart for that drugs are saved and stored for later (many hospitals the authorities to handle the survey. The delegate from expect us to leave soon, “we would be here for one year ECHO left temporarily the country (?), the WFP head only...”). Very difficult to change, especially when our kits (Douglas Coutts) left as well, and also Dr Omawale will are delayed. leave in August they say, so who will follow up this matter? UNICEF: the poor functioning of UNICEF was also Morbidity mentioned in the report of the EU delegation visiting the Morbidity forms collection is a ‘prayer without end.’ The country in May. To continue the trouble: 3 international concept just does not work: in some clinics it turns out 108 staff members (all Norwegian) resigned: the medical co- they have special morbidity recording for patients treated returned from avisittoNorthKoreaand announced On 14June 1998, WFPandFAOrepresentatives ism ?…] he knewthatatfuneralstheyatemeat.[meaningcannibal - member ofhisclosecirclebuthedidn’twanttogobecause leagues toldherthathewasinvitedtothefuneralofa I madethemtoastwithbutterandsugar.’Oneofhercol - I ofteninvitedthemhome.Weputtheteatoonesideand ter. They ate them by the spoonful. Once I’d realised that, wasn’t theteathatinterested them, butthesugarand- blocks wheretheinterpreterslived,butIsoonrealisedit sometimes invitedthemtoteainmyrooms,thetower She becameveryclosetohercolleagues.Andshetoldus,‘I Korea. SoV….endedupstayinginPyongyangforayear. Koreans etc.Theoldinterpreterwastoosicktoreturn pletely enslavedtothecause,totallybesottedwith interpreters whosettledoverthereyearsagoandarecom- seriously ill.Alltheregime’spropagandawaswrittenby Pyongyang, replacinganoldFrenchinterpreterwhowas had beenlivinginChinaforawhile.Shedidaninterim classes. ShewasaninterpreterinChineseandKorean was cannibalism in North Korea, even in the upper social distribution system. health structuresweremorefreelyaccessibleusingthis field visitsandseemstobedonequitecorrectly.The tribution planoftheircounty.Thisisevaluatedthrough we decidedtoaskthecountydirectorspresentdis- to give us an updated list of health facilities. Therefore initially receivedsomekits.Theauthoritiesarereluctant accordingly; alsosomeprovincialhospitalsnotincluded and provincialauthoritiesadaptedthedistributionplans for theverysmallones,nodrugsweregiven.Thecounty reflect thereality:somefacilitieswerenotincluded,and - Distributionlistsprovidedbytheauthoritiesdidnot were sent to theoff-limit counties - Redistributionofthekitsonequitablebase:450 plans: it is clearthat these havenotbeen respected: Discussion withthecounterpartsaboutdistribution [...] Monitoring South Pyongyan Province and insist on accesstothese in theMoU.[...] ferent wayofdatacollection(files/wardadministration) slow (monthsbehind).Myideaistoconcentrateonadif- line’ treated patients, and overall, the collection is very with ourdrugs,inotherhospitals,theyaddthe‘second for ayear.Shetoldusthatshewascertainthere woman, V…who’dbeenaninterpreterinPyongyang During theFoundation’sconference,wemetthis Dr. Philippe Biberson, President MSF France, (in French).

some ofthem in caseof possible shortages. distributing theentirefoodstocksandweresaving reported thattheNorthKoreanauthoritieswerenot carious andthatthefoodcrisiswasnotover.They that thefoodsituationincountryremainedpre- needed forthe periodofNovember1997to October1998, the FAOandWFP evaluatedthat1.95million tonneswere a “majordeficit”in international food aid. Last October Mr RashidconsidersthatPyongyang isconfrontedwith are obligedtodotheirwashing intherivers”,hesaid. drop to less than 20 degrees during the day. “People and heatingduringthewinter, evenwhentemperatures have observedaquasi-totalabsenceofrunningwater tryside, therepresentativesofinternationalorganisations and chronicdiarrhoea,aboveall in children. In the coun- The foodshortageshaveprovokedariseinpneumonia their lack ofnutritional value.” “the mainformofnourishmentformostpeople,despite preparation of green-coloured biscuits” which hasbecome reduced to“pickinggrassintheparksofPyongyangfor explained. Accordingtohim,theinhabitantshavebeen have beeneasytotreathadtheyeatingenough,”he the streets.They’redyingofdiseaseswhichwouldnormally has ledtoseveralmillionvictims.“Peoplearen’tdyingin that thefamineraging in theworld’s last Stalinistbastion dinator inNorthKorea,refusestoconfirminformation For hispart,DouglasCoutts,theUN’shumanitariancoor- main rainy months of the year”declaredMr Rashid. [...] the yearremain‘uncertain’beforeJulyandAugust,two “seem generallysatisfying,theperspectivesforrestof event of the shortage worsening. Even if the harvests international foodaidtoonesidefordistributioninthe authorities haveapparentlychosentoputthestocksof normal needis450grams.AccordingtoMrRashid,the been reducedto100gramsperdayadult,whilstthe the fooddistributionsystemcametoastop,rationshad ference at the endofaten-day trip inthe country. Before many partsofthecountry”,headdedduringapresscon- distribution system hasn’t been working since last March in because foodstocksarealmostexhaustedandthepublic concerned aboutthetwonextmonthswhicharecritical, Programme (WFP)inNorthKorea.“Weareparticularly and Agricultural Organisation (FAO) and the World Food declared AbdurRashid,HeadofMissionfortheFood country and we cansaythat the foodcrisis is notover,” situation remainsprecarious.Wehavetravelledalloverthe of foodindicatedinBeijinglastSunday.“The the population,twoUNorganisationsincharge and the monthsof July and August will be ‘critical’ for The foodsituationinNorthKorearemains‘precarious’ Extract: Beijing 14June 1998 (inFrench). According toFAOandWFP,” ” Precarious FoodSituationinNorthKorea, AFP (France),

109 MSF and North Korea 1995-1998 MSF Speaks Out

but only 400,000 tonnes were sent, with another 400,000 staved off a catastrophe... These recent declarations raise expected. […] huge questions, which we should put to them directly.

According to certain information, the famine in North Korea has caused at least a million victims over the last few years. The organisation Médecins Sans Frontières talks about cannibalism and states that international aid In June, most NGOs, including MSF, encountered is diverted to the military and senior ranks of the regime. increasing difficulties conducting their work and in The two Koreas did not manage to agree about the dis- gaining access to the populations in need. In mid-June, patch of fertiliser from the South to the North during MDM (Médecins du Monde) did not succeed in signing discussions organised last April in Beijing. a new MoU. They were the first of a string of NGOs, which would later leave North Korea. The North Korean authorities announced to MDM that in the future, they would rather import raw materials to produce medi- ”North Korea Famine – Remarks,” Email from cines locally rather than rely on NGOs. Pierre Salignon, MSF France Programme Manager to the North Korea network, MSF Belgium, MSF Holland, MSF United States, 15 June (in French). D126 Memo from Marie-Rose Pecchio, Coordinator MSF DPRK, to William Claus, MSF Belgium pro- Extract: gramme manager, June 1998 (in French). D127 I’m taking the liberty of sending you this dispatch in order for you to question your WFP and FAO contacts for more details on these declarations. Maybe there’s a mission Extract: report in circulation? Catherine, could you get more info Here’s the news I received last night in the Pyongyang in NY if you can? As you can see, there are several trou- social club. Some of it is rumour, other bits are official bling remarks about the aid distribution system in North […] Rumour has it that the authorities don’t want to let Korea and the current situation: people stay here too long because they acquire too much - The conclusion for the FAO and WFP mission: the situa- knowledge on how things work. So the ‘old timers’ are in tion still remains ‘critical’ for the FAO and WFP… (indica- the process of leaving. Douglas Court – 1 year, the number tors? direct observations?) […] “The public distribution 2 of WFP, John Proud – 2 years, the Swiss Disaster Relief system hasn’t been working since last March in many parts representative – 2 years, Omawale – 1 year, UNICEF of the country.” We’ve heard about this from refugees on the border, but it’s the first time we’ve heard it from a 3. MDM: it’s not very clear what’s going on. The HoM has UN representative. They go further still, “the authorities started negotiating with the FDRC. They’ve talked about have apparently chosen to put the stocks of international money and the length of the programme, but not yet food aid to one side for distribution in the event of the about the programme itself. There were two visits from shortage worsening.” Is this a recent WFP discovery? A headquarters in May to launch the idea of new projects. half-acknowledgement of the diversion of food aid? We The FDRC doesn’t know yet if it’s yes or no. The reason: can ask ourselves, and them, the question. […] MDM started its project very late, so it’s not reliable. But, the FDRC will see. In short, nothing’s definitive yet. -3 Other troubling remarks/observations, which need fol- According to the anaesthetist who was on mission here low up in Pyongyang and NY/Geneva: for a month, their headquarters is ready to make conces- (1) “The lack of fertiliser, machinery, and sources of energy sions in order to stay. Which is a bit contradictory with oblige school children to work in the fields, cultivating Paris’ information, isn’t it? Remarks on the anaesthetist land”… + surgeon’s mission – their month in the field was worse (2) “The rations had been reduced to 100 grams per day per than awful. They could help with interventions but weren’t adult. According to the FAO, the authorities have apparently allowed to see patients before and after. Techniques date chosen to put the stocks of international food aid to one from before the 1960s; rules of hygiene and asepsis are side for distributing in the event of the shortage worsen- non-existent, and the reasons for operating were very ing….” unclear. In short, very very dangerous. They have some (3) “The inhabitants have been reduced to picking grass in regrets about introducing general anaesthesia […], which the parks of Pyongyang for the preparation of green-coloured makes me very happy we’re not doing surgery and that Ton biscuits which have become the main form of nourishment didn’t distribute ketamine. […] They can’t get a visa for for most people, despite their lack of nutritional value”… someone from headquarters to come and discuss how the Without second-guessing why such declarations are being programmes should continue. made by the WFP and FAO (their annual appeal provoked little response), we should once again note how much 4. ACF: their work’s completely blocked: they still haven’t their tune has changed from a few months ago, when received the list of children in the nurseries. No list, no 110 the WFP was rejoicing in the ‘efficiency’ of its aid, which distribution. In addition, the 2 nurses are obliged to the potential forMSFtohaveaccess thesocially the MSFproject inNorthKorea.Oneofthe issueswas the DPRKauthoritiesregarding thepossiblefutureof was runningout,MSFcarried outnegotiationswith In JulyandAugust1998, as theMoUsignedearlier Marie-Rose other NGOs will follow (CAD, Helpage). that’s it.That’sallIhavetoreport,thoughit’ssurethat 72 tonnes of medicines that have already arrived and then come. Theycanstayuntilthe10-15Julytomonitor People fromtheParisheadquartersarenotauthorisedto signed thecontract in January. but theprogrammeonlystartedinJanuary.ECHO -MDM is a bit lightweight: it signed its MoU in September in medicines via NGOs. required formanufacturingmedicinesratherthanbringing -In thefuture,Koreapreferstoimportbasicmaterials in personduring a meetingwith the FDRC. Thereasons: MoU. There’s no written notification, but they were told OK, it’ssettled,MDM’sleaving.Theycan’thaveanew Hello, Extract: no children? It seemslogical, no?? What abouttheoptionweselected:shuttingifthereare sion, asdootherexpats.[…]SomeTFCshavenochildren. fed upandleave.Metheteamherehavethisimpres- they’re puttingupmoreandobstaclessoweget the situation’sgraduallygoingdownhill.Inmyopinion, ing TuesdayinsteadofFriday.[…]Ihavethefeelingthat visits toallprovinceshasbehandedinonthepreced- his tetherwiththis‘villagedoctors’thing.Planningfor leave thehotel,evenaccompanied.Gunter’satendof hospital forcountingboxesareabitexcessive.Theycan’t until theplantingseasonisover.2doctorsinsame all 3teammembersareobligedtomovearoundtogether 8. Thing’saren’tlookinganybetterforus:InChondjin, visas for headquarters staff havebeen issued. While Geneva’smakingupitsmindonthisfoodissue,no beneficiaries chosenby the localRedCrossasproof.[...] ing a kind of food basket study carried out with certain sentative pleadedwithGenevatochangeitsmind,offer- from thelocalRedCrossandauthorities.Therepre- since anevaluationcarriedoutlastApril.Massiveoutcry 7. TheRedCrosshasdecidedtostopfooddistributions Coordinator has gone backtoParis for discussions […] move aroundtogether,likeus,infact.Tocutitshort,the operations, 17 June1998(inFrench). Marie-Christine Ferir,MSFBelgium,Directorof de Briey,MSFBelgiumProgrammeManagersand Coordinator DPRKtoWilliamClausandPatrick ” MDM,” Email fromMarie-RosePecchio,MSF D128

on the plight of these children. tions thatwereremaining in thecountry to followup objective wastoconvincethehumanitarianorganisa- present in North Korea from 11 September 1998. MSF’s to theauthoritiesandaidagenciesdonors these ‘sociallydeprivedchildren’thatwascirculated ‘rejected bythesociety.’Theypreparedareportabout a KimIl-Sungdecreeregardingpeopleclassifiedas children were earmarked as 27/09 - in reference to preparing thenegotiations,MSFdiscoveredthatthese they suspectedtobeorphanedstreetchildren.When deprived childrenidentifiedbythevolunteers,whom of the general population). exceed 1%ofthe underfivepopulation (estimated at10% tively low:thenumberofadmissions underfivedoesnot - Thenumberofchildrenadmitted tothecentresisrela- However: protocols. of diagnosismalnutrition and alsothespecificcurative Korean medicalstaffunderstoodquicklythenewmethods In generalthecentresfunctionedwelltechnicallyas ised in all the countieswhere we were allowed to work. tional programme. The feeding centres have been organ- it ispossibletomakesomeobservationsaboutthenutri - and September1998.Afteroneyearoftheprogramme, These twoactivitieswerecarriedoutbetweenJuly1997 tion oftherapeuticfeedingcentresinthesameprovinces. tribution ofdrugsinfourprovincesandtheimplementa - MSF cametotheDPRKwithadoubleprogramme:dis - dren Identification of an at risk group: socially deprived chil- Report: solution. concerned bythisproblemandwillfindahumanitarian are surethatalltheinformationorganisationswillfeel information givenshouldnotbeinterpretedassuch.We the authorities or political system of this country and the direction. Bynomeanswasthisreportmeanttocriticise have theopportunitytodevelopfurtheractivitiesinthat ing solutions.AsMSFisleavingthecountry,wewillnot continue afollowupandassisttheauthoritiesinfind- organisations still present in the country, so they can we wanttosharethisinformationwiththehumanitarian main concernisthehealthofchildrenandtherefore given to the authorities and discussed with them. Our issue, somespecificgroupsofchildren,andhasbeen visits bytheMSFteams.Thisreportisaboutanimportant Please findenclosedareportmadeafteroneyearoffield Extract: GAA, 11September1998(inEnglish). Anamur, OXFAM,Cesvi,USAPVOConsortium, ECHO, IFRC,SDR,CAD,Concern,ACF,Cap UNICEF, WFP,FALU,UNDP,OCHA,WHO,DG8, Pecchio, CoordinatorMSFDPRKandReport,to Deprived Children’,” “ Identification ofan‘AtRiskGroup:Socially Letter fromMarie-Rose D129

111 MSF and North Korea 1995-1998 MSF Speaks Out

- We still have no idea how representative are these chil- centres were not an important factor in solving the nutri- dren treated in the centres. Are they all the malnourished tional problem of the country, they did not give us a clear- children of the county or only part of them? er idea about the nutritional status of the children either, but they allowed us to identify certain specific problems These are the major reasons why we decided to put an end that we probably would not have noticed otherwise. Two to the nutritional programme, even before the end of the Nutritional Rehabilitation Centres (NRCs) are particularly actual MoU, and discussions [are] still going on for a next interesting: the one of the city hospital of Pyongsong and one. It is quite clear that MSF will not be able to conduct the one of the provincial paediatric hospital, also located a nutritional survey, not even in the counties where we in Pyongsong. The number of children treated there is work. We are therefore not able to evaluate the nutritional rather important (613 admissions in 9 months, in the two status of the population (is there still acute malnutrition hospitals, children under and above five years old) but and which age group is most affected?) and at the same more important is the fact that the population of children time we are not able to evaluate the current programme seen in these centres present some common characteris- (is this kind of feeding centre a possible solution for the tics that we hardly find in other centres of the province. nutritional problem?). Another important factor in the decision to close the feeding centres was that in many A. History hospitals we noticed that our confidence [trust] was Until the middle of November 1997 the paediatric hospital abused: admission criteria were on purpose [intentionally] seemed to function normally, at least that’ what it looked not respected, and many ‘fake malnourished’ were added like. We paid relatively few visits to this hospital as the in the registers only to increase the theoretical daily con- programme focused more on the health facilities of a sumption of milk. Are these quantities of milk retained, lower level, the county hospitals. However, as the provin- constituting a stock for when the programme will be fin- cial hospital is the referral structure, it served twice as a ished? Was this extra milk given to other children? Was meeting place for the paediatricians’ training course about the milk given to children who did not need it? On the malnourished children. The first course took place at end other hand we found, among the children admitted in the of July and was given for the paediatricians of the hospital feeding centres, a specific group of children who more by Dr Egil Sorensen of UNICEF in the presence of Brigitte urgently needed our help. With all the observations we Noel, the MSF nurse. During these two days of training made we can say that they do not only have a nutritional a group of about twenty severely malnourished children problem, which is often very serious, but also clear social were present for the clinical demonstrations. While wait- problems. ing in the morning to enter the hospital, Brigitte and Dr Sorensen were very surprised to see two children in bad MSF is a medical organisation, which works closely with general condition that were driven away in a cart to an the population and insists that the aid it brings will go to unknown destination. No reasonable explanation could be the most vulnerable ones. We have doubts that this was given by the staff. During a regular visit made two days the case here. later we were not able to trace one single child present We asked repeatedly for access to these children from the during the training, they were obviously brought there for different authorities so we could help them and solve their the clinical demonstrations. problems at ground level. The local and provincial health authorities more or less admit the need for intervention A second course was given in this hospital, by MSF, to and even more, the difficulty to reach these children. The all the responsible paediatricians of the province. This central authorities simply deny their existence. We do not course took only one day and we could not see these understand why such a wall of silence is being erected children. Also during the next two regular visits made by around these children, maybe it is only because for the Brigitte nothing special could be noticed, there were some Koreans it is difficult to admit that certain things do not malnourished children in the ward but nothing special. function as they should, which is not surprising taking William Claus, responsible of the MSF-Korea programme into account the difficulties they had after several years of in Brussels, visited the paediatric hospital in October. natural disasters. At the same time we noticed that impor- Severe malnourished children were presented to him, but tant efforts were made by the health authorities to take during the whole visit we had the impression that things care of these children. Certain centres put a lot of energy were set up. This suspicion was confirmed a few days in them and we were impressed by the will of many Korean later during an unexpected visit by Brigitte: none of the paediatricians to assist these children. But now we think children shown to William could be found in the hospital, that it is time to go a little bit further and try to solve the and again no valid explanation for this fact could be problem at a higher level, if possible. At the present time given. After this incident we paid no further visits during we can only put a plaster on a gaping wound, as we have several weeks and put more effort in the other centres in no possibility to treat the problem at its source. the province.

The nutritional rehabilitation centres of Pyongsong It was only on the 21st November that Brigitte returned It is through the nutritional rehabilitation centres that we there for a regular supervision visit. She noticed however were able to gather most of the information concerning that there were no malnourished children at all in the 112 the socially deprived children. It is very likely that these wards she usually visited. She was informed that they cases (often kwashiorkor), which is in contrast to the - Themajority ofthemalnourishedchildren aresevere 2. Nutritional status: Their clothes are dirty and inpoorstate. clothes isnotfoundinthe generalKoreanpopulation. Upon theirarrivalthepoor hygiene oftheirbodiesand 1. General condition: B. Common characteristics of thechildren library. except afewsmallthingsorbookfromthehospital -There is analmost total absence of personal belongings, children who were kept in separate rooms. in the ward, except the mothers of young malnourished months ofweeklyvisitswenevernoticedonerelative often not accompanied by relatives, but during eight members. Also in other centres the bigger children are - Wenoticedtheabsenceofparentsandotherfamily ties supposedly working independently. day inthetwohospitals,whichissurprisingforfacili- * These grouped exits happen sometimes on the very same day). groups ofchildrenleavingthesameday(upto12onone centres. Butnexttothattherearemoreorlessregularly * Dailyafewchildrenarebeingdischargedfromthe important observations: somehow regulatedinsteadofatrandom.Wemadetwo - Theexitofthesechildrenisremarkableandseemstobe in thepaediatric hospital, 54% in thecity hospital). 43% boysinregularcentresand62%Pyongsong(67% age groups:forthechildrenaged6to18yearswefind in other centres (53%). This is not due to the different -The sexdistributionismoreinfavourofboys(61%)than years) than thecity hospital (average7.4 years). provincial hospitalhasevenolderchildren(average9.9 we havemainlytheabovefive’s(average 8.8 years). The under five’sarethe majority (average4.1years) but here we observedintheotherfeedingcentres.Ingeneral -The agedistributioniscompletelydifferentfromwhat B. General impressions characteristics. provincial paediatrichospital.Theypresentedthesame ised childrenbelongedtothesamegroupasthosein end ofthewinteritbecameapparentthathospital- the other centres throughout the province. Only at the were finished.Initiallythechildrenadmittedasin opened onlyinOctoberaftertherehabilitationworks one, the paediatric ward and the nutritional centre were located ataboutfivehundredmetresfromtheprovincial all presenting similar characteristics. In the city hospital, surprise thiswasthe beginning ofaninfluxchildren to makesurethattheyreceivedatleastbasiccare.Toour to holdonthesechildrenandorganised weekly visits too weak to stand up. From this moment on we decided suffered fromseveremalnutritionandsomeofthemwere together inthecornerofapoorlyheatedroom.Theyall physical, medical as well as nutritional. They were grouped ing, aboutthirtychildreninaverybadgeneralcondition, director finallygavehispermission.Shesaw,inthisbuild- not allowedtoenter,butassheinsisted,thehospital were placedinanotherbuilding,whereatfirstshewas [...] dren inKiljuboardingschool couldbeinthiscategory. cases werenevershownon the regularvisits:manychil- children comefromthelisted institutionsbuttheworst Also nottoexcludeisthepossibility thatsomeofthese big tobehandledbythem, others denytheirexistence. children; othersdidnotastheyjudgedtheproblemtoo the TFCshavesurely(andtheyadmitthis)acceptedstreet fact recentlyacceptedbysomelocalauthorities.Someof Many ofthechildrenareundoubtedlystreetchildren,a only institutions we know of aretheorphanages. children comefrominstitutions.Atthepresenttime crowding that might indicate that at least some of these -The general presence of scabies and lice are signs of over- of children. tions visitedintheprovincewedidnotseethesekinds along the streets, in other hospitals and in the institutions foracertaintime.Itisimportanttoremarkthat Pyongsong indicatesthattheylivedinprecariouscondi- -The generalandsanitaryconditionofthechildren several possibilities: It is not clear where these children come from. There are D. Origin of thechildren medical files of the children. These areonlyimpressions;weweredeniedaccesstothe noticed butwith a seasonalpattern. whole year, also respiratory tract infections are often - The prevalence of diarrhoea is important during the - Certain children aresuspected tuberculosis cases. toes have been seen. - Somecasesoffrostbiteonthefeetwithamputation 5. Other problems: tion. of emotionalreactions,evenafternutritionalrecupera- Some childrenareveryabsent-minded:fixedlook,absence 4. Psychological status: disorders. - Somechildrenhaveasuntan,theypresentwithlessskin have their heads shaved. during themonthofFebruary.Manychildrenadmitted -Lice areverycommonandwerepresentinallchildren marked by amoistinflammation on the ear lobe. mainly onthescalp.Theearsareveryofteninfected, -Many haveabscessesorscarsfromhealedabscesses, oedema. bacterial infection on the hands resulting in inflammatory -Almost allchildrenhavescabiesoftencomplicatedby 3. Skin diseases: scurvy. have anaemia,some cases ofpellagraandonecase -Some casesofdeficiencieshavebeendiagnosed:many serious condition they present at admission. 0.3% in the other centres. This is probably due to the city hospitalcentre,3.8%intheprovincialcentreand -The mortalityishigherthaninothercentres:3%the the moreorlessvoluntarymanipulationsofstatistics). moderate casesofmarasmus(eventakingintoaccount observations in the other centres where we see mainly 113 MSF and North Korea 1995-1998 MSF Speaks Out

4. Conclusions: registers, which was often applied to the children in the worst - The orphans that we were able to see do not correspond states. We realised that these children were being classified with those admitted in Pyongsong. None of them had skin in a particular way. They probably had no parents and they problems similar to those observed in the two hospitals. had a kind of registration number, shared by them all, 27-9. - The orphans not taken care of by the authorities (? num- We found out later what this stood for. 27-9 corresponds to ber) and the children abandoned by their parents have to the date of a decree made by Kim-II-Sung concerning the be somewhere, or in an institution under the responsibil- reassertion of control over elements living outside society; ity of the county, or with individual families, or outside street children. Every time we saw this date, it was applied in the nature... It is unclear where they go to once they to a child in really bad shape, who probably came from an leave the institutions for the babies. institution for street children, and who had been mistreated. - The numbers of orphans who are in the official institu- Those in the worst state were sent to nutritional centres. tions are less than the number of children treated in the NRC. In reality, it wasn’t easy to see street children. We caught F. The future of the children in the feeding centres glimpses of them from time to time, they were mostly At present time we do not know their destination and do concentrated at specific points like train stations. Outside not receive a clear explanation about this. This is not very the capital, the Action Against Hunger volunteers sights, encouraging but strengthens the idea that they belong to groups of 30-40 children walking around at night. What was a special category of the population. A probability is that strange was that in the other provinces, the teams almost they return to special institutions. The presentation of never saw these children. Yet when we pushed the authori- these children at the beginning of our programme (dur- ties a bit, it was really obvious. We never managed to know ing the course of UNICEF and the visit of William) might what became of them once they’d left our nutritional centre. indicate that this institution is located near the provincial We never had proof of what happened afterwards, where hospital. Also the fact that we had some re-admissions they ended up. Did they go back to the streets or return points in the same direction. However it is very difficult to institutions? We discussed amongst ourselves whether to understand what really happens. we should try and follow them up or not. We were pretty much in favour of trying, because it was obvious that most Conclusions. of them came from the streets, not institutions, and were - MSF worked for one year with the Korean malnourished going back to the streets too. children. One of the conclusions is that it is very difficult to have a clear picture about the nutritional status of the Dominique Lafontaine, physician, MSF Programme in population. This will stay like this until a serious nutri- DPRK, August 1997 to September 1998 (in French). tional survey can be carried out. - In the feeding centres we clearly identified a population of children in a very bad nutritional state and with characteristics that indicate that they live in difficult social conditions. They arrived at the hospital, in the paediatrics - Through these observations we think that besides the department, in groups but not of their own accord. institutions officially listed, there is or are other institu- We think they were street children who’d been gath- tions where children of different origin stay. ered up by the authorities and put into certain centres, for - We hope that after our departure efforts will be made to which no one took responsibility. Neither UNICEF nor anyone find a solution for this humanitarian problem of socially else had access to these children because officially they deprived children, and this in collaboration with the didn’t exist. The authorities said that they didn’t exist. We Korean authorities. In this case the work of the Korean were ready to take care of them. We proposed an additional doctors for these children will not have been in vain. element to our programme, without taking money from elsewhere because the authorities were really sticklers about that. We proposed to take care of them; going to the source of the problem, i.e. to the orphanages that we suspected existed. There were special orphanages for these ‘non-exis- There were negotiations for renewing the contract at tent’ children who in fact came from the street, whose par- the end of the first year. I don’t really know what ents were dead or in prison, and who had been abandoned happened at headquarters level, which decisions were by the regime. taken, but during the discussions we had with the authorities, we had a mandate for the second year to try and get Marie-Rose Pecchio, Coordinator MSF DPRK, December official access to children. As a reward, we would continue to 1997 to September 1998 (in French). supply medicines. Our condition for staying was the development of a nutritional programme for children. Whilst preparing for the negotiations, we collected information from a variety of sources to identify where we could set up this programme, in which centres and on what scale. That was I was amazed by the naivety we displayed in using 114 when we realised that they used an abbreviation in their the term ‘street children.’ It was like the game ‘spot nightmare. The penny had todrop at some point. keep certainthingssecret,butwewereinthemiddleofa just atheatreofshadows,builtuptoimpressforeignersor the side,etc.’Westartedsayingtoourselvesthatitwasn’t for taking a few people in their trucks to make a bit on broken downtrucks,ormilitarywho’vestoppedtobargain people movingaround,takingtotheroads.Maybethey’re on, but we toldourselves: ‘there are nonetheless some cigarettes. Ourinterpreterscouldn’texplainwhatwasgoing roads thereweresometimespeoplebrandishingcartonsof but whenwewentbackoverit,recalledthatoncertain on theroads.Wethoughttheywerewithbrokendowntrucks clean, pathologicallyorderedcountry,wehadseenpeople After somereflections,werecalledthatinthisclinically seen. border. Butitnonethelessmadeusthinkaboutwhatwe’d researchers had described for us: people started crossing the for ourselves, but therefugees had toldusabout,the helped usbelieveinsomething that wehadn’treally seen papers and everythingwasorganised beforehand. This residence when normally the smallest little trip required about, wanderaround,leavetheirareasofproductionand was becausetheregime had lostcontrol.Peoplecouldmove unbelievable: iftherewerestreetchildreninNorthKorea,it way of trivialisingasymptom that was nonetheless totally street children in Cairo, Bangkok, or Guatemala. It was a Korea hadfarmorerepercussionsthatwhenreferringto going on? For me, using the term ‘street children’ in North who wasregroupingtheminthetrainstations,what were allowedtowanderabout?Andifitwasn’tallowed, manically ordered;wasludicrous.Howcomethesechildren Korea whereeverythingwasclinicallyclean,organised, ‘spot thatdoesn’t belong.’Talking about‘streetchildrenin the middle of them a fox and a wolf and you’re asked to the oddoneout’:youhavetwelveAfricananimalsandin facilities in4provinces We supplieddrugsandrenewablesuppliesto A are therefore consideredasimportant andhavemoreimpact We arerunning a bigprogram(enormous financialinput),we People knowMSF andhaveapositiveimageofMSF chievement Dr. Philippe Biberson, President MSF France, S the health the health (in

French). - - - C - at the end ofthecurrent MoU. North KoreaformallyagreedtoclosetheDPRKmission sections (France, Belgium and Holland) involved in an inter-Programme Managers meeting, thethree MSF plan toclosethemission.On13August1998,during August theMSFCoordinatorinPyongyangproposeda which wouldindicatetherightmomenttoleave.On10 North Korean population and to define a threshold, MSF continuetotryandgainaccessthevulnerable On 29 July, a MSF Holland group recommended that July, MSFreceivedaone-monthextensionontheMoU. ments andtheprospectsofprogramme.On24 had ameetinginPyongyangtodiscusstheachieve- and 21July1998,thewholeMSFteaminNorthKorea fuelled byvariousdiscussionsheldwithinMSF.On20 The negotiationsaboutthepossiblenewMoUwere price. This struggle for access was exhausting. it asafailure.Butwecertainlyweren’treadytostayatany doing nothingofanyuse.Theyweresadtoleave;theysaw them, if they didn’t have access to these children, they were tified thechildreninquestionwereveryconcerned.For What have we achievedinthe programme after one year? Extract: onstraints off limit counties without our consent) for other NGO’s) due tologistic problems of transportation in DPRK (same financial reasons (delay in obtainingbudgets)andalso Chongjin notproperly treated) big delayin some patients distribution lists program logistic and most. Thedoctorandnurseintheteamwho’diden- children issuethatbotheredtheauthorities In myopinionitwasourstirringupofthestreet Dr. Eric Goemaere, Executive diector, MSF Belgium Minutes D130 Pyongyang, 20and21July1998(inEnglish). financial constraints to continue a such big the distributionof drugs duetologistic and did notgetthe drugs (caseofmeningitis in were not respected (drugs went tothe ofthemeetingMSFDPRKin

(en français).

115 MSF and North Korea 1995-1998 MSF Speaks Out

AchievementS Constraints

Supervision to all facilities where we officially distributed - planning was needed, given on Friday for the following drugs was possible week, has to be given on Tuesday now - information about accessibility of a certain county or facility came always at the last minute - is very restricted, very difficult for MSF to change if needed or if plans cannot be respected due to “security” reasons - it is a one-sided inflexibility that restricts our movements

The MoU has been respected in general - the MoU was too restricted - often practical problems on the field - are we implementing the MoU? Access is written. - it is difficult to have changes in such country after only one year but there should be more political will to back up our program - not enough explanation about the aim of our work at higher level - we have little manoeuvring space

Identification of training needs could be done - limited access to tools to do a proper assessment: patient files, morbidity forms

We could stay inside the country for one year - high financial input - judgement on the name of the organisation: political interest to keep us in the country - we are tolerated only - we did not make big statements - presence less impact than we hoped

MSF is present in case of an outbreak - very unlikely we will be informed about any outbreak

International mission - HQ do not know exactly what we do (empty page in the Dutch annual report) - different way of working in the 3 HQ, for establishing policies, human resources, finances, logistics - delay in our activities because of lack of common policy from HQ

Improve the basic knowledge about drugs and medical mate- - difficult contact with MoPH [MoH] because FDRC was not rial in favour of it - no clear medical policy was made, MSF-B has no person in the medical department to follow up Korea - medical co-ordinator not accepted by FDRC before Jan 98 - evaluation about knowledge of MD and co-operation with MoPH was too optimistic - professionalism suffered from emergency approach

Opening of the fourth province - should have benefited more from the experiences from the other provinces - we wanted to go there because it was far and difficult accessible, although WFP has an office there since Sept. 97

We have some idea about the general health of the Korean - data cannot be trusted population, about their health systems, some idea about - morbidity forms are extremely difficult to evaluate: often diseases, impressions but no clear figures in some provinces, not correctly recorded (only OPD or only consultations at field level, it is possible to see the patient files and pres- where MSF drugs are used), case definitions are not the criptions, some access is possible same, personal observation is more important - to care for other people is maybe not part of this culture, doctors have other obligations and do not work only in the hospital, there is a lack of commitment to care for the patients - too many health facilities and too much staff but they are 116 part time only Why is itimportant for MSFto stay inthe country? ful knowing the rigidity of the government. collaboration withtheauthorities, whichisquietsuccess- is very,verylimited,there were smallimprovementsin A positivepointisthat,although thehumanitarianspace -Enough quantity, little quality. -No access or preparedaccess to vulnerable groups. tory). -Freedom ofmovementlimited(weeklyplanningobliga - -Collaboration with the authorities difficult. gramme. -No meansofevaluation,especiallyforthenutpro - ered amount. -No accesstodataorbiasedinfunctionthedeliv - magnitude of the programme. -Small numberofexpatsonthefieldcomparedto tion) -Difficult/no accesstothepopulation(windowconsulta - Major constraints: Extract: • • • • witnessing • • W implement feedingcentres give training aboutdrugs distribution of drugs The A benefited fromit Feeding centres have been implemented andsomechildren chievement hy of the situation drug training: nutritional emergency improve objectives of the current programme havebeenachieved:

stay distribution: Negotiations WiththeDPRK, “Discussion PaperorReflectionontheComing ager, 23 July 1998(inEnglish). William Claus,MSFBelgiumprogrammeman- ------ the quality of basic health care health basic of quality the update of the knowledge: the of update for training weneeddrugs has to be recognisedatnational level no other people aredoingit more long termobjectives should be relatedtoconsumption data items can bereduced other donors no plans rehabilitation: preparedness: quicker assessment, knowledge assessment, quicker preparedness: S to takeover by thegovernment or in time,less per province, less ” D131 Memo from

• • • • W - - C - - - and investment in more quality mustbe priorities. It must be clear that access to the population on all levels of the MoU. In any case one province should be closed after the end respectively provinces. -3 sectionsareworkingin one countyhospitalintheir province. -3 sectionsareworking in 3countyhospitalsone government. The possibilities are how canbediscussedfollowingtheappreciationof to thegrassrootslevel(homeconsultation).Whereand consultations???) andthedifferentreferralstructureup to work in a county hospital (paediatricservice, bedside have tolimitourgeographicalarea.Theoptioncanbe on thefieldtoguaranteeacertaindegreeofqualitywe As thereislittlechancethatwecansendmoreexpats 2. Magnitude of the programme, medical approach. distribution activities. negotiated. Thiswillcertainlyleadtoadiminutionofour consumption andwith‘reliable’morbiditydatacanbe distribution. Adrugdistributionbasedonmonthly distribution itisimpossibletocontinueablanketdrug Without any means of evaluation of the impact of the 1. Distribution of medicines. Points of negotiation forthe second MoU. hy the healthcareofitspopulationandhasotherpriorities: can in access to vulnerable groups. and WHO,copingmechanismsarebeingdeveloped,no able data,generalprogramscanbeassistedbyUNICEF ties duringtheroundtableconference, we havenoreli- a chronicproblem,thisisevenrecognisedbytheauthori- emergency drug onstraints centres relatively the population: has notbeenachieved the hiddenobjective: correct to motivate difficult

case of non-respect of the MoU the of non-respect of case leave we sustain the regime that does not take charge of charge take not does that regime the sustain we distribution at this rate is not sustainable not is rate this at distribution - - - - -

management of HEM doubtful use of Koryo drugsis still widespread new drugs are introduced we distributed big quantities of drugs new vehicles for the army many goods cameintothe capital care forsevere cases few children were admitted in thefeeding phase is probably finished, nutrition becomes nutrition finished, probably is phase the doctors is difficult evaluate the nutritionalstatus of 117 MSF and North Korea 1995-1998 MSF Speaks Out

3. The nutritional program. 1. We still have not been able to document a nutritional During our last inter-desk meeting we all agreed on the or health crisis fact that conducting a nut. survey was a sine qua non 2. We have not been able to gain free access to popula- before negotiation of a new nut programme. Actually tions and places and it is unlikely that we will ever get UNICEF, WFP and ECHO is negotiating a nut survey which permission to do a random survey. includes 2/3 of the overall counties (83 out of 210 are not 3. We have not been able to clearly identify who would included) Already now the guarantee to conduct a ‘real’ be vulnerable people other than assuming children in survey is not very encouraging. This, of course, changes institutions (are there vulnerable families/communities, our position. I think: we can no longer insist to do a sur- population groups, geographic regions?) vey because it is a loosing battle; somebody else will do it. 4. We have been successfully distributing drugs and medi- Therefore, I propose to hand over the actual centres to the cal materials of which at least 75% seems to have reached government or the ones who are conducting the nut sur- the targeted health structures vey (because we have no means of evaluation) and keep 5. We do not know whether all populations have access to a nut program incorporated in the above mention medical these health structures program. At this time, Sonya is working on an overview 6. The feeding centres we are running see very limited and an analysis of the data from the different centres. numbers of malnourished children. Not clear whether 4. Institutions. due to lack of malnourished kids or lack of access. Also If there are pockets of malnutrition, they will certainly effectiveness of treatment of kids in FC cannot be inde- exist in the institution (social welfare centres, boarding pendently assessed. […] We come to the following pre- schools, orphanages). Negotiations were already done and liminary conclusions […] limited access was granted [...] but as before the visits, * The programme has so far not been able to achieve its were very often arranged. We should make it clear that original objectives and cannot be sure that we will be able we need to have access to the existing institutes, the to achieve them in the near future freedom to make an evaluation and when necessary to set * The Korean government still has full grip on us and we up a program. might have been successfully used by the government to cover up a crisis Timetable. * By lack of other access and due to ample ECHO funding Upon my arrival there will be first discussion with the focus of attention seems to have shifted too much towards team. On Monday there will be a first discussion with drug distribution part of programme the FDRC on the future. At the end of my visit there will Otherwise we feel there are three questions that have so be another discussion on the proposed objectives and a far not sufficiently been answered: debriefing with the team. Upon my return we should have - We say that human rights are violated. Which human an inter-desk meeting for debriefing, conclusions and rights do we refer to and how are they violated? And what future plans. (13/08/98 if possible). At this moment, it should be our answer to that. is difficult to put cut-off points. I prefer to wait for the - Who are the vulnerable populations that we should try outcome of the negotiations. Voilà, this is a synthesis to access? on what was more or less discussed during our inter-desk - Has there been a famine/crisis and do we know that it meetings. Meanwhile the NK had a reunion on the same is over now? issues and it will be interesting to compare both and create a mutual approach (oef). Feel free to give comments Balancing reasons to stay... appreciations on this. I am leaving on the 29 to NK. * We feel that Korean govt is trying to cover up a crisis and denies the population in need to be assisted and given relief. We need to be as close as possible and continue to try and get access, to try and assist (effective Minutes “North Korea Cluster Meeting: humanitarian assistance). Conclusions and Recommendations,” Amsterdam, * But even so when can not be very effective, just be pres- 29 July 1998” MSF Holland 29 July 1998 (in ent (proximity, solidarity). English). D132 * We need to continue to try and witness humanitarian crisis and human rights violations (witnessing/advocacy). Extract: * A change is expected in the short- or medium-term Reading the different documents.... future. A violent change with important humanitarian 1. Minutes of meeting MSF DPRK in Pyongyang crisis is one likely scenario. If that happens we should be 2. Data on Feeding centres present and prepared. 3. Interpretation of data FCs [...] while taking into * We might not have exhausted all possible strategies yet account our original objectives […] to gain access. 1. Investigate whether there is a health/nutritional crisis * One needs to have patience when trying to gain access going on to a country like N Korea. 2. Get access to and assist the population that are victims * If a new disaster happens we are closer at hand and still of this crisis (in case we indeed find that there is one) have contacts with govt. 118 […] and making the following observations […] […] Against reasons not to stay: should stick to that. that themomenthascometoleaveandallsections Finally weneedtoclearlydefinethresholdsthatindicate level -Should providepermissiontotrainevenatcommunity as well as droughts, well asepidemics, etc.) -Should allowustointerveneduringnewdisasters(floods, -Access to institutions -As widea geographical accessas possible Therefore the MoUshould include thefollowing: evidence of an emergency it does not mean there is none. -Make cleartotheoutsideworldthatwhilewedonotsee strategy to achievemain objective). objective oftheprogramme(canonlybeusedastool/ -Improving basichealthcareshouldneverbecomethe and natural disasters coverage, to be able to travel and note changes in harvest at the same time continue a reasonably wide geographical build upmoreregularandin-depthcontacts.While be donebychoosingpilotareaswhereweconcentrateand information andmoresources.Partlythiscan -Continue active attempts to gain access to more reliable lations -Continue activelobbytogainaccessvulnerablepopu- pre-conditions: cover upbythegvtandthereforetherearefollowing all meanstrytoavoidbeingimplicatedinusedasa continue totryandgainaccess.However,weshould,by relationship and build up an information base as well as We shouldprobablystayandcontinuetotrybuildour […] Weconclude and recommend: vulnerable population orto get reliableinformation). * Wemightneverbeabletoachieveouraims(reachthe happen. * Duringanextfamineorhealthcrisisthesamemight ourselves. and violationsofhumanrights.Inthiswayweimplicate * Govtseemssuccessfulinusingustocoverupacrisis messages. to dothatall the 3sectionstogetherand not 3different action andwhichmessageto giveinEurope.Please,try 1. Europelevel:Ipresumethat theHQwilldecidewhich Political matters. what happened in themeeting.Kiss […] absent untilSaturday,butI’ll callyouonFridaytosee Thursday’s inter-deskmeeting.Whatdoyouthink?I’llbe think it would be good topass it onto F andH during Attached: thepropositionforclosingdownMSFDPRK. I Hi both, Extract: D133 10 August 1998 (in English and inFrench). Bourgeois, MSFBelgianProgrammeManagers, Coordinator toWilliamClausand ” Closure, FirstEpisode,”

Email fromMSFDPRK 1998 andsigned by the president of MSF. ing thatMSFis leavingthecountryon 31st ofOctober -Official letter(withintwoweeks) totheFDRCmention- meeting. North Korea.MSFHollandis toorganisetheroundtable our informationandtodiscuss themutualapproachin with UNICEF,WFP,ECHO,and theNGOsinordertoshare -Round table meeting in Europe (2nd half of September) rumours about selling of MSF drugsinChina. sons why.Thedatawilldependontheconfirmationof that MSFisleavingthecountryandmentioningrea - -Press release (end of August or mid-September) saying -MSF will close theDPRK mission. We agreedupon: CONCLUSIONS François Jean. in the country. MSF could combine it with the study of order todiscusstheirapproachaswellMSFactivities table meetingwithUNICEF,WFPandfundingagenciesin and goingintoinstitutions.MSFcouldorganisearound agencies toreactbyhavingacloserlookonthesituation Perhaps thepressreleasemaypushUNICEF,WFPandother on the spot in order to follow up the impact afterwards. release? MSFhastogopublicwhilehavingtheexpatriates could stopitsactivitiesbutcontinuepresence.Press manent onebutalsotheregularvisitstocountry!MSF our presence?Presencedoesn’tnecessarily mean theper- data ofthe8months’study.Isitconceivabletomaintain react NOW(eveninpublicbyapressrelease)usingthe manoeuvre spaceforanyaction.ThereforeMSFhasto to certainareasorinstitutionsisdeniedandMSFhasno not confirmtheallegedseveremalnutrition.Theaccess After a one-year presence in the country MSF still can- DISCUSSION: of William Claus inJuly 1998. Those were the subjects of the discussion during the visit agreed uponacommonstrategyaswelltheobjectives. Back inApril1998allsectionspresent in NorthKorea Extract: the closure of MSFDPRK. that theHQsendsanofficialletterforauthorities HQ cametonegotiateanextensionoftheMoU,itisbetter told attheinter-agenciesmeetingonWednesday.As be signedandMSFwillcloseitsmissioninDPRK.It the localdoctorsandpopulation.AnewMoUwillnot MSF isanorganisationthatworksonthefield,closeto ask for raw materials and rehabilitation of drug factories. quite different;thenewhealthpolicyforcountryisto FDRC, it appearsthat the objectives of MSF and FDRC are 2. Locallevel:AftersomemeetingsbetweenMSFand in NorthKorea, Minutes “InternationalMeeting:MSFPresence English). D134 ” Brussels,13August1998(in

119 MSF and North Korea 1995-1998 MSF Speaks Out

-German money still at the disposal in MSF Holland for talked to them about medical issues, you’d think all dis- North Korea will be used: eases had been eradicated in Korea, listening to them. So ° for round table in the end, when I negotiated for a possible new contract, ° to pay the extra costs of the period which is not I said to them: ‘We want free access, we want to carry out financed by a nutritional survey.’ They replied: ‘We understand.’ But °institutional funds especially during the phasing out (to they didn’t need MSF anymore then. They knew there were be defined by Marie-Rose and to see with Pim how the plenty of people involved on the ground who would do as remaining money can be used) they were told, plenty of money available, plenty of NGOs -North Korea follow-up is to be done by MSF Holland in around, so they could do without us. As for staying to dis- order to keep contacts after closing the mission. tribute medicines and material they just needed to call DHL -Pipeline: Everything in the pipeline will be sent but no – they would have come to do the same thing! new orders will be introduced. William Claus, MSF Belgium Programme Manager, (in French).

Letter from Ri Si Hong, Acting Director, Department of External Affairs, Flood Damage Rehabilitation Committee DPRK to William Claus, Programme Manager MSF Belgium, 24 We had to renew a sort of collaboration protocol August 1997 (in English). D135 with the authorities. For this, the authorities sum- monsed us to Pyongyang to tell us they were very Extract: happy with MSF’s work. They were delighted with our col- Dear Mr. William Claus, laboration and had decided to continue with MSF. They also I would like to express my thanks to you and MSF for told us that from now on, it wasn’t worth MSF teams leaving providing sincere assistance to our people who are suffer- the capital because we’d done such a good job of training ing from shortage in medicines due to natural disasters the North Korean teams. So in the future, MSF would just lasting for several consecutive years. Your humanitarian intervene at capital level. They announced all this in assistance encourages our people to get rid early of the Korean-fashion; with a big smile. Yet during my visit I aftermath of natural disasters and has been used effec- couldn’t have explained our conditions of intervention more tively in curing patients. I also take this opportunity to clearly to the person in charge of humanitarian aid, telling highly appreciate Madam Marie Rose Pecchio and MSF him it was all or nothing, and if these conditions weren’t team members for their work in our country and express respected MSF would prefer to leave. When he made this thanks to them. We will not forget MSF for its assistance proposition to the local team, I immediately wrote him a to us suffering difficulties. letter saying: ‘When I consider what was said in our previous meeting, which you no doubt recall, I can only think Mr William Claus there has been a misunderstanding. I explained to you at Médecins Sans Frontières the time that MSF would never accept to work at a dis- Brussels, Belgium tance.’ Obviously I never received a reply to this letter. He didn’t even tell the local team he’d received it. It was a We hope you and MSF pay deep attention to provide polite expulsion; in Korean-fashion. We didn’t leave; they pharmaceutical raw materials as we have proposed during kicked us out. We fought to the end for access to the vic- your recent visit to our country. I wish you and MSF every tims. Obviously this begs the question on where the limits success in future work. to this fight should be.

Dr. Eric Goemaere, Executive Director MSF Belgium, (in French).

The lack of access, the inability to evaluate the quality of our programme and the lack of any perspectives of improvement all led to our decision to withdraw. I understand Marie-Rose’s reasoning. But we were It was framed as a MSF decision not to continue but talking about a budget of 5 million ECUs; we didn’t want to the North Koreans set such conditions that it was in invest on this scale anymore. They wanted us to continue fact, their decision that MSF could not continue. I with the distribution like before and nothing on their side think on that point, there was not much disagreement any- guaranteed that we would have increased access to orphan- more between the sections. In the end, we did not have a ages or psychiatric institutions. We had no access where we lot of disagreement that we had to withdraw - the North really wanted to work. Our ideas didn’t interest them. They Koreans were making it impossible for us to work. The least didn’t want us to be present with expatriates outside the we should do is have a conference and share our informa- capital. They said that they were capable of doing the work tion with everybody else who is relevant. I think that we 120 themselves, that they were just short of material. When we should have stayed there because we should have realised it’s goingto improve. This is it.’ don’t getaccess,itcostsalot;wehavenoguaranteethat they want,it’snotthesame,soweleave.Because and saidsomethinglike:‘thisiswhatwewant, one or twoweeks, William came back to see the authorities they weretripledemotivatedafterthepressreleases.After demotivated. Asforthemanagementteam,Icanimagine survey andtheydidn’twantustodoit.Theteamwas dren, anditwasdifficult.Wewantedtodoanutritional exhausted. We’vealreadytriedandtofindthechil - ates wereherefor6or12monthsandeverybodywasabit that’s howthethingsendedquitenaturally.Allexpatri - raw materialsandthatyouhelprebuildoursystem.’So They answered:‘no.whatwewantisthatyougiveusmore or something,WilliamandMarie-RoseproposedtotheFDRC. work inourownprovince.Andthat’swhat,onAugust7th special relationship between MSF andNorth Korea. just politicsfromNorthKorea.Idon’tthinktherewasa from anNGO.Theywereonlytryingtogetthatmoney.Its the shelfforNorthKoreaandthattheycouldonlygetit they knewexactly,attheEUlevel,howmuchmoneywason another. TheymusthavehadsomanyvisitsfromNGOsand a choiceofNGOsthattheycouldeasilytradeoneinfor NGOs werewillingtogothereandintheend,theyhadsuch just tokeepthingsgoing.From1995on,moreand assistance, they’retryingtogeteverythingtheycanget, that this is theway. to happen and if you want to work there, you have to accept ation. Youshouldhaverealisedbeforethatthiswasgoing approached thisliketheGreatLakes.Or,asanyothersitu- make peryear-orfiveyears.Youshouldnothave you measuresuccessbythemillimetreandprogress when goingintoNorthKoreathatthisissuchacountryand Dr. Corien Swann, physician, MSF Programme in DPRK, [...], Physician, MSF Programme inDPRK, September ect, nowyoumustgo.’It’sacountrythatneeds but toldusveryfriendly:‘It’stheendofproj- It wasclearthatthegovernmentdidn’tkickusout Programme Manager].Wesaidthatwewantedto other meetingwithWilliam[Claus,MSFBelgium We hadthismeetingwiththewholeteamand Pim DeGraaf, MSF Holland Executive Director to December 1995, January 1997, June1997 January to September1998 (in English). (in English). (in

English).

from hunger. 1995, 10%oftheNorthKoreanpeoplemighthavedied Congressional delegationstatedtoCNNthatsince on itsreturnfroma4-dayvisittoPyongyang, a US to developacommunicationstrategy.Thesameday, about MSFpullingoutofNorthKorea,started On 19 August1998, with some journalists having heard Claus. The lineIgotfrom William is: from North Korea. Asthiswasnews to meIcalledWilliam called me yesterday asking for details of MSF’swithdrawal press quotingMSF’sWilliam ClausonNorthKorea.AP Below, pleasefindoneof the manyarticlesintoday’s Extract: The Before that there will no officialstatement of MSF. NK refugees done byParis. ing ofthatwilldependontheoutcomesurveyamong reasons whyMSFwillwithdrawfromNorthKorea.Thetim- -An officialpressreleasewillbewritten to explain the ferent sections lastweek it wasdecided that: the earsofjournalists.Duringameetingamong3dif- Dear all Extract: We willkeepeverybodyinformedonallthedevelopments. the work. -We stillhaveteams on thegroundthatarecontinuing release. we havealltheelementstomakeagoodanduniquepress -There willbeanofficialstatementfromMSFassoon obvious thatbothpointsofviewcannot be matched. groups andprovidemorequalityinsidetheprogram.Itis tion, reductionoftheactualprogram,accesstovulnerable medicines. MSFinsistsonhavingaccesstothepopula- and thedeliveryofrawmaterialsforproduction the rehabilitationofexistingpharmaceuticalindustries were negative. Theauthorities asked MSF tointervenein negotiations onasecondMemorandumofUnderstanding draw of MSF you can tell them that, the results of the last about it.Ifjournalistsarecallinganeventualwith- end September,beginningofOctober.Youwillbeinformed NGO’s. Ifeverythinggoeswell,thisshouldtakeplaceatthe ference todiscusstheNKchallengewithUNagenciesand -After the press release MSF will organise a round table con- fact that MSF will pull out of North Korea has reached

19 August1998 (in English). directors ofcommunicationandpressofficers, Peter Thesin, MSF Belgium Press Officer to MSF “MSF’s PullingoutofNorthKorea,” English). directors andpressofficers,20August1998(in Hong KongPressOfficertoMSFcommunication “ North Korea,” D137 Email fromJustineGeldard,MSF

D136 Email from

121 MSF and North Korea 1995-1998 MSF Speaks Out

1)MSF is negociating access to target populations, institu- the Sino-Korean border to collect witness accounts from tions, vulnerable groups… North Korean refugees and academics, identify a network, 2)The govt. priorities do not seem to be the same as MSF’s and look into future work possibilities. They will be dis- 3) Should we not be able to reach an agreement we will cussed upon his return in early September. MSF would like have to review our position to organise a round table in mid-October with external participants who have a wider analysis of the situation “Famine may have killed 2 million in North Korea” – CNN – and the system. Beijing – 19 August 1998. Two million North Koreans - nearly 10 percent of the population - may have died during three years of famine in North Korea, U.S. congressional aides said Wednesday. ”Exploratory Mission to the Sino-Korean border [...] “The food shortage continues,” said Mark Kirk, one of – 18 to 25 August - Marcel Roux, Marine the bipartisan delegation’s four members. “They are out of Buissonnière, Dou Rae, François Jean,” Report, food. That’s clear.” Over the past three years, the famine September 1998 (in French). D139 has killed an estimated 300,000 to 800,000 people annu- ally, with the number of deaths peaking in 1997, Kirk said. Extract: He said the figures came from U.S. government sources, This mission had a double objective: collect refugee tes- refugees and North Korean exiles. “Two million would be timonies of the situation in North Korea and look into the highest possible estimate,” Kirk said. Deaths were possibilities for future work in/around the border area. most likely from famine-related illnesses, like pneumonia, We will not go into the first point here other than empha- tuberculosis, and diarrhoea, rather than starvation itself, sising that the testimonies collected, conform to those he said. [...] of last April’s mission, and above all are coherent with researchers’ work on North Korea. The refugees’ personal Meanwhile, an official from Doctors without Borders said accounts confirm, detail, and shed light on the analyses on Wednesday that the medical aid group may leave North of academic specialists on the North Korean economy Korea unless the government grants it better access to and system. Above all, we aim to share our reflections on people sickened by famine. Doctors without Borders has the operational side of things. Obviously we are not in a distributed medicines in North Korea for a year, but has position, at this stage, to make any detailed propositions. found it hard to gauge the results because of the govern- This brief visit to the border was just the first stage in ment’s lack of cooperation, said William Claus, an agency the search for a new way of working in Korea, or at least official based in Brussels. The group, one of a half-dozen that is how we see it, and as a first step: we have decided aid organizations in North Korea, has 12 people working to try something from the Chinese side. Marcel, Marine, in the three provinces, Claus said. and Dou Rae are keen to be involved in the attempt to find new modes of intervention, because this is what is required and there is obviously a volunteer aspect to such a plan. First of all, because we do not want to drop the North Koreans, given the terrible situation they are in at From 18 to 25 August 1998, the MSF France team the moment, and then because we are well aware of the in China together with François Jean, from the MSF difficulties with and limits to the aid we would like to pro- France Foundation, carried out a second assessment vide via China to those left by the wayside in North Korea. on the border between China and North Korea. Beyond collecting testimonies, their aim was also to explore What does this involve? options for the delivery of assistance from the border 1) Help to refugees both to the refugees and to the people inside North Little working space in China (!), especially for a foreign Korea through cross border activities. On 9 September, organisation […] leaves a very limited possibility, given extracts of the testimonies were published in the South the few working options of supporting individual initia- China Morning Post, presented as collected by an MSF tives or the action taken by certain networks, whilst first team. ensuring that the support we offer is not superfluous (aid from Korean or American churches, the same networks)? In short, it appears that there are limited possibilities, especially bearing in mind the outcome of those caught Minutes of MSF France’s Board of Directors’ by the business of fines for providing illegal aid […] Meeting, 28 August 1998 (in French). D138 At first glance, however, it seems that there may be more possibilities in Yanji (town/anonymous, Korean/ Extract: Chinese, prefecture/autonomous, investments/business, North Korea etc.), maybe also at Hoonchoon, and therefore possibly The negotiations for an agreement protocol with the to access Russia (?), and in places where the China/Korea North Korean authorities did not reach a conclusion. Our dilution is more balanced: to be explored […] activities are suspended as from the end of September. 2) Aid in North Korea 122 François Jean is carrying out an exploratory mission on We think that it is possible to provide aid to the popula- effective and equitable distributionatlocal level,asall that a modest approach is the best way to guarantee an (on average10tonnesperoperation). Wehavebeentold tonnes inoneyear),splitup betweensmalldispatches only managedtogetverymodest amountsthrough(271 Buddhist SharingMovement, forexample),theyhave through. Asfortherareorganisations involved(Korean circles findacommercial cover forthefoodtheysend volume, thoseKoreansinChinalookingtohelptheirclose and acts of family solidarity. Once they go over a certain and settingupoperationsoverabovesmallnetworks lack ofmeansbutthedifficultyinbuildingupchannels involved, itseemsthattheproblemisnotsomuch Following ourinitialdiscussionswithpeoplealready -The first optionstrikes us as the most promising. channels. supplying aidacrosstheborderorbuildingupourown porting theorganisationsornetworksalreadyinvolvedin Theoretically, therearetwotypesofpossibilities:sup- and direct aid. only waytomaybe,gradually,endupproducingconcrete step withtheurgencyofsituation[…]butitis mitment overthelongterm,whichisobviouslyoutof - Wouldalsorequirepatienceandperseverancewithcom to the scale oftheneeds […] for workwhichwillatbestremainverylimitedwithregard - Wouldinvolveacautious,discreteandindirectapproach approach inparticular. So, a borderintervention; the questionofaidtoNorthKoreaingeneralandthis Without countingtheparadoxesanddilemmasraisedby are wellawareofthedifficultiesandlimitsthisproject. progressive and cautious approach. Whatever the case, we level –andwewillonlyfindanswersbytrying,followinga ularly onthepossibilitiesofdealingwiththingsalocal is stillverytheoretical.Itraisesalotofquestions-partic part, thosewhoneedit.Asyouwillhavenoticed,allthis ourselves thatouraidreallymanagestoreach,atleastin (directors offactoriesorinstitutions,etc.)andreassure the outcomeofpeoplepreviouslyundertheirdirection take upcontactswithlocalauthoritiesconcernedabout networks that can help us identify groups of beneficiaries, lot dependsonourcapacitytoconnectupwithKorean possible forKoreanswhotryandhelptheirfamilies.A distribution system?Wehavetotryitout.Itisobviously to crosstheborderwithoutbeingsuckedintoregime’s outside theframeworkandperhapsitwillprovepossible by the regime for international aid. At least here we are if not impossible, to break loose of the framework fixed country for the last year, where it seems unthinkable, than theonewehavebeenstrugglingwithinside this unfavourableenvironmentproduceslessconstraints on theKorean-Chinesenetworks.Wemayevenfindthat the conditionofbeingdiscreteandindirect,i.e.leaning we thinkitmightbepossibletostartsomethingup,on very opentocross-borderactivities,saytheleast!Yet its mostsensitiveborders.AndasforNorthKorea,itisnot dim viewofhumanitarian initiatives starting up onone of option, obviously.China,asyoucanimagine,wouldtakea tion ofNorthKoreafromChina.Thisisnottheeasiest building upanetwork andmanagingfrom a distance. […] ularly difficult context, innovationintheways ofworking, on thepeople:determination todosomethinginapartic- sion. InKorea,morethanelsewhere, everythingdepends be largelydependentonthe peoplestartingupthismis- In Korealikeanywhereelse, our workingpossibilitieswill North Korea. ity oftakingcriticalandpublicpositionswithregardsto to openupworkingspacewhilstpreservingthepossibil - links withMSFbutmaintainingacertaindistanceinorder get overlysophisticated[…]Thisisnotabouthidingthe as simple as possible: we could trip ourselves up if things type solution.Whateverthechoice,weneedtokeepit commercial cover–butwecouldalsothinkofanUDA- by thefactthatmostcross-borderinitiativesadopta to wayapproachthisStalinistregime,asdemonstrated tion whilstbusiness,paradoxically,remainsthebestway or abusinessscreen?Thelatterisperhapsthebestsolu- Which begsthequestionofcreatingacoverassociation public debate, that MSF does not act in its own name. for ourinvolvementinNorthKoreaandtheaccompanying regards totheChineseauthoritiesofJucheregimeand of institutionalpositioning.Itmaybebetter,bothwith place toRajon-Sonbong-haveaddressthequestion will eventually-andmaybeevenrapidly,ifavisittakes If weopenupoperationalpossibilitiesonthisborder, about their work. ways peopleinvolvedinaidandcross-bordercommercego the existingnetworksandabetterunderstandingof try). Thesecontactsaimtoformabetterdefinitionof an investment area set apart from the rest of the coun- could beanaccesspointintoNorthKoreaorifit’sjust ‘development area’ of Rajin-Sonbong (to see if this region Finally, itwouldnodoubtbeinterestingtolookatthe certain localauthoritiesontheothersideofborder). staff herecouldundoubtedlyfacilitateourcontactswith definitely ahandicapwhilstitremainsfactthatsenior Korea (onthispoint,havingno‘guanxi’intheregionis nessmen), thenwiththeChineseincontactNorth (religious network,othersactiveonthisissueandbusi- ticularly inYanbian.FirstofallwiththeKoreansChina this stage,tomultiplycontactsinthenortheast,andpar- To sticktothemainpoints, it seems essential tous, at atory process we would like tocarry out. will followandbecomemoredetailedduringtheexplor- in apositionrightnowtobemoreconcrete.Propositions sounds bothtrivialandabitmegalomaniac,butwe’renot all findingtherightpeople[…]We’reawarethatthis work, perhapscreatinganadhocorganisationandabove -Setting upourownchannels implies buildingupanet- organisations involved –onthe contrary? exclude looking to set up forms of collaboration with the initiatives thanmultiplyingthechannels;whichdoesn’t which iswhytheproblemlessaboutreinforcingexisting impenetrable circuitsoftheregime’sdistributionsystem., bigger scaleoperationsriskgettingrecycledintothe 123 MSF and North Korea 1995-1998 MSF Speaks Out

Once again, we’re looking for rare birds – but we’ve already would give us some maize or farm produce, which we could got a few! Marcel, Marine and Dou Rae are ready to invest resell on the markets. We could then buy corn flour or larger in this effort, which is already looking like a long haul. quantities of cheaper corn with the money we made. She is This team has a lot of advantages: motivation, quality of able to help us because she is allowed to farm a small plot contacts, knowledge of China, aptitude to weigh up the of land in the mountains and keep the produce for her own possibilities in a context full of constraints, etc. and for consumption. Evidently, the same thing is not possible in Dou Rae, knowledge of certain Korean networks. town and town life is much tougher than life in the country.

So the exploratory phase can start already […], as soon Another way of making a living was to go to the coast and as the team of this already overloaded Chinese mission collect shellfish and seafood to sell in the markets. North has organised itself for taking on the new priority at the Korea has markets instead of shops where everyone trades Korean border. As a first step, the team needs to find the and is able to buy corn, food, and medicines. These markets time for two or three trips to the northeast to connect up are only allowed to trade in North Korean foods. It is forbid- with the networks involved and listen to their experiences den to trade in foreign produce, which is what everyone is so we can hone our own approach and define the ins and looking for because Korean produce is of a very poor quality. outs of our intervention. We should also use this first Those who trade in clothes from China remove the labels to stage to identify any networks/organisations for future avoid being caught. The only way to obtain medicines is to collaboration and recruit staff from the Korean community buy them from the markets because there are none in the in China (or Australia, Canada, Japan etc.). This recruit- hospitals. Doctors also recommend that herbs and roots be ment will be critical for the operation’s initial phase given gathered from the mountains. the central role the person/people chosen will play in piloting a programme that, for practical reasons such as The government gave us very little explanation in 1993 exercising discretion, MSF expatriates cannot be directly when the reduction in ration distributions began. We would involved in. Here again, we need to find the right person/ see the international aid come in to the port of Chongqing. people. It’s not possible to fix a time scale for all this, but It would be stored in the distribution centres then divided ideally we should pass from the exploratory phase to the in order of priority between the army and executives. More operational phase next December. than 70% of the aid would be allotted to them with the remainder being distributed to the people on national holi- Young men: 19 and 25. days. Some of the executives together with members of their Crossed the border July 29, 1998. Interview conducted in families would take advantage of their position and their Yanji, Yanbian Autonomous District, August 22, 1998 contacts to make a very profitable living by reselling the corn in order to amass other goods; consequently, a small There are six of us in our family, my father and mother, my portion of the aid would end up in the markets. Bearing in older sister, my two younger brothers and me. We grew up mind that a kilo of rice sells for 70 wons and a kilo of maize in Musan, a town close to the Chinese border. In 1989 my for 35 to 45 wons, most people buy corn flour or its by- father, who was 45 years old, died of a bowel infection. products whereas executives buy goods of a higher quality. My mother remarried in 1992 and we went to live on the east side of the country in Chongqing. We lived reasonably I graduated after two years at a college specialising in well during 1992 and 1993. However, at the end of 1993, car mechanics run by the army. After graduating, I was the distribution of corn became more and more infrequent. assigned to work in a factory but I am only a name on a list Up until this time, the highly organised system for issuing of employees as I did not go to work because we were not rations was clearly defined: paid either in money or in corn. My brother and I spent most -Adult - 700 grams of our time doing a little trading in order to buy food but -College graduate - 600 grams life in North Korea was becoming more and more difficult -4th year senior school - 500 grams and we could no longer make ends meet. We have family -Junior school - 400 grams living in South Korea and America but it is not possible to -Infants - 100 grams contact these countries from North Korea. Consequently, my -Honoured senior citizens - 600 grams + 2 won per day brother and I have come to China to contact these members of our family and ask for their help. Travel nowadays is Nowadays these same criteria are used on national holidays possible providing you are discreet and do not shout about for distributing rations. In 1995, rations were distrib- where you are going nor where you come from because the uted every 3 to 4 months. Then, they were distributed on tight restrictions on travelling which used to make it very national holidays, which are the 1st January, 16th February, difficult to move about are not so rigidly enforced. However, 15th April, 9th September, and the 16th November. On each there is a 50-won fine for unauthorized travelling if you are national holiday, we would receive the equivalent of two caught. days worth of corn, which is 1.2 kilograms per family. Our 22-year-old brother died of hunger in 1997, proof that the We left Chongqing by train on the morning of the 29th of distributions were not enough to live on. My older sister is July and we arrived in Musan after travelling for 3.5 hours. married and lives in the country where she works on a collec- We then walked for 2 to 3 hours until we came to the 124 tive farm at Kyangsan in Hangyan Bukdo. Occasionally, she border. Everyone in Haeliang knows that the way of life is and so is notreally very important. known as‘Huxi’.Thisdoesnotchangeagreatdealforus the governmentchancetochangeresidencepermits […] Therewereelectionsthislast26thofJuly,whichgave way oflifebutIcouldneverimprovemysocialstanding. in AmericaandSouthKorea.Thisdoesnotaffectmydaily army. Iamautomaticallydisqualifiedbecausehavefamily get theirstrengthback.Inanycase,Icouldneverjointhe They dosaythatparticularlyweaksoldiersaresenthometo in the hope of receiving rations however poor they may be. ing about.Manyoftheyoungwouldliketojoinarmy lots ofverythinchildrenwhohavetostealeatwander- hanging ontothedoorswhofallfromtrain.Yousee people travelling ontheroof get electrocuted and others are oftenaccidentsontheovercrowdedtrains.Ihaveseen because thereisaregularcollectionservice.However, You donotseebodiespiledupbythesideofroad everyone is busywatching everyone else. are committingacrimebysaying:‘it’sbetterinChina,’and the borderbutwecannotsaythissortofthingopenly.You better in China and lots of people would like to cross over per meal and three meals a day. The best rations were for eat. In1995, an ordinarysoldierhad200 gramsoffood service, Ifoundoutthatoutside peoplehadnothingto After Ileftthearmyin1994, aftermorethan10years’ Soldier, 35, and his9-year old son: camp for three years. explanation. WewerebeatenandIwasputinalabour of mysonIwenttohissuperiorofficerandaskedforan raise animalsforfeartheywillbestolen.Afterthedeath Today peopleareafraidofthearmy.Theydarenoteven the armytostealfrompeople.Hewasimmediately shot. homes. Onedaymysonprotestedandsaidhewasnotin they foundnothinginthegranaries,robbedpeople’s Small companies were sent out to steal village stocks and if my son’sunitorderedthemtoforageinthecountryside. daily rationsalthoughitwasnotenough.Sothechiefof leave thearmy.Mysonwasanarmycadet.Soldiersreceived a retired soldier. Many years ago I fell sick and so had to expressing dissatisfaction:theyendedupinthecamps.Iam food problems. At thetime,peoplewrotetogovernment the interiorofcountryeverydistricthadtosolveitsown bicycle. Welasthadrationsin1993.Thegovernmentsaid hiding here for over a year. We crossed by giving a guard a 14. Seven are dead in North Korea, the rest of us have been Counting childrenandgrandchildren, tier that give insightsinto life inthestricken country. Koreans byMédecinsSansFrontièresontheChinesefron- The followingareextractsfrominterviewswithNorth Extract: 9 September 1998 (inEnglish). S “Tales ofHardship,”byJasperBecker,Beijing, outh ChinaMorningPost(HongKong), we wereafamilyof the summerof 1998.Therewasnodoubt that operations when MSFwas preparing itself to pulloutofNorthKorea in involved inthesetwoways.Then athirdoccasioncameup customs, thepositionstoassume duringhisvisit.SoIwas go overthereandhewanted to learnaboutthenormsand to givehimsomeSouthKorean contactsbecausehehadto the SeoulPeacePrizein1997, PhilippeBibersonaskedme tor atthetimeandinchargeofthisdossier.WhenMSFwon detail withMarcGastellu,whowasdeputyoperationsdirec - 1995. I’dfollowedMSF’sinvolvementinNorthKorea responded to North Korea’s call for international aid in and that the foreign medicines make one sick. China carryviruses,thatthefoodaidmakesoneloseweight accept foreignhelp.Theyeventellusthattheclothesfrom to tightenourbeltsuntil2003.NorthKoreaistooproud skin isblackandinfected.Thegovernmenttellsuswehave swollen andeyesbarelyvisible.Theirlimbsarebloated;the Hyesan. Manychildrenarewithoutstrength.Theirheads The situationtodayisterrible.Manypeoplehavewalkedto tion. So onekeeps everything inside. Everyone is frightened. ment isdealttothewholefamilydownthirdgenera- If oneisdenouncedforsayingtraitorousthings,punish- with China: Couple withinfantfromHyesan,atownontheborder we will go back. crossed the river. It was easy. When we have enough money piled upbythedoor.Whenwegottofrontierjust The railwaycarswerelockedandthosewhodiedsimply other boys.Becausewehadmoneycouldtakeatrain. HK$15). We took to the road, together this time with two home. Grandfatherhadsoldthehousefor300won(about I managedtoearn300Yuan(aboutHK$280)andwent some friendsandwecrossedthefrontier.Throughbegging and travelaroundtofindfood.Fourmonthsago,Ijoined There werecorpsesintheroad.Wehadtoleavehome so wecouldsurvive.Thenpeoplehadnothingtogiveus. first neighbours helped us with a soup or rice or maize, tion oftheintestine.Welivedwithourgrandfather.At our youngerbrother,whowasfive,diedofaninflamma- mother diedoftyphusinthesameyear.Soonafterwards, metal factory.Fouryearsago,hediedofparatyphus.Our We wereafamilyoffivefromHaeliang.Fatherworkedin Two brothers, aged 15and19: during festivals. they need.Whatremainsisdistributedtothepopulation first distributed to the army, then the cadres take what arrives, 30tonnesofcerealsforexample,20are distributed everythreeorfivemonths.Whenashipment secret police,thesecurityservicesandcadresgetfood people inPyongyangstilleatwell.Peoplewhoworkforthe pilots who obtained 800 grams a day. Today, I hear only I wasworkingintheParisheadquarterswhenMSF doing aMastersinpoliticalscienceonNorthKorea. Before IjoinedMSFspenttimeinSouthKorea, 125 MSF and North Korea 1995-1998 MSF Speaks Out

were coming to an end and the Memorandum of Understanding North Korea has been technically at war since 1953, but would not be renewed. At the time, MSF France wanted to also because the army has control over the country and so document this famine to show how it was being manipu- forms part of the privileged groups receiving assistance. We lated, and explore operational alternatives. This was when learnt more about how this assistance worked: The stocks François Jean, who worked at the Foundation, asked for my were used to feed the army, with food being stored for war help in setting up contacts with people in my network, and efforts, the party’s senior officials, and those loyal to the proposed that I accompany him to South Korea. We left in regime concentrated around Pyongyang and the big towns, August 1998, and we met people working on North Korea, on the main routes to the capital, with this class of the mainly South Korean academics who are very involved in faithful representing around 11-12% of the population and this research topic, which has a direct impact on them. I’d controlling the country. maintained contacts with them and others, mainly protestant organisations who provided one-off aid to North We built up a vision of the destruction and violence gener- Koreans in an unofficial and clandestine manner. We did ated by this system when we met people coming from the some exploring on who did what. But François’ objective was camps. We obtained confirmation of economic events since to research the situation to show that aid wasn’t reaching the collapse of the Eastern bloc and a famine which started the most vulnerable people and then go on to improve the at the beginning of the ‘90s, affecting the hostile classes information available on the mechanisms of power and the first of all and reaching the upper classes in the middle of system in place in order to demonstrate that humanitarian the ‘90s (‘94-’95), i.e. at the moment of the call for inter- aid could never reach the most vulnerable people. The sys- national aid and MSF’s arrival. We made the links between tem was discriminative by nature, so once aid passed what had happened during North Korea’s economic collapse, through the system, it followed the same lines. the way the system was structured and the way assistance had been channelled. It echoed what had transpired during Sophie Delaunay, research officer, Foundation MSF our time inside the country and the difficulties we had in France, June to August 1998 (in French). our work, which had pushed us to question the pertinence of being there at all. We realised that this assistance was used to reinforce a regime that oppressed its own population and didn’t reach the most vulnerable people it was meant for.

The second trip took place during the summer with Marine Buissonnière, administrator, MSF France in the first stage involving François [Jean] and Sophie China, December 1996 to January 1999 (in French). [Delaunay] in South Korea. They contacted activists heading groups working with refugees on the border and researchers working on North Korea. These latter could help us understand how North Korea’s society and economy was structured. Then François continued on with us - Marcel, the On 9 September 1998, the MSF USA Programme Officer Korean who worked with us at the time and me - the and a group of US NGOs held a meeting, with US 3 people involved in the first exploration. We went up to the Congress representatives and the UNICEF representa- border and saw not just all the people we’d met in March tive in North Korea. but also the contacts arranged beforehand by François and Sophie during their visit to South Korea. This allowed us to complete our image of what was happening on the border. We did the same exercise: meetings with field activitists involved in the provision of aid and direct meetings with Our message was in total contradiction with what North Korean refugees at different points on the border, via other American NGOs and Congress were trying to different networks. This gave rise to a second report, which say. During this meeting, I was shot down in flames tried, with François’ support, to be less anecdotal and more The American NGO community, like Congress, was interested structured with regards to the elements we were trying to in Korea. Korea always aroused strong feelings in the United understand through these people’s stories. We can’t claim States. It’s a bit like the Congo for the Belgians. There have that our methodology was perfect but we wanted to go always been links and religious American missions installed further than the March report. over there. There was the Korean War. There was a meeting on the morning of 9th September, and the doctor Omawale We received confirmation of our suspicions about the sys- of UNICEF, the European Union representative for Asia and tem, its class structure, the discrimination existing since the N° 2 for the WFP were all present. There was certainly 1953, which had always been behind the organisation or someone from USAID or the government or State Department structuring of the country, and thus access to services and as well and American NGOs working in the WFP consortium. daily needs, and which simply continued when international aid appeared. This aid was channelled via the public distri- In September 1998, all American NGOs intervening in North bution system, which discriminates against its population, Korea were under the umbrella of the WFP. They weren’t and so aid became a tool for discrimination. We also learnt authorised to send American personnel, so they weren’t 126 a bit more about how the army was organised. Because directly operational and were fighting for one thing only they were doing. We weren’t able to change much. working groupofAmericanNGOs.Wetriedtoworkoutwhat etc…’ That’showwestartedabitofparticipation in this saying tohim:‘Icanexplainwhywe’rehavingproblems, annoying himagaininperson.SoIspicedthingsupabit, The guywasn’texpectingsomeonefromMSFtobethere, the room,Isaid:‘yes,you’rehavingdifficulties with us.’ English mustbecalled:DoctorsWithoutFrontiers.’Iwasin ‘we’re havingdifficultieswithoneorganisation,whichin Government. One of the three started out by announcing: Damage and Rehabilitation Committee of the North Korean a meetingwiththethreerepresentatives of theFlood That afternoon,withthesameworkinggroup,wehad You must review your position!’ more aid.Itsendsacompletelycontradictorymessage. right atthetimewe’reapproachingCongresstoaskfor You can’tleaveKorea.saythesesortsofthings completely overwrought,saying:‘MSF,youcan’tdothat. pushing forincreasesinaidtoNorthKorea.Shebecame was there for Tony Hall, the Congressional representative us. Yes,we’refundingtheirprojectetc.’DeborahYang he was lapping it up. He said: ‘its true MSF approached with its donors. As for the European Union representative, because MSFBelgium hadn’t beenveryclearinitsrelations old donor!TheEuropeanUnion,noless!’Itwaspainful to exposeMSF’sdependenceonadonor:‘andnotany the EuropeanUnion.TheAmericanNGOswerereallyhappy Union. Wecouldn’tdenythatwewereheavilyfundedby by MSFHollandwerealmost100%financedtheEuropean the programmerunbyMSFBelgiumandpartofone with thisissue.Ofthethreeprovinceswewereworkingin, European Unionfundinghasended.’Theytriedtosinkus you’ve takenthisdecisiontopulloutjustatthetimeyour the EuropeanUnionrepresentative: ‘well well,howstrange, term problemetc.’TheAmericanNGOsremarkedinfrontof have access before. You haven’t understood, it’s a long up regionalofficesindifferentprovinceswherewedidn’t long negotiations.UNICEFhasgradually managed toopen haven’t understoodtheKoreanculture.It’sacultureof Dr O.ofUNICEFsaidtous:‘MSF,you’rearrogant.You selves. They said:you’retotally mad.’ more’ itcausedariot,theywerecompletelybesidethem- us saying:‘we’releaving,wedon’twanttoworkthereany to beacertainaccessthepopulation,sowhentheyheard all thewell-knownconstraints–hadwhattheyconsidered Korean government,hadpersonnelinthefieldand–despite ernment, etc…Forthem,MSFwasregisteredwiththeNorth community thatthey’dgotfurtherthantheAmericangov- out directoperationsinordertoshowtheAmerican-Korean with the North Korean government. Their objective was carry recognition i.e.tobeableregisterthemselvesdirectly – whichtheygotayearlaterwasindependent Antoine Gérard, Head ofProgrammes, MSF USA, (in French).

country that remained cut-off fromforeign visitors. was blocked from visiting another two-thirds of the tance hadpreviouslybeenpresent,howeverthisteam of thecountry’sterritorywhereinternationalassis- vey inNorth Korea. Theteamwasable to accessathird received authorisationtoimplementanutritionalsur- On 21September1998,UNICEF,WFPandtheEU from North Korea. would issueapressrelease toexplainitsdeparture present inNorthKoreainformed theFDRCthatMSF September, theexecutive directors ofthe3sections the dateofplannedpressconference.On28 North Korea.Anembargowasputuntil30September, issued tothepressregardingMSFwithdrawalfrom Programme Managersworkedoutthemessagetobe On 20September1998,theMSFNorthKorean country where the situation is more serious”. most vulnerable.Wesuspectthatthereareareasofthe about thedifficultiesencounteredfor“reallyreaching either. Jean-FabricePietri,Coordinator,nonethelesstalks ent sinceearly1998,isnotreadytoventureanoverview to stayinthecountry.”ActionContreLaFaim(ACF),pres- vary, and “if we want to have a long term impact, we have objectives ofthedifferentorganisationsonground nonetheless theFederationhasaverywidemandate.The tion ofitsaidand“nodiversionhasbeenobserved”.But Federation; hisorganisation“cancontrol”thedestina- malnutrition,” reports Michel Tailhades, a doctor from the The onlythingwe’vebeenabletoseearecasesofchronic ground since1995.“We’veneverseenpeopledieofhunger. Cross andRedCrescent,whichhashadsevenpeopleonthe famine, asdoestheInternationalFederationofRed that itisequallyunabletodrawupanoverviewofthe relates ChristianeBerthiaumeoftheWFP.UNICEFstates vided bytheWFPwerefoundinthreeshopsPyongyang,” diversion ofaidonce,inFebruary:“1000litresoilpro- Korean provinces,statesthatithasonlycomeacross lected by MSF come from. WFP, which works in 12 North border withChinawheremostofthewitnessaccountscol- out of210inthecountry[...]excludingareason Union. Butthesurveycanonlytakeplacein130counties World FoodProgramme(WFP),UNICEFandtheEuropean the firsttimefora‘nutritionalsurvey’tobecarriedby On the 23rd September, North Korea gave permission for The difficulty of carrying out surveys: Extract: Franklin, ”The DifficultyofCarryingOutSurveys,Romain 1998 (inFrench). Libération D140 (France) 30thSeptember

127 MSF and North Korea 1995-1998 MSF Speaks Out

fines it’s policy and conditions for the delivery of aid, and stops looking the other way when confronted with such “North Korea Press Conference,” Email from a system. Pierre Salignon, MSF France programme manager, 24 September 1998 (in French). D141 Documents to be circulated: testimonies collected on the border (we’ll get the translation done in Paris), press Extract: release announcing MSF’s departure and the reasons why, Hello everybody; Dominique’s report (summary) on the children in institu- Last Monday, a meeting was organised to speak about the tions. Embargo with the media until 30th September, next press conference in HK about North Korea. Please contacts on national level in France, Belgium, and Holland find enclosed a little update about this meeting. The + other sections in process/to do. Concerning Paris, con- press conference will be organised in Hong Kong the 30 tacts have already been taken up with the different press Sept 15h00 (9h00 Paris time). Possible attendees: Eric including the daily papers (Libération, Le Monde, etc), the Goemeare, Dominique (?) doctor MSF Pyongyang, Marine weeklies, and the radio. It seems that the announcement MSF Beijing who went to the Chinese border and may be of our departure has raised a lot of interest due to the Marie Rosé HoM Pyongyang. Samantha will be in charge of analysis we have built up these last few months, the bor- the organisation of the press conference. der visit, the work on children in institutions, our analysis of the health situation and our conviction that thousands Content of our message (sorry in French I already wrote of Koreans will continue to die. So we can expect a lot of it before): coverage in papers such as the Libération, which wants to 1/ MSF is obliged to leave North Korea (not a voluntary publish special dossiers on the 30th or 31st September to departure; health is not a priority for the authorities; accompany our departure, including interviews and using request for basic materials by the authorities to re-launch the documents that will be distributed during the press their pharmaceutical industry, impossible to have access conference. None of which will please the North Koreans. to/proximity with what we define as “vulnerable groups” – nothing like the more political definition of the authori- Marie-Rose and Sonja in Pyongyang and Brussels have ties - etc.). been informed due to the planned departure of the last MSF staff from the country on around the 5th October. 2/ Obliged to leave whilst being convinced that the situa- That’s it, in short. tion will get worse and thousands of people will continue Take care to die and pay the price of the regime’s policy. Evidence PS English translation of witness accounts collected from of a catastrophic food situation, no matter what it’s called the refugees on the border is in progress. It will be avail- (famine, food shortage etc.) ref François Jean’s argu- able by Monday morning at the latest and passed on to ments. There were discussions between the sections to see Samantha and the MSF network. if the term famine was appropriate. Opinions are divided. This is not like a Sudanese famine, but the consequences of 1) a structural food deficit lasting several years; 2) a distribution of the available resources by the regime in Minutes of MSF France’s Board of Director’s accordance with what it considers the priority for its sur- Meeting, 25 September 1998 (in French). vival (meaning that certain categories of the population D142 are absolutely not priority). People are dying because they are weak, victims of a chronic food shortage to which the Extract: implosion of the health system should be added. A press conference will take place in Hong Kong on the 1st October to announce and to explain our departure from 3/ Illustrations: North Korea . Philippe Biberson emphasized that we must - Analysis of MSF’s medical programme during the last nuance our discussions because our position is complex months of its presence with all the limits of our position; to defend. We should not say too much and at the same implosion of the health system, future very black in terms time, we must be able to give factual arguments, other- of health, etc. wise people will suspect we are too ideology-based. On - Evaluation of the situation of children in institutions the 21st of October, there will be a meeting along these (ref Dominique’s report which ties in with info obtained lines in Amsterdam. From now to the end of the year, 5/6 on the Chinese border; lay out currently under revision). people will meet to reflect on a more political discourse: - Witness accounts from refugees on the Chinese border how does the system function? How is it organised? We (ref report in the process of being translated into English). should put together all the refugee testimonies over the last few years. 4/ Analysis: We should put together all the refugee accounts collected - Terrible situation, perversion of the system, inadequate- over several years. ness of the aid system (assistance doesn’t reach the most vulnerable, no control possible etc.) etc. 128 - Urgent that the community of international donors rede- Dr Karim Laouabdia -Executive Director MSF France Dr Alex Parisel -Executive Director MSF Belgium Dr Lex Winkler -Executive Director MSF Holland Yours sincerely these matters. to engageinadialoguewith thegovernmentofDPRKon different working agreements. At alltimes we are willing the peopleofDPRKandarewillingtoreturn,albeitunder We reiteratethatweremainavailableforassistanceto conceal our differences with the government of the DPRK. statement willbeissuedinwhichwenotableto accountability mentionedabove.Forthatreasonapress our opiniononthesituationinDPRK.Thatispartof public andthedonorsofreasonsourdeparture At the moment of our departure we need to inform the DPRK itself is notan activity, appropriate for MSFtodo. the middleofAugust,supporttodrugsproductionby earlier, amongstothersinhisletterthatyoureceived Médecins SansFrontières.AsDrGoemaereexplained ority to these needs that it seeks further assistance by We canonlyregretthatFDRCdoesnotgivesuchapri- and nutritional needs inDPRK. refugees inChina;theywitnessabouttheextrememedical observations wereaddedaccountsfromNorthKorean medical field that should be urgently addressed. To these and other children. Also, we have seen many needs in the need formoreattentionandbetterassistancethese sufficient malnourishedchildrentobeconvincedofthe ing conditionsimposedonus.However,wehaveseen consistently expressed ourdisagreementwith the work- that wouldsupportourwork.Forreasonwehave by usandtocollectrelevantmedicalnutritionaldata in theprovinces,tomonitoruseofdrugssupplied in DPRKlimitedourabilitytoassesscorrectlytheneeds institutional donors.Therestrictedaccessgrantedtous of theaccountabilityrequiredfromusbyourprivateand dard inthefieldofhumanitarianwork.Theyalsoarepart monitoring oftheresultsourworkarecommonstan- the needsinfieldofnutritionandmedicine humanitarian assistance.Theassessmentoftheextent have moredirectcontactwiththepopulationwhilegiving we have repeatedly expressed our wish towards FDRC to Since thestartofouractivitiesinDPRK,June1997, our activitiesandclosingdownofficesinPyongyang. Understanding, wecurrentlyareintheprocessoffinishing agree onthetermsforrenewalofMemorandum Since theFRDCandMédecinsSansFrontièrescouldnot Dear Mr Lee, Extract: Holland, AlexParisel Letter fromLexWinkler,ExecutiveDirectorMSF September 1997 (inEnglish). Director MSFFrance,toMrLee,FDRC,28 Belgium andKarimLaouabdia, Executive General DirectorMSF D143 haven’t managed toestablishwheretheaid delivered tothe serious suspicions thatthere’sanenormous famine, andwe we havenoaccessforgivingmedical assistanceandwehave we’ll dosomethingonthefamine. Wecan’tmovearound, in China,to-ingandfro-ingfrom theborder,wesaid:‘OK, cal aspect above all. It was true. But as the French were point buttheythoughtthat we shouldworkonthemedi- more controversy.EverybodyinMSFagreedwiththefamine in NorthKorea’wasmuchmorepoliticalandprovokedfar A messagewiththehookof:‘thinkaboutwhatyou’redoing medical aid, we’re not allowed access to follow it up.’ We don’tknowwherethefoodaid’sgoing.Andasfor North Koreabecausewedon’tknowwherethisaid’sgoing. national communityreallyhastoreviseitsaidpolicyfor the otherhand,whatwedohavetosayisthatinter - famine. Andwehaven’tgotmuchexcitingdataaboutit.On every TomCobblerandhiswifearetalkingaboutthisbloody talking aboutit,it’snothingnew.TheBuddhistmonksand The others and I said: ‘OK, fine for famine but everybody’s the Frenchcontinuedtopushforusingtermfamine. informed andinterested.DuringthemeetinginBrussels, manage international subjects inthe field where people are know about the situation in Hong Kong and it’s easier to are ahead and so you make headlines elsewhere. People Hong Kong.Whenyoudoaconferenceoverthere,theclocks We neededeveryonetoagreeinorderdosomething ences between the sections. We moreorlessbuiltupthemessage,buttherewerediffer- decided thatIshouldgotoHongKongandorganisethings. know whoelse.Wespentthedaylookingforagreementand managers, variouscommunicationspeople,andIdon’t up inBrussels.’Weheldthismeetingwiththeprogramme which isonnobodies’territory.’Theyallsaid:‘OK,let’smeet thing inAmsterdam.WeshoulddosomethingHongKong, in public.It’s inadmissible. It’s a waste of time doing any- on? Youcan’tleaveNorthKoreawithoutsayinganything saying thatweweregettingitreallywrong:‘what’sgoing I camebackandraisedsomehell,callingeverybody with academics interested in Korea.’ ing: ‘wecanorganisearoundtabletodiscussthesituation don’t wanttoholdapressconference.’TheFrenchweresay- Everyone wassaying:‘dowhatyouwantinHollandbutwe William Bourgeois[ProgrammeManagerMSFBelgium]. Hervé [Bradol,OperationsDirectorofMSFFrance]and of itinHolland,explainingwhyMSFwasleaving,andJean- Director MSFHolland]whosaidhewantedtomakeanevent it. ItbecameanissuebetweenPimdeGraaf[Operations French wererefusingbecausetheydidn’twanttotalkabout statement, makeabigfussaboutourdeparture,whilstthe because foronce,itwastheDutchwhowantedtomakea country without saying anything. It was really weird lots ofinterestinNorthKoreaandwecouldn’tjustleavethe because Iconsidereditvitaltospeakout:therewas North Korea without saying anything. I wassickened I wasinAfricawhenheardwewere going toleave 129 MSF and North Korea 1995-1998 MSF Speaks Out

country is going. We’d like to know, so people need to look of MSF. “The new policy of ‘normalisation’ has nothing to into this.’ That was the message. do with the reality of life in North Korea and will cost the lives of thousands. What these people urgently need is Samantha Bolton, Communications Coordinator, more effective accountable humanitarian assistance while MSF International, (in French). structural solutions are found to the underlying crisis,” he added.

Since early June, there has been a clear high-level policy change to further restrict and limit effective humanitar- On 1 October 1998, MSF issued a press release and a ian aid, which makes it impossible to deliver aid in a press conference was held in Hong Kong. Marie-Rose principled and accountable manner. MSF is today calling Pecchio and Dominique Lafontaine, members of the on all donor governments to review their aid policies MSF team in North Korea, Eric Goemaere, MSF Belgium towards DPRK to ensure it is more accountable, so that Executive Director, and Marine Buissonnière member humanitarian agencies can freely and impartially assess of the MSF China exploratory team to the China/North needs, deliver aid, have direct access to the population Korea border took part in the press conference. They and assess the effectiveness of their programs. presented the reasons for MSF’s withdrawal, the issue of the ‘socially deprived children,’ the experience of Urgent Medical Needs the famine, and the discriminatory nature of the North • Since the national DPRK production of pharmaceutical Korean system, as described by the refugees to the MSF supplies collapsed in the early 90’s, most of the hospitals team at the China/North Korea border. and health centres MSF visited had not had any antibiotics or fresh medical supplies for years. Doctors on a local In most of the western newspapers, the news was pub- level estimate that without outside assistance, they were/ lished on 1 October. According to some observers and to are around 75% reliant on herbals or traditional medicine. the press articles themselves, the MSF message regard- • There is an unusually high level of hospital admissions ing the famine issue as delivered during the press among normally young and healthy age groups: around conference was unclear. Some commented that the mes- 50% of the patients admitted as in-patients in the inter- sage was even contradictory. Main contradictions were nal medicine and surgical wards are between 20 and 40 around two things: was there a famine or not? Was MSF years old. kicked out or did it choose to leave? Moreover, there • The majority of the admissions to the in patient had been leaks in the European and US press. As early departments (IPD) are gastro-intestinal (gastro-enteritis, as 30 September 1998, the French daily Libération, had typhoid, diarrhoea), mainly caused by deteriorating sani- published several of the refugees’ testimonies. Also, tary conditions: lack of fresh water supplies; people wash- the US International Herald Tribune quoted MSF on the ing in and drinking from the rivers* etc. issue of the socially deprived children. V5 • To counter these infections and to prevent the spread of cholera and other diseases, the government runs mass forced vaccination campaigns against cholera and other diseases. The national cold-chain is not reliable, so people “MSF Calls on Donors to Review Their Policy in are often only vaccinated in the winter**. DPRK - Urgent Needs in North Korea But MSF • Among patients hospitalised for gynaecological reasons, Forced to Pull Out,” MSF Press release, Hong around 50% are for abortions. Before MSF distributed Kong, 30 September, 1998 (in English). D144 standard gynaecological supplies, hospitals were performing caesareans, abortions and other surgical interven- Extract: tions with rusty instruments and without little or no The international medical relief agency Doctors Without anaesthetic, sterilization equipment, antibiotics or anti- Borders/Médecins Sans Frontières (MSF) today announced haemorrhagic drugs***. that it has been forced to pull out of North Korea (DPRK) this week, despite urgent medical and nutritional needs “There are serious risks of outbreaks of diseases and death throughout the country. MSF was the largest medical from terrible health and nutritional conditions, but there is a organisation working in North Korea and had tried to problem with the way needs and solutions are prioritized.,” negotiate to continue to work in North Korea, to have free said MSF field doctor Dr Dominique Lafontaine. “While access, to assess the needs, to bring humanitarian assis- there is an urgent need to restructure the water and sanita- tance to those most in need and to monitor its aid. The tion system, the government responds with mass vaccina- government, on the other hand, refuses to acknowledge tion campaigns against cholera and while there are urgent that there is still an emergency and only wants structural day to day medical and nutritional needs, the government support to rebuild the national pharmaceutical industry. refuses to allow humanitarian agencies to assist and only focuses on rebuilding the pharmaceutical industry.” “We are sorry to be forced to pull out when there are serious medical, nutritional and sanitation problems which need Refugee Reports of Famine 130 to be addressed,” said Dr Eric Goemaere, Director General In addition to the medical problems, there are worrying vulnerable groups suchashomelessandorphan children. to continue this assistance and to target particularly medicines, equipmentandtraining.MSF wasnegotiating assisting seven million people in four provinces with to support around 1,400 health centres and hospitals had managedtoexpandits medical assistanceprograms and how it will be implemented. Over the past year MSF contract), whichdefineswhatsortofassistanceisneeded renewal oftheMemorandumUnderstanding(working down thismonthbetweenMSFandtheDPRKover need it most,”saidDr Eric Goemaere. Negotiations broke provide effectiveandaccountableassistancetothosewho is nowmoretopreservetheself-sufficientideologythan have changed.“ItisclearthatthepriorityinNorthKorea crisis bytheinternationalcommunity,prioritiesseemto However, afterconsiderablefinancialcommitmenttothe the urgent need for food and humanitarian assistance. and internationalreliefagencieswereallowedtoaddress during which the government had started to open up The changeofpolicyinNorthKoreafollows two years Humanitarian Needs vs.Government Priorities international teams hadnoaccess. which arediscretelymentionedbylocalstaff,butto institutions orplaceswherethesechildrenarecollected, from thestreets.MSFisconvincedthattherearecertain Many ofthemwerehomelessandpickedupstarving which MSFwasable,tovisit,wereorphansorabandoned. about aquarterofthechildren,innutritionalprograms, was abletogetmoreinformationandestimatesthat ment. Howeverinoneprovince,SouthPyongyan,MSF the childrencamefromandwheretheywentaftertreat- children. Itwasdifficulttogetinformationaboutwhere centres infourprovinces,takingcareofaround14,000 children. Intenmonths,MSFworkedinsixty-fourfeeding authorities insistthattherearenohomelessorstreet that theycan’tdealwithit,butonacentrallevel,the local authoritiesrecognizethatthereisaproblemand by the existing health and institutional structures. The is concernedthattoomanyarenotbeingtakencareof dren, mostofwhomarehomelessorstreet-children.MSF and poornutrition,therearethousandsoforphanchil- Because oftheharshlivingconditions,badsanitation Vulnerable Populations but nopermission has beengiven. and representativenutritionalsurveysinsidethecountry, ating since1996withtheauthoritiestoconductreliable conduct surveysinsidethecountry.MSFhasbeennegoti- tematically preventedfromhavingfullandfreeaccessto nutritional status of the population, MSF has been sys- for food.Givingfurthercauseconcernaboutthereal of homelesschildrenroamingthecountrysidelooking position andtopartyloyaltyspeakoflargenumbers criminatory fooddistributionsystemsaccordingtosocial long termandrecentlackoffood.Theyalsodescribedis- famine, ofrelatives,friendsandneighboursdying arrived inChinafromNorthKorea,speakofwidespread interviewed byMSFinAprilandAugustwhorecently reports aboutwidespreadfamineinNorthKorea.Refugees Committee DPRK, dated Pyongyang Aug. 24,1998. of ExternalAffairstheFloodDamageRehabilitation of MissionbyMrRiSiHong,ActingDirector,Department heavy bleeding****TakenfromlettersenttoMSFHead biotics to prevent infection and homeostasis to prevent Curettage equipment with sterilised instruments, anti- ***Standard obstetricssuppliesincludeDilatationand vaccines is difficult to ascertain. ing coughandcholera.Theorigincontentofthese mass vaccinationcampaignsagainst:diphtheria,whoop- polio, measlesandtetanus.TheDPRKgovernmentruns world. InDPRK,UNICEFandWHOvaccinatepeopleagainst cines againstcholeraonthemarketanywherein **There arenointernationallyrecognizedeffectivevac- water. * MSFteammembersalsocaughttyphoidfromfoodor therapeutic feeding centres and healthstructures. distribution programs,trainingprogramsandsupporting after working continuously for 16 months running drug North Korea tomorrow morning, Thursday, Oct 1, 1998, ner”. ThelastoftheinternationalMSFteamswillleave aid isimplementedinaprincipledandeffectiveman- ments toensurethatthehumanitarianaidtheyfund humanitarian assistance. It istime for the donorgovern- responsible forthehealthofitspeopleandtoallowdirect “Now itistimefortheNorthKoreangovernmenttotake able. ThisisnotthecaseinNorthKorea.”Heconcluded: help thosewhoneeditwhenisimpartialandaccount- danger. But in the end, humanitarian assistance can only when thehealthandlivesofsomanypeoplearestillin doctors topull-outwhensomanypeoplehavediedand that assistance.DrEricGoemaeresaid:“Itisnoteasyas the mostvulnerable,andtoassesseffectivenessof impartiality andoffreedomtoassessneeds,assist adheres totheinternationalhumanitarianprinciplesof tarian needsinDPRKwhichneedtobeaddressed,but MSF isconvincedthereareseriousmedicalandhumani- materials****.” “MSF topaydeepattentionprovidepharmaceuticalraw of medicalandnutritionalassistanceforDPRKbe Instead the authorities insist thatthe most effective type International Herald Tribunegotsomeof the journalists and intheend theyhadtobecutshort. The leakinthe everyone thismorning.There werealotofquestions and stucktotheirbrief,which wasworkedoutbetween the drivergettinglost!Allparticipants werereallyclear on thedot,inasweatthanks toHongKongtrafficand - Wentreallywelldespitethe factthatwearrivedat3pm Extract: work, 30September1998(inEnglish).D145 Kong PressOfficertoMSFcommunicationnet- Coordinator andJustineGeldard,MSFHong Bolton, MSFInternationalCommunication “ North Korea Feedback,” Email from Samantha

131 MSF and North Korea 1995-1998 MSF Speaks Out

irritated, especially the US - Boston Globe (but calmed ing to do with the reality of life in North Korea and will cost down when MSF was equally irritated by leak) as their the lives of thousands.” The medical charity announced papers picked the story up off the Washington Post news its retreat from North Korea just weeks after the United service and not from them. However, - the secretary of the State committed itself to increase donations of food to FCC said that many told him that they had been alerted North Korea by 300,000 tons, making the United States by their editors because the Post and Libé were told to by far the biggest international supporter of the program go and get the story as it was news. Some correspondents to stop a food crisis that, according to a US congres- who I didn’t even know were in HK turned up because of sional delegation’s report last month, is killing 300,000 this. The Libération leak was disappointing because it took to 800,000 North Koreans a year. The U.S. decision met hours to negotiate each word of the press release and then opposition from aid officials, who questioned the ability too much went out before, prompting other journalists to of the World Food Program and the five American chari- leak and to get angry, making it difficult to get anything ties in North Korea to monitor the food deliveries. The organised on an international level. A lot of people are Tuesday announcement detailed a string of setbacks suf- upset and say there is no point in keeping embargos fered by one of the world’s most respected aid agencies despite the fact that overall the impact of what we have in its attempts to crack North Korea’s system and help done as been very high so far. Also, Marine is worried that suffering children. the priest mentioned by name and location is going to have his life in danger. Nevertheless, so far the coverage Aid officials said that, compared with European charities, has been better than expected. the Americans had been even less successful in ensuring that the aid was not going to Communist Party loyalists or to the army. Western aid officials have privately criticized the United “Aid Agency Pulls Out of North Korea - Doctors States for sending food to North Korea as a vain attempt Without Borders Fears That Food Sent For to ensure that the volatile Communist state would not col- Children Is Misused,” by John Pomfret, Beijing lapse or undertake military adventures – such as attacking The International Herald Tribune (Washington South Korea, where 37,000 US troops currently patrol the Post Service), 30 September 1998 (in English). demilitarized zone along the North’s border. “It’s a bribe, D146 nothing more,” said one aid official. “But if you don’t insist on better monitoring, very little of the food will go to the Extract: needy. It will go to loyal party people and the army.” BEIJING - The largest international charity operating in Dominique Lafontaine, a French doctor who has been North Korea announced Tuesday that it was pulling out based in North Korea since August 1997, said Doctors because the Communist government had refused to give Without Borders had fed 14,000 malnourished children the charity access to a large population of malnourished in therapeutic centers during his time there.As they con- and ailing children. The European charity, Doctors Without ducted inspections, health officials noticed that some Borders, withdrew its team of 13 professionals, including of the children were extremely malnourished while oth- nine doctors. The move, rare for an international organiza- ers were relatively healthy. When they asked about the tion, underscored the growing problem that Western aid malnourished ones, they determined that they had been agencies are having in North Korea as they try to deter- collected in “9-27 camps”. The North Korean leader estab- mine whether medicine and food are getting to the truly lished the camps, aid officials said, as part of a police needy in the isolated Asian nation. action to force millions of people who had left their In early August, the Paris-based Doctors of the World villages in search of food to return to home. The people left North Korea for similar reasons. Officials of Doctors are arrested, incarcerated in camps and then sent home, Without Borders said they were concerned that the North where they are incarcerated again, according to Western Korean government was adopting a double standard - aid officials. “We have asked for access to the places where feeding children who came from families loyal to the the children are, but we were refused,” Dr. Lafontaine said. regime and neglecting those children who did not. The “Local authorities confirmed that there were many home- officials said they had obtained evidence that orphaned less and orphaned children but when we asked the central and homeless children had been collected in centers, government, they denied that they existed. The plight of known as “9-27 camps,” named after the day last year these children concerns me deeply.” Officials of the char- that the North Korean leader, Kim Jong II, ordered the ity said that North Korea needed to allow aid officials to establishment of the centers to “normalize” the country. conduct a nutritional survey of its children throughout the Conditions at those camps are believed to be horrible, the country. A survey begun Sept. 21 by UNICEF, the European officials said, citing interviews with refugees from such Union and the World Food Program will not be allowed to centers who escaped into China. enter one-third of the country. One Western aid official expressed concern that Unicef risked being tricked by the “We are sorry to be forced to pull out when there are serious North Koreans into reporting that things were much better medical, nutritional and sanitation problems which need to than they seemed. “Then they will ensure that the limited be addressed,” said Eric Goemaere, director general of the aid will go to the right kind of children,” he said. 132 organization. “The new policy of ‘normalization’ has noth- est political deviation is translated into never-ending aspects ofasystem inwhere,atthesametime, thesmall- its ‘Great Leader.’These are just a few of the grotesque diffusion of“immortalrevolutionarysongs ” tothegloryof month onanattempttoput asatelliteinorbitforthe armies intheworldandisspending acolossalsumthis Jong-II’s regimecontinuesto maintainoneofthebiggest tion oflastyear[...]134deaths.Atthesametime,Kim The NorthKoreanregionapparentlyretainsitsestima - dead since1995inthiscountryof23millioninhabitants. famine. Othernon-verifiableestimationstalkof3million sand people”haddiedofstarvationordiseaseslinkedto during thelastthreeyears“atleastseveralhundredthou - MSF toldLibérationthatit“hadnofurtherdoubts” people huddle up together inthe train stations. road, buryingthemincommunalpits.Crowdsofstarving of thestarvedorvictimstyphoidfromsides alongside hundreds of others. Thearmy collects the bodies there, theyendupdyinginatorpor;theirbelliesempty, countryside to avoidstarvation,but, finding nothing agony: factoriesclosed,populationsmovingouttothe the Chineseside.Theiraccountsdescribeacountryin the secondinAugust.MSFteamsquestionedrefugeeson border separatingNorthKoreaandChina,thefirstinApril, and propaganda,theNGOhadtocarryoutsurveyson this country,apastmaster in thearts of disinformation A countryinagony:tofindoutwhat’sreallygoingon the cold. international effortleavesthemostneedycompletelyin diverted by the powers that be, but also, in addition, this humanitarian ethics.AccordingtoMSF,notonlyisaid dictatorship. Conditionswhichformanyarecontraryto been obligedtobuckletheconditionsimposedby the population.Upuntilnow,NGOsprovidingaidhave of itsveilonthehorror experienced on a dailybasis by the country.ButPyongyangonlyliftsupatinycorner since letnumerousothercharitableorganisationsinto a bankruptStalinistregime,thecommunistrulershave Anxious to attract international aid in order to reinforce it isaware of havingbeen ‘manipulated.’ stemming thefamineragingincountry,nowsaysthat organisation, whichin1995wasthefirstNGOtoattempt definitive departurefromNorthKorea.Thehumanitarian Médecins SansFrontières(MSF)hashadtoannounceits Extract: hunger or disease linked tofamine,”according to MSF. “At least several hundred thousand people have died of 1998 (inFrench). Franklin, Humanitarian AidbytheRegime,”Romain Country andDenouncestheDiversionof – MédecinsSansFrontièresisPullingOutofthe Communist Korea Has Become the Hell of Hunger “ North Korea: Accounts of a Hidden Famine – Libération (France), 30 September D147 to awarsituation. Contrarytothoseof the communist to all the famines of the twentieth century, it isn’t linked “This typeoffamineisunique, ” continuedJean.Contrary Widespread bankruptcy founding of theWorkers’ Party.” year ontheoccasionof Great Leader’sbirthdayorthe the twoorthreekilosofriceprovidedtimesa some revenue,aredeprivedofalldistributions,apartfrom disloyal duetotheirfamilyhistories,orwhocouldbringin food distributionswhilstthosepeopleconsideredpolitically the militaryandseniorofficialsalwaysbenefitfrom inhabitants ofPyongyang(whoare,assuch,privileged), people’s socialandeconomicutility.Soconcretely,the it has according to criteria reflecting political loyalty and it’s beencausedbytheregimedistributingfewresources policies carriedoutoverthelastfiftyyears,andonother marked politicaldimension.Ononehandit’stheresultof role. “Thisfamine”confirmsFrançoisJean,hasavery The floodsofthelastthreeyearshaveonlyplayedaminor explains Pierre Rigoulot, a specialist onthe country. purpose inthisregardisexposedtothedangerofdeath,” priority istomaketheregimelast,andwhoeverservesno officials areatthetopofit.“TheNorthKoreanauthorities’ the bottomofscale,andsystem’shighest-ranking categories. Thefamiliesof“counter-revolutionaries”areat consisting of three main categories and some fifty sub- ing itsfoodrations,ascaleforclassifyingthepopulation that theNorthKoreanregimeuses,asabasisforcalculat- regime neverreachesthesepeople.”Severalexpertssuspect that aid most vulnerable, whereas we have every reason to believe tives. “Humanitarianaidaimstoprovideassistancethe between humanitarianprinciplesandtheregime’sobjec- MSF. MSFisconvincedthereatotallackofconformity in 1995” relates François Jean, Director of Research in “We haddoubtsaboutourworkrightfromthebeginning, Potemkine village where everything was set up.” MSF. “Whenwegotit,hadtheimpressionofvisitinga visiting dispensaries,” related a programme manager for discussions. “Wehadtoaskpermissionaweekaheadfor cials, MSFvolunteerscouldnevermeetpeopleforfree in July.Watchedoverpermanentlybytheregime’soffi- obstructions after 6 months in the country, pulled out Médecins duMonde,bangingitsheadagainstthesame last spring,formanideaoftherealscalefamine. The NGOrealised,amongst others, thatitcouldnot,until anything otherthanasupplieroffoodaidandmedicines. MSF becameconsciousofthefactthatitcouldbarelybe inces anditsinsistenceonworking‘agrassrootslevel’, from July1997on.Despiteitspresenceinseveralprov- first ofallfor6monthsandthenonapermanentbasis country, having started working in North Korea in 1995, Until lastweek,MSFhadateamof13peopleinthe Surveillance to the most far-removed cousins. punishment foritsauthorandhisfamily,oftenextending arriving inthecountryandchannelledby 133 MSF and North Korea 1995-1998 MSF Speaks Out

systems (Ukraine in 1932 or China in 1959-1961), it isn’t mantled state companies and sold the metal piece by piece, linked to a frenzied transformation of the recent social the doctors sold their working tools too. Hospital medicines order, but to a problem with the structural order. It’s hap- were sold in the market and the hospital stocks were empty. pening in a mainly urban society of an industrial nature Doctors have to survive like anyone else. More and more (even if the industries are bankrupt). The worst affected people were leaving their towns to head for the countryside categories are the inhabitants of medium sized towns in search of food. The train stations were packed and the working for collapsed businesses that hold no interest for dead were piling up, especially old people and children; to those in power. “This famine is also the consequence of a such an extent that the train stations in the area were shut general bankruptcy of the economy” added François Jean. down. Bodies in the streets were a daily sight.” “But everything leads us to think that this bankruptcy will not, at least in the short term, lead to a collapse of the “I’m a priest in the church of Hungcun. I’ve been going to regime.” In the meantime, thousands of people continue see my brother in Xinouzhu (in North Korea) in January to die. every year since 1992. There was no free market in Xinouzhu five years ago. Now everybody gathers at the market, Accounts of daily horror because it’s the only place to find supplies. Starving people, The terrible daily reality of the ‘hidden famine’ raging with no strength left, are sitting or lying on the ground. in North Korea can no longer be doubted. The accounts There are children everywhere, really thin with blackened, published here were collected by researchers mandated by damaged skin. They’re hardly wearing anything. In the mar- Médecins Sans Frontières in August on the Chinese side ket, people are selling bowls of rice for exorbitant prices. of the Sino-Korean border. They corroborate another MSF I’ve seen people dying in the streets. Dying of hunger and study carried out in April. Refugee accounts are often cold. People are hardly wearing any clothes, no socks. no the first to ‘expose the truth’ on closed-off regimes. This leather shoes. When I visited my brother in January, I saw was true for the Khmer Rouge genocide in Cambodia in seven children frozen to death. They’d taken shelter in a 1975-1979 (2 million deaths), described right from the pigsty. They were all squeezed up together, huddled up, half first months in testimonies collected by Father François naked, and they’d frozen during the night. I saw them. The Ponchaud. It was true for horrors in China during the army uses a metal box for collecting bodies, transporting 1959-1961 famine (25 to 30 million dead), described to them to a pit where they’re dropped in the ground. The box the western press by Chinese refugees; or for the cultural is re-used for the next batch of bodies. Collection normally revolution of 1966 – 1976 (30 million victims of diverse takes place at night. You can’t imagine how far this society status), brought to light by the China expert Simon Leys has sunk into violence. I’ve seen children literally have who questioned Chinese refugees who swam as far as Hong bread stolen from their mouths by their elders. The months Kong. Today, it’s true of the North Korea refugees who of April through to September will be critical, as they were crossed the river Yalu, separating North Korea from China. in 1996 and 1997. It’s not surprising to hear about can- Two of these accounts refer to cannibalism. Even if they nibalism in these conditions. It’s possible that 15 to 20% should be handled with care, it should also be born in of the population is literally dying of hunger, and 5% of it mind that cannibalism was practiced during a comparable is living decently. event, the big Chinese famine of 1959-1961, as attested in a recent book by Jasper Becker, the Great Famine of Couple aged 68 and 63 years old, interviewed in Yanji: Mao. [...] “one day, my son stated that he did not join the army to steal from people. He was shot on the spot.” “I come from the town of Hvesan, just over the border from China. I got over the Sino-Korean border by crossing the Young people of 19 to 25 years old, Yanji: “really thin Yalu, which isn’t very deep, in July ‘97. I was employed in children wander around, stealing to feed themselves.” a state-run company. When my company gradually wound down its production, I found myself with no salary. I saw Couple, with one child, Yaniban district: “we were told people dying of hunger around me, but it didn’t really that foreign medicines made us ill.” affect me. Then my 5-year-old son died of hunger too. That changed everything [tears]. My situation isn’t unique at all. It was the same everywhere, and Hveshan, on the border, “There were a lot of children sitting around with no strength was one of the better off towns. Last June, a distribution left. Their heads were puffed up out of proportion and their of one kilo of rice per family came out of the blue. I asked eyes were barely visible. Their legs were swollen, sticking where the rice came from. I was told: just take it and straight out in front of them like pillars from the top of mind your own business. I thought it must have come from their thighs to their ankles. Their skin was blackened and international aid. It was the only time it happened. Most they had skin infections all over their bodies. In winter, aid goes to the army’s officer ranks and the government; it they passed away from cold, but in the summer they stayed never reaches the common people. Those who have a bit of haggard and lifeless for days on end. There were thin, money get rich and do business; the others die of cold, hun- exhausted adults too. In the parks in the next town along, ger and disease. There were epidemics of cholera in Hvesan. bodies were left lying around for up to two or three days The hospitals were empty and the medicines were no more before being collected. The propaganda was raging. We were 134 free of charge than the food. Just as the factory workers dis- told that we had to tighten our belts in until 2003, that they’d died of starvation or sickness.” and cholera.Finally,whenpeopledied,wedidn’tsaythat or less:diarrhoea,stomach-ache,typhoidandpara-typhus, foreign medicines made us ill! [...] Everybody was ill, more coming frominternationalaidmadeusthinnerandthat that clothes coming from China carried viruses, that food admit toforeignaid,itwouldlooseface.Soweweretold our effortsweren’tsufficientyet.Korea’sfartooproudto and ate an orphan that noone had takenin.” us, webecamehuntedobjects:ourneighbourkilled,salted ents, werealwaysdangerous.Notonlywastherenopityfor What’s more,thelives of abandoned children, without par- died ofhungerat1and4.Wewereeatinggrassroots. of diseaseshortlyafterwards.Oursister’stwoeldestchildren Our fatherdiedofhungerthreeyearsagoandourmother old), originallyfromtheneighbouringvillageofHamHung. “We were a familyof four children (25, 18, 15 and 8 years ours can return tothe field, ” declared DrGoemaere. government and ensure that in the future organisations like change theiraidpolicyinorder toincreasepressureonthe organisation. “We are now asking the donor countries to needy,” addedtheGeneral Director ofthehumanitarian sufficiency, ratherthanprovide effectiveaidtothemost government’s priorityisobviouslytoshowanimageofself- and we couldn’t reach an agreement” he explained. “The level,” addedDrGoemaere.“Butwedon’tworklikethat cines. Weweretocontinueprogrammefromacentral areas outsidethecapitalandstopdistributionofmedi - we wereunexpectedly asked to withdraw our teams from “During therenegotiationsforourcollaborationagreement, State’s pharmaceutical laboratories. medical aid;itwouldliketoreceivebasicmaterialsforthe was capable of a return to self-sufficiency and instead of on Thursday,wasinformedthatthiscommunistcountry tarian organisation,whosefinalmemberleftNorthKorea for restrainingandlimitinghumanitarianaid.Thehumani- country have modified their policy at the highest levels the beginningofJune,authoritiescommunist Goemaere, ExecutiveDirectorofMSF,explainedthatsince Korea andimposecontrolontheuseoffoodaid.DrEric for donorcountriestorevisetheiraidpolicyNorth Médecins SansFrontières(MSF)calledonWednesday Extract: An 18-year-old North Korean and his8-year-old brother: Military, 35 yearsold, and hisson,9: distributed to the army, then to senior officials.” Hong Kong,30 September 1998(inFrench). Revision of Aid to North Korea,” ”North Korea-FamineMSFCallsfora “orphans become hunted objects.” “aid is first of all AFP (France), staring fixedly into nothing” shesaid. die inwinter.Inthesummer, peoplelieimmobileallday, to comefromthebordertown ofHysan.“Alotpeople blackened skin,”relateda30-year-oldrefugee whoclaims children withenormousheads, legsstiffaspicketsand haggard childrenandadults. Thereareunder-nourished hunger. Inthesetowns,“weseepeoplearrivingingroups, border with China, where they can at least stave off their the interiorofcountryinhopecrossing groups ofstarvingNorthKoreanswhoarrivebyfootfrom Korean towns close to the border with China receive to twoorthreedaysbeforetheyareremoved.TheNorth starved bodieslyingintheparksofcertaintownsforup According tothesewitnesses,itisn’tunusualthesee ourselves,” addedtheMSF representative. but we’re not in a position to confirm these statements said. “Severaloftheserefugeestalkedaboutcannibalism, dead fromstarvationordiseasecausedbymalnutrition”she to hadalllostone,twoorthreemembersoftheirfamilies, along theborderwithNorthKorea.“Thepeoplewespoke interviews inperson,differentpartsofnortheastChina she added,explainingthathadtakenpartinthese even thoughit’simpossibletoverifywhatthey’resaying,” no doubt about the sincerity of the people we interviewed, MSF announceditswithdrawalfromNorthKorea.“Wehave Hong Kong,interviewedbytelephonefromTokyo,theday explained Marine Buissonière, Administrator for MSF,in situation isextremelyserious.There’snodoubtaboutit,” and affectedbyanunprecedentedfoodshortage.“The the northofcountry,whichiscutofffromworld North Korea,withtwothirdsofthemoriginatingfrom and AugustthisyearalongtheChineseborderwith North KoreanrefugeeswereinterviewedbetweenApril Frontières andmadepubliconWednesday.Sometwenty according totestimoniescollectedbyMédecinsSans is dyingofhungerordiseaseslinkedtomalnutrition, North Koreawhereanimportantpartofitspopulation TOKYO, 30 Extract: five years ago. supplying foodrationstothepopulationsomethree North Koreanstate,accordingtothesewitnesses,stopped tarian aidwasreachingthevictimsoffamine.The revealed that ‘almost none’ of the international humani - lected multipletestimonialsfromNorthKoreanrefugees, country. LastApril,theMSFofficeinBeijing,havingcol- assistance, with a team of some thirty people in the health facilitiesinNorthKoreaandprovidingnutritional by famine.Thehumanitarian organisation was supporting 1,400 healthcentresandhospitalsinthiscountryravaged MSF, presentinNorthKoreafortwoyears,wascovering th (France), Serious Famine,”PierreAntoineDonned,AFP ” Testimonies of North Korean Refugees Talk of a September(AFP).Thefamineisseriousin Tokyo, 30

September 1998(inFrench). 135 MSF and North Korea 1995-1998 MSF Speaks Out

MSF questioned two brothers of 19 and 23 who said they’d against serious diseases, the agency said. Dr Goemaere crossed the Chinese border via the river Yalu on the 29th said it was difficult to confirm reports of widespread fam- of last July, following hours of walking and avoiding ine. MSF said it was convinced food and medical aid was road checks. Originally from Musan, near the border, they being distributed along political lines, with party faithful explained that they’d lost an older brother to starvation in receiving food as others starved. It also expressed concern 1997, aged 22, and that they’d managed to survive by col- about the number of orphaned and homeless children wan- lecting shells and seafood, which they sold at the market. dering the countryside in search of food. Dr Goemaere said They explained that the situation started to deteriorate in authorities had told the agency that homeless children their region at the end of 1993. The distributions of food were not a priority. MSF said it had discovered an unusu- rations became irregular, then sporadic, perhaps once ally high level of hospital admissions among the young. every three or four months from 1995 on. Rations were Dr Goemaere said MSF’s withdrawal could throw the coun- distributed on national holidays. The inhabitants then try back ‘almost into human experimentation’, meaning received two days of rations, being 1.2 kilograms of rice doctors did not have drugs to treat serious diseases and or cereals per family, they said. if they did have the supplies, they did not know how to use them. He described horrific conditions in provincial International aid, according to witnesses, rarely reaches its hospitals, where doctors were performing operations destination. In some 70% of cases, it goes to the regime’s without anaesthetic, sterilisation or antibiotics. Old beer senior officials and the army, with only the remainder bottles were being used for intravenous drips. The last of reaching the devastated population. MSF announced in the 14-strong MSF team will leave North Korea today after Hong Kong on Wednesday that it was pulling out of North 16 months. Korea where it has been one of the main international charitable organisations. It considers that it cannot carry out its mission correctly due to the obstacles posed by the North Korean communist authorities. For their part, on “ Aid Agency Quits North Korea,” The Guardian Wednesday UNICEF and the World Food Programme (WFP) (UK), 1 October 1998 (in English). D148 of the UN declared that they could not confirm MSF’s accusations on the diversion of aid and added that they did “North Korea Rejects Medical Aid,” The Independent (UK), not envisage pulling out of North Korea. A delegation from 1 October 1998 (in English). D149 the American Congress last month evaluated the number of deaths caused by the famine at between 300,000 and “Aid Agency Forced Out,” The Times (UK), 1 October 1998 800,000 per year. North Korea is going through an acute (in English). D150 economic crisis following floods on the back of successive droughts, which have already derailed the country’s “Aid Agency Suspends Operations in North Korea,” The economy. Telegraph (UK), 1 October 1998 (in English). D151

“Policy Change Forces Out Relief Agency, Leaving “Charity Forced Out of Korea,” The Irish Times Famine Victims to Their Fate,” The South China (Ireland), Hong Kong /Paris, 1 October 1998 Morning Post, 1 October 1998 (in English). (in English).

Extract: International relief agency Médecins Sans Frontières (MSF) said yesterday it had been forced to pull out of North Minutes of MSF France Board of Director’s Korea. The French-based group urged donor governments Meeting, 30 October 1998 (in French). D152 and multilateral agencies to review aid policies to the North and demand greater accountability from Pyongyang Extract: authorities. MSF director-general Dr Eric Goemaere said Denis Pingaud [Director of Commu-nications and since early June there had been a clear high-level policy Development since July 1998] was struck by the profound change to restrict humanitarian aid in the famine-stricken differences existing within the MSF family on the under- country. MSF, which had been supporting 1,400 health standing of what MSF is about. According to him, MSF F centres and hospitals, was told North Korea was able to shouldn’t follow or reject the international movement, but return to self-sufficiency and instead of medical aid it rather fight the ‘World Company’ culture, which is taking wanted raw materials supplied to its state pharmaceutical root within the organisation. This culture involves the factories. ‘It is clearly more a priority for the Government belief that international consensus is more important than to show an image of self-sufficiency than to provide aid for taking important decisions if they generate disagreement. the most vulnerable,’ Dr Goemaere said. Take North Korea, for example. The fundamental issue is the content of the message with regards to the popula- Since the early 1990s hospitals had been about 75 per cent tion. The need to agree amongst sections to deliver a 136 reliant on Korean herbal medicines, which were useless common message in the name of MSF International is only I wasn’t completely sure. thinking thatitwastoolateforpublicationdeadlines,but the storyandIsenthimreporteveningbefore, Post correspondent in Peking,who was really interested in a longweekend.IspoketoJohnPomfret,theWashington nalists atthepressconferencebecauseitwasdaybefore planning toreleasesomething.Ihadfighthavejour- we’re ahead of everyone in Europe. I suspected Paris of because ifwesaysomethinginHongKongthemorning, sage andIwasabitscaredthey’dmakepre-emptivestrike feel thattheFrenchreallywantedtopushtheirfaminemes- which wouldbereleasedwhentheteamleftKorea.Wecould idea was,asusual,tohaveamessageunderembargo, piled thedifferentwitnessaccounts,pressreleasesetc.The with thousandsofphonecallsallovertheplace.Wecom- finalised themessage.Therewerestandarddiscussions Goemaere which wereallunderembargo, andallthese In addition,I’d setupsomepriorinterviews withEric don’t careaboutthosedamned French!’ […] message; focusonthemessage, that’sthemessage.We and the Washington Post that everyone reads. Look at the on aworldwidelevel.It’sthe HeraldTribunethatmatters, you’re Belgian,butinrealityitdoesn’tcountforanything a littleFrenchnewspaper.Itonlyinterestsyoubecause down – it was total bedlam – saying: ‘who cares, it’s just always doingstufflikethis,etc.Itriedtocalmthecrisis ence, itwasimpossibletoworkwiththeFrench;theywere train. Theysaidthattheydidn’twanttodothepressconfer - the messagewasgoingtocomeoutbeforeshe’dcaughther ing because there was still an expatriate in Pyongyangand hell wasgoingon.Ericandtherestofteamwerepanick - French pressandtheHeraldTribunetheyaskedwhat informed. They’dheardthatitwasgoingtocomeoutinthe faxes fromallovertheplacebecauseteamswerealready completely focusedonthefamine.Wereceivedinsulting above allbeinghighlypolitical,andtheotherwhichwas more onthemedicalissues,mentioningfaminebut were twodifferentmessages,moreorless.Onewhichwas said: ‘there’safamineandthousandsofdeaths.’Sothere the meantime,ParishassentitsdossiertoLibé,which famine andwedon’tknowwheremedicalaid’sgoing.’In think carefullyaboutwhatthey’redoingbecausethere’sa broke theembargo.Ourmessagewas:‘donorsshould Herald Tribunethesamedayaspressconference.Sowe Obviously, itwaspublishedintheBeijingeditionof the true sense ofanaction. to an ‘international label’ mentality and does not reflect society and bears the name of globalisation. It responds search foracommonmessagecanbeseenthroughout concerning populationsindangertoemerge.Thefrenetic sections isnotabigdealifitallowsstrongmessage a secondaryissue.Acommunicationhiatusbetweentwo the sameday,andwe’ddothispressconference.We team would close the North Korea mission and leave We arrivedinHongKong.We’ddecidedthatthelast we agreed.But it’snotaproblembecause everybody took the embargo. You didn’tfollowthemessage exactlyas went nuts. I said to them: ‘too bad. You didn’t respect his message was not primarily focused on the famine. Paris It wasEricGoemaere;theExecutive DirectorofMSFand sage published in the opportunity tosaythecomplete oppositetotheFrenchmes- some thirtyjournalistsfromtheworldover.Erictook was full.Thereweretelevisioncamerasatthebackand listened toeverythingandaskedsomequestions.Theroom The journalistswereinterested in whatwehadtosay.They manipulated. clear thatwe’dbeenmanipulated,ouraidhad us tore-launchthepharmaceuticalindustry.Wewerereally our medicineswere going. Thefact the authorities wanted we couldn’tmovearound,thatfindoutwhere we’d seen.Theorphanageswereinshambles.factthat interest peoplewaswhatgoingoninsideKorea.What ing thatMSFwasrepeatingit,butitwasn’tnew.Whatdid had alreadybeensaidaboutthefamine.Itwasinterest- China andwedidn’thaveanydata.Andinadditionalot balanced becausetheseobservationswereonlymadefrom had completelylostcontrol,wasstarving.Itwasn’ttotally said builtupaglobalpictureofcountryinchaos,which was aconsequenceofalltheotherdysfunctions.Whatthey that itwastotalchaosinNorthKorea,thefamine On listeningtoallthesetestimonies,itwasreallyobvious about the famine, the witness accounts etc. mark aswell.Marinereallysaideverythingtherewastosay whole affair.Thereweretheorphanstories-theymadetheir the destinationofaid.Whichwasrealscandalinthis about the famine, medicines and our incertitude concerning adopted thepoliticalmessagewe’dagreedon.Wetalked got started.Itwentreallywell.Theywereallgreat.Eric a holidayandtheywereallinhurrytoleave.Wefinally were hopping mad. They almost spat in our faces. It was hem! Finally,wegottheretenminuteslate.Thejournalists was andwewerelateforthepressconference:itmay- we’d losttheothercar,Ididn’tknowwhereEricGoemaere understood withthetaxidriver,whoonlyspokeChinese,and centre, whichnolongerexisted.Ijustcouldn’tmakemyself understand anything and they took us to the old press Chinese territoryagainon1January1997]buttheydidn’t with these new Chinese taxi drivers [Hong Kong had become located atthetime]andIdon’tknowwhatwasgoingon Kong situatedonthecontinent,whereMSFofficewas We tooktwotaxis.crossedKowLoon[thepartofHong didn’t want togo anymore. And Eric Goemaere was livid…. them all.Andthentheteamlostplot,draggeditsfeet; conference andtheywerefuriouswithus.Iwasinsultedby conference.’ Sotherewereloadsofjournalistsatthepress You’ve missedtheboat.You’llhavetogopress ‘It’s alreadyoutintheFrenchpress,HeraldTribune. nalists who werefurious because theireditors were saying: in Peking.Ireceivedsomereallyoffensivecallsfromjour- denly found themselves confronted with an article published people whohadwaitedfortheembargotobeliftedsud- Libération, to set the story straight. 137 MSF and North Korea 1995-1998 MSF Speaks Out

up our common message and that’s the one in circulation.’ It was a bit of a war between the sections… just for a change… but it was really funny. The French had their MSF decided to leave North Korea and organise a opinion. They wanted to try and do it their way, in the press conference to take place in Hong Kong. Three French press. But it didn’t matter too much because in the people were there to present MSF’s position: Eric end, the message adopted by everybody was the message Goemaere presented the official institutional position, we’d decided on in Brussels. Too bad for the two papers in Dominque Lafontaine, the MSF team’s doctor in North Korea France. described the incapacity to assist children, especially in the north of the country, and I talked about the refugees. I was We were on television throughout the region, CNN etc. It sent by Marcel [Roux, Coordinator for MSF France in China]. worked very well. The message was really strong and allowed We said that there were urgent needs; that the refugees WFP and diplomats to be asked for help later on. There reported the existence of a famine, that the humanitarian were lots of discussions afterwards. The fallout went on for needs were considered a priority by the government and that a while, with interviews, opportunities to explain ourselves we were leaving. Most of the questions were for Eric etc. I had to give a 15-minute television interview with an Goemaere. Dominique and I were very much in the back- ex-ambassador in London, for example. ground; we were the ‘beginners.’ The main message was carried by Eric; Dominique and I came to prop up it up. Samantha Bolton, Communications Coordinator, MSF International, (in French). During the press conference, I noticed a kind of contradiction between what Goemaere and I were saying. He couldn’t bring himself to use the word famine. As for me, I wasn’t bearing a message regarding MSF’s position on the inside of North Korea, but I was obviously in a legitimate position to I’d been in regular contact with Romain Franklin of pass on the refugee’s accounts. I had the vision of these the Libération for some time. He’d been following refugees in my head, so I was more radical on the issue. Korea for a while. I saw a lot of him; we trusted I was familiar with them, I felt comfortable with how this each other. That’s how I functioned when I was a Programme information had been collected, and I had met sufficient Manager. I had regular contacts with journalists, I followed numbers of refugees who’d described the reality to me. I their work, I knew what they were working on, and I kept reported what they had to say. I don’t think I passed an them informed from my side. In this case, we knew the story institutional message for MSF. Eric Goemaere was there for was ‘big’ for the Libération, but we didn’t know what they’d that and I don’t remember working totally against him. do with it, we didn’t know if it would make headlines. It was Nonetheless, relating the witness accounts allowed me to go a bit like with Zaire . We didn’t know from the outset, but further than Eric Goemaere or Dominique Lafontaine. we knew the circumstances were favourable. There was a link with the press conference in Hong Kong. But the Our message ended up being a sort of compromise. We Libération dossier was more substantial because the jour- wanted to protest and say that we couldn’t work inside nalist had been kept informed for a while and he had all the North Korea, that aid was being manipulated, and at the documents. same time we had trouble being strong and clear in our messages. We were missing clarity; it was obvious that we The subject of the press conference was our withdrawal. had difficulties putting our message together. In the end, Marcel arrived on the 30th September with a subject that we asked for external pressure on North Korea to be stepped was in no way related, being ‘the situation in North Korea up so we could have access. When a journalist asked if a as seen by refugees,’ and, this automatically reinforced the famine existed in North Korea, Eric replied that we didn’t effect of announcing our withdrawal. Our timing was good know, which was precisely the problem. I had the impression here. When we look back at it, we always have the impres- that you could feel this internal ambiguity in the contradic- sion that the different stages were well planned, but actu- tory articles published following the press conference, some ally it was much more off the cuff. And there were windows saying that MSF had talked about a famine, others saying of opportunity. Romain opened one up. We jumped on it that MSF said there was no famine. It showed our unease and it caused waves. The refugee accounts fed the basis on the subject. of the dossier. At the time, there were few organisations considered independent who did this sort of work. So in Marine Buissonnière, administrator, MSF France in France, this reinforced our position when we were talking China, December 1996 to January 1999 (in French). about Korea: MSF is leaving, and the refugees confirm what we can’t see from the inside.

Pierre Salignon, MSF France programme manager, from October 1997 on, then MSF France Executive Kong. I was really uncomfortable with being obliged Director from January 2004 on. to speak out. I didn’t really want to talk about it like this; my English was never very good. I was sup- 138 posed to represent someone from the field. I didn’t manage we havetobe there, whatevertheconditions. ’ Yethewas are millionsof dead, then youmust follow up bysaying: ‘so ‘there are millionsof dead.’ If you come back saying there game aren’trespected.’ThenMarcelshowedupsaying: manage toimprovethesituation becausetherulesof towards anagreement.Wesaid: ‘whateverwedo,won’t English and no oneunderstood. we couldsee.MaybeIdidn’texpressmyselfveryclearlyin field, outsidethecapital,everyday,andIdescribedwhat the storiespublishedbypress.Isaidthatwewerein the field,insideNorthKorea.Theydidn’tcomeoutatallin was interestedinthetestimoniesonwhatgoing discourse hung together well. But I don’t suppose anyone afterwards. TheyfocusedonEric,undoubtedlybecausehis and Marie-Rosebuthardlyanyjournalistsaskedquestions press conferenceitselfwiththeofficialremarksfromEric being diverted.Iwasastonishedbecausetherethe with theiranalysis,whichconcludedthateverythingwas they’re distributing,there’saproblem.Itwasincoherent nothing andontheothersidepeopleinsidecountrysay If ononesidepeoplewho’veleftcountrysaytheyreceived they’d received nothing; thatthey’dhadnoaccesstoaid. The refugeeswho’dpassedtotheChinesesideclaimed that described therealityinfield,includingaiddiversion. presented someinformationcollectedontheborder,which MSF. Marinecamewithhermessage.Fromtheirside,they theless, anagreementtodeliveramessagecomingfrom two waysoflookingatthesituation.Therewas,none- During thepressconference,wekindofpatchedtogether since. before we’d evenspoken.Ihaven’treallytrusted journalists even said.Hedatedthestory27 the articlehepublished,putdownthingsthatwenever a bit-wedidn’twanttotalkaboutthingsindetail,and familiar withthesituationinKorea.Hedistortedourwords journalist already had alotofinformationandwasvery Herald Tribune,publishedbeforethepressconference.This was annoyedaboutit.IsawthearticleinInternational after the press conference, but he did it before. Everyone riot becausewe’dagreedhewouldonlypublishhispiece talked abitaboutallthesestories.Afterwardsitcaused to theconference.Hewantedtalkusdirectly.We interview becausethejournalistinquestioncouldn’tcome who wasmanagingtheoccasion,hadaskedustogivean journalists before the press conference. Samantha Bolton, children’s storywasnotdiscussed.We’dbeencontactedby ian aidwasn’treachingthepopulationsneedingit.The was verylittlehumanitarianworkingspace,andhumanitar- to saymuch.Wemostlypassedthebasicmessage,i.e.there Dominique Lafontaine, physician, MSF Programme in became abitcontradictory. Wewereworking for our overall image. At this point our messages The testimonies of Marcel Roux’steam bothered me DPRK, August1997 to September1998. th September,whichwas know what they want?’ people outside MSF were asking themselves: ‘do these guys to showerthecountry with aid.’ Honestly, once again worth giving.ThensuddenlyMarcelarrivessaying:‘wehave for thecoordinationofaid,sayingthatotherwiseitwasn’t were totally incomprehensible. We were applying pressure we aretotallyincomprehensible,andhere,onceagain, no partyline,spokesman.Buttherecomesatimewhen encourage people’sspontaneityinMSF.It’sagoodthing- our attempttoapplysomestrategythiswitnessing.We I canseetheclashbetweenakindoffieldspontaneityand tory withwhatweweresaying.Idon’tknowifI’mright.But bombarded withfoodaid,whichwascompletelycontradic- population. Accordingtohim,thecountryshouldliterallybe they’d hadtheirfill,whatwasleftwouldgotothegeneral the famousmillionmembersofmilitary-butonce aid, thatobviouslythemilitarywouldbefedasapriority- clearly saying that the country should be flooded with food made waves.Others weresayingittoo,butwe weretheonly needs, allthese thingsrelatingtototalitarianism, they divided upfairly,talkingabout theimportanceofevaluating billion a year and having no impact because it wasn’t political.’ Sayingthatinternationalaid wasworthhalfa aid is provided to North Korea on such a massive scale are really clear when we said: ‘the reasons why humanitarian was generallywellreceived[outsideNorthKorea].Wewere again, wereallychallengedthegovernment.Themessage did the press conference. Hong Kongwhenthearticlecameoutinpress,andhe but thiswasn’tMSF’sopinion,wehadnoproof.Ericleftfor tradict Marcel, saying that there were unconfirmed rumours was taken up on a regional level and I was obliged to con- prove them.IthinkwasinChinaatthetime.Thestory were launching ideas into the air without being able to with intelligenceandsaythingswe’resureof.TheFrench isation, people listen to us, we have to use our visibility that there’safamineinNorthKoreabutwe’rebigorgan- things wecouldn’tprove.Ihavenoproblemwithsaying we missedthemark.Theproblemwasthatweresaying ened byallthisconfusion.Ithinkitwasagoodone,but Dr. Eric Goemaere, Executive Director MSF Belgium, distribution. We had a lotofpresscoverage.Once the populationandlackofcontroloverfood We didsomegoodworkontheabsenceofaccessto disappear like that. Our message was really weak- don’t knowifit’strue.But2milliondeadjust They spokeof2milliondeadduetothefamine.I William Claus, MSFBelgium programme manager, (in French). (in

French).

139 MSF and North Korea 1995-1998 MSF Speaks Out

ones in the humanitarian community to be raising the issue. One of the two: still I find it very difficult to believe that so And that was the value of our speaking out. We had the many North Koreans have died and that MSF people in three legitimacy to do it. I was completely at ease with all this. different provinces and later four did not witness any sign of It was really useful and effective in terms of raising aware- that. But we do have many concrete proof of the fact that ness. We did a great job. I think it’s an example of a cam- our information was manipulated. But if 10% of the popula- paign that worked. The sad thing is that it’s the sort of tion had died during that time, as was claimed, we would campaign that works because we’re leaving… have seen fresh graves. We would have seen some people dying. We never saw people dying in hospital. So, that is why Anne-Marie Huby, Executive Director, MSF UK I think that both our information was manipulated. (in French). Pim de Graaf, MSF Holland Executive Director (in English).

There was this article by John Pomfret of the Washington Post. There were three editions of the International Herald Tribune, [which re-published On 30 September 1998, while the nuclear and peace articles from the Washington Post and the New York Times]. talks regarding the Korean peninsula were about to One in Hong Kong, one in Paris, and one in New York. We resume, the USA promised to provide more fuel oil to actually announced our departure in the Hong Kong edition, DPRK. The USA also asked the North Korean authori- i.e. before announcing it in New York [due to the time dif- ties to solve the issue of the access in order that MSF ference]. It was perfect announcing it in Hong Kong. It could resume its activities, but the US continued with seemed really logical to me, as this was the region con- the provision of 300,000 extra tonnes of food aid to cerned. But it caused a real hiatus. MSF Belgium wanted to the DPRK. stop giving us information. They said: ‘our agreement on communication has been broken by MSF USA, because Hong Kong communicated before us, etc.’ They really gave us a hard time on this point. I had Marie-Rose, the “US Gives N. Korea Fuel Oil as Talks Resume,” Coordinator, on the telephone. She reproached me, saying: Carol Giacomo, Reuters (UK), Washington, 30 ‘and you, in New York, you were involved, etc’ and she September 1998 (in English). didn’t even want to speak to me anymore. I had to pull out all the diplomatic stops to get information out of her - I had Extract: to communicate with her directly to understand what was The United States on Wednesday made good on a promise going on. to provide more heavy fuel oil to North Korea as key talks were set to resume on Pyongyang’s missile sales and on Antoine Gérard, Head of Programmes Department, bringing peace to the Korean peninsula. Circumventing a MSF USA, (in French). reluctant Congress, President Bill Clinton used presidential authority to provide an extra £15 million to buy some 150,000 metric tons of fuel oil, US officials said. The funds are being shifted from anti-terrorism, non-proliferation, and other programmes to allow the United States to fulfil I don’t think that we have done anything else except a commitment to the reclusive Stalinist regime under emptying our own emotions and that was it. We emp- a 1994 nuclear accord called the “agreed framework,” tied our souls and our emotions by these perfect the White House said in a statement. “We continue to statements and I still think that it was completely useless. believe very strongly that it’s important to go forward“ Now it looks like we went in, we tried, we were naively sur- with the implementation of the agreed framework,” State prised by the lack of progress, and then we decided to turn Department deputy spokesman James Foley told reporters. our back on North Korea. There was obvious manipulation of “And it is essential in this regard for the U.S. to live up to information to us. We had information coming from the its commitments just as we demand obviously that North Chinese side and there was even done a sort of field visit - Korea fulfil all of its obligations under the agreed frame- assessment - two missions -assessment missions on the work.” The announcement came one day before the United Chinese side and among North Korean refugees. And their States and North Korea were to resume talks in New York information was that many people in North Korean were on Pyongyang’s missile programme. The two sides last dying from hunger. And our information from within North discussed the issue in June 1997. Korea was not at all like that. We never witnessed signs of any kind that on a large scale, people were dying. So we have Washington wants Pyongyang to halt production, deploy- always said, either, they are so skilful at manipulating our ment and transfers of the weapons, which have been sold information that even if you are very suspicious, you do not to Iran, Syria and Pakistan, among other countries. The see the real side, or the témoignage from the North Koreans issue took on a new urgency after Aug. 31, when North 140 who say in China, that so many people have died, is false. Korea launched a multistage missile that flew over Japan ing was a prerequisite. went throughtheUNWorldFoodProgrammeandmonitor- the accessproblemimmediately.”HesaidallU.S.foodaid had beenrestrictedandcalledonNorthKorea“toremedy disturbed byreportsthattheMSF’saccesstoruralareas toring oftheprocess.FoleysaidUnitedStateswas in whichaidwasbeingdistributedandthelackpfmoni- North Koreainprotestagainstthe“discriminatory”’way Frontières (MSF)saidonWednesdayithaspulledoutof dren. TheFrench-basedmedicalcharityMédecinsSans 300,000 metrictonnesofwheattofeedstarvingchil- would providefamine-plaguedNorthKoreawithanextra The UnitedStatesalsoannouncedrecentlythatit China. [...] on Oct.21-25withtheUnitedStates,SouthKoreaand agreed toresumefour-partypeace’negotiationsinGeneva ity wasbecomingmoreadvanced.NorthKoreahasalso the regionbydemonstratingthatPyongyang’scapabil- apparently failedtoputasmallsatelliteinorbit,itshook before crashing,intothePacific.Althoughrocket not withdraw from North Korea. dence thataid wasbeingdivertedandthat theywould UNICEF andWFPcommented thattherewasnoevi- “significant diversion ” ofAmerican aid. nonetheless addedthattheUnitedStateshadobservedno istration would like to increase its measures of control. He remarked Mr Foley, pointing out thatthe American admin- mechanisms inplace.Thissituationis“farfromideal”, by theWorldFoodProgramme,(WFP),whichhascontrol United States,emphasisingthatitwouldbedistributed patch of300,000tonnesadditionalfoodaidfromthe announced thatMSF’sdecisionwouldnotaffectthedis - the useoffoodaid.Nonetheless,StateDepartment their aidpolicyforNorthKoreaandimposecontrolson to theregime.MSFcalledondonorcountriesrevise because they were not part of families considered loyal Korean childrenwerebeingdeprivedofinternationalaid North KorealastTuesday,afterstatingthatsome State Department.MSFannounceditswithdrawalfrom ties,” declaredJamesFoley,adeputyspokesmanofthe aid) withoutdelaysothatthisgroupcanresumeitsactivi- in NorthKorea to resolve the problems of access (to food drawal onTuesday.“Weareaskingthepeopleresponsible Médecins SansFrontières(MSF),whoannounceditswith- aid tothecountry,asdenouncedbyorganisation resolve theproblemswithchannellingofinternational On WednesdaytheUnitedStatesaskedNorthKoreato Extract: Washington, 1 October1998(inFrench). the ChannelingofAid,” ” Pyongyang HastoResolvetheProblemsWith AFP (France), able.’ The Red Cross qualifies them as ‘pretty improbable.’ aid distribution, considersthesefigures‘onllyslightlyreli - tions. TheUnitedNations,which headstheworld’sfood scepticism thanhorroramongst humanitarianorganisa- As terrifying as all this is, these figures give way to more deaths from starvation each year. 1995, therehavebeenbetween 300,000and800,000 after amissionofonlyfourdaysinPyongyang,that,since August, adelegationfromtheAmericanSenatedeclared, population ofbetween35%and40%incertainregions.In smuggled secretlyoutofNorthKorea,revealsadropinthe poorest agriculturalareas.Someelectoralinformation, to 2.4 million deaths, with victims concentrated in the Natsios, oftheInstituteforPeace,figureiscloser a populationof23million.FortheAmericanAndrew led tomorethan3.5milliondeathssince1994outof tioned some1,500refugees,claimsthatthefaminehas Buddhist organisationpresentinChina,whohasques - […] The Venerable Pomnyun, head of a charitable “We cannot state that there is a generalised famine” MSF the WFP. persons,” declaredChristianeBerthiaume,spokesmanfor should stay,intheinterestofchildrenandothervulnerable reached thepeopleitismeantfor.“Wethinkthatwe a thirdofthepopulation,alsoemphasisedthatit’said counties ofthecountryanddistributesfoodtonearly Programme (WFP),whichhasaccess to 210ofthe250 “concerned bythequestionsraisedMSF,” without anypoliticaldistinctionsbeingmade.Whilst that thechildrenassisted by UNICEF received their food operations,” saidaspokesmanforUNICEF.Heconfirmed any proofofdiversionfoodaid.We’recontinuingour the UNagenciesoperatingincountry.“Wedon’thave But these statements were questioned on Wednesday by demns anyone outside the system to certain death.” health careisbasedonpoliticalconsiderations,whichcon- “Our onlycertitudeisthatthedistributionoffoodand the sixteenmonthsofourpresence,”repliedEricGoemaere. areas? “Wedidn’tseeanytruckscollectingbodiesduring the MSFteamsmissvictimshiddenawayininaccessible received thelargestamountoffoodaideveraccorded.”Did country. Weshouldn’tforgetthatthisyearNorthKorea confirm thatthereisageneralfamineaffectingtheentire bodies arebeingleftbytheroadsides.Weabsolutelycannot Kong onWednesday30thSeptember.“Noone’sdying;no Goemaere, GeneralDirectorofMSF,passingthroughHong situation isverydifferenttothatinSudan”explainedEric Despite itsoutburst,MSFseemstohavedoubts.“The Yet isNorthKoreasufferingfromageneralisedfamine? Extract: 2 October1998 (in French). Brunschwig, Aid ReachesthePeopleitisMeantfor,”Valérie Korea –TheUnitedNationsConsidersthattheir “ Debate ontheExtentofFamineinNorth Le Monde(France)HongKong, D153 the WorldFood

141 MSF and North Korea 1995-1998 MSF Speaks Out

Between the thesis of ‘a genocide masked as a famine’ forces set on sabotaging humanitarian assistance to North and the ‘Timisoara syndrome’, the way forward looks tricky Korea,” continued KCNA. The agency added that humani- for those working ‘in a totally impenetrable regime’ which tarian organisations are free to visit the affected regions uses humanitarian aid for political ends. “On one hand “unless there are any particular problems” and that aid Pyongyang uses orphaned children, in a terrible nutritional does reach the people concerned. state, covered with sores and lice, to attract food aid and medicines. On the other, it refuses us access to them on the grounds that this is not a priority population,” relates Eric Goemaere of MSF. MSF has no doubts about these refugee testimonials, “which have their own value,” said one of its “UN Aide Charges North Korea With Blocking representatives, Marine Buissonnière. “But extrapolating Relief Workers,” International Herald Tribune them to the entire population leads to overblown conclu- (Reuters), Tokyo, 13 October 1998 (in English). sions.” Will MSF be accused of non-assistance to persons in dan- Extract: ger? In withdrawing, the organisation is aware that it is Namanga Ngongi, Deputy Executive Director of the World nudging the country further towards a return to the medi- Food Programme, said North Korea denied UN aid workers cal ice age, where surgical operations take place without access to at least 26 famine-stricken counties for “secu- antiseptics, anaesthesia or antibiotics, makeshift drips are rity reasons.” Mr. Ngongi told a news conference that his pieced together with beer bottles and doctors don’t know agency had asked the North Korean government to allow about aspirin. “The risks are really serious” recognises Eric its aid workers to monitor food distribution in at least 171 Goemaere. “But we couldn’t continue working without being of the nation’s 210 counties. North Korea, however, did able to carry out free evaluations of the needs, without not say when it would allow relief workers to enter the helping the most vulnerable, and without being able to counties to monitor food shortages triggered by floods in measure the impact of our work.” 1995 and 1996 and a drought last year.

“Is North Korea Ravaged by Famine?” Frédéric On 5 October 1998, the North Korean authorities Koller, Le Temps (Switzerland), 26 October stated that the MSF statement was inconsistent. On 1998 (in French). D154 13 October 1998, the WFP deputy director stated that North Korea was denying aid workers access to many Extract: areas where they planned to monitor food distribu- But today Philippe Biberson denounced the hypocritical tion. Whilst acknowledging that the situation in North silence surrounding North Korea “when everyone agrees Korea was serious, most of the NGOs and aid agencies about the state of affairs.” A unanimous agreement? kept denying that there was a widespread famine. An It’s not so sure. As diplomatic talks on the future of official from the Swiss Cooperation Department even the Korean peninsula started up again in Geneva last stated that the refugees had exaggerated their testi- Wednesday, MSF invited all the NGOs still active on the monies because they had to justify why they were on ground to Amsterdam for a private debate, on the same the run. Several NGOs intensified their aid to North day. Korea, asserting they had always been able to control its distribution. Is there really a famine in Korea? Is it impossible to work there? Give or take a few nuances, the reply from NGOs and programme managers of international aid is unanimous: there is no formal proof of the famine denounced by ”North Korea Denies the Accusations of Food Aid MSF, even if the situation is considered very difficult and Diversion,” Le Monde/AFP (France) Tokyo, access to North Korean territory is limited. On the other 7 October 1998 (in French). hand, we consider that we have a satisfactory control over our aid, even though we can’t always follow it up 100%. Extract: Finally, humanitarian aid can only be linked to a political On Monday 5 October, North Korea rejected the accusa- situation and we don’t have the right to abandon children tions of Médecins Sans Frontières (MSF) regarding the who haven’t chosen their place of birth. authorities’ diversion of international aid destined for victims of the famine (Le Monde 2 October). According to Thus, there is no question of Swiss humanitarian aid, a senior member of the Aid Committee for Flood Victims, amounting to some 30 million francs, dropping its pro- cited by the official agency KCNA, received in Tokyo, MSF’s gramme, and it is even considering extending it by two accusations are “incoherent.” The agency is astonished years. “We cannot talk of a famine,” explained Stefan that a humanitarian organisation can call for a stop to Kaspar, spokesman for the Direction of Development aid for North Korea, claiming the diversion of assistance and Cooperation (DDC). “There are serious malnutrition 142 to the army. “We consider this an act motivated by hostile problems, but the situation has improved in the hospitals Democratic Republic’s CommitteefortheRehabilitation of MSF withdrew incommonagreementwith theKorean So thatleavestheNorth Koreanregime’sversion: Bethiaume regarding MSF’scriticisms. way of exerting political pressure,” concluded Christiane month. “It’sverydangeroustousehumanitarian aidasa which the results should be available at the end of the European Union,tocarryoutafirstnutritionalsurveyfor finally allowedWFP,associatedwithUNICEFandthe of leaving. Especially as on 23rd September, Pyongyang still regionswecan’tgetto.”Butthere’snoquestion to 171countiesoutof210.It’sascandalthatthereare with 47peopleontheground.Butweonlyhaveaccess next year.“Wehavegoodcontroloverourdistribution, 400 milliondollarsinfoodaid.Butthiscouldgodown people isgettingworse.In1998,theWFPaccordednearly improved forchildrenunder6,thesituationolder explained ChristianeBerthiaume.Evenifthingshave under threat,wecanalreadytalkaboutpocketsoffamine,” “We can’tconfirmordenyit.Butwe’resurethecountryis (WFP), thereisnonethelesssomecaution.Afamine? In theGenevaheadquartersofWorldFoodProgramme Pyongyang is gradually opening up.” extremely difficult,it’simportanttostay,showpatience. in needwithoutanyproblem. And evenifthesituationis lion dollarsthatwe’reofferinginaid.Itreachesthosemost north of the country: “We have control over the 6.2 mil- the provincesinNorthKoreaexceptforHamgyong autumn doesn’tlookgood.KaithiZellwegerhasvisitedall it lookslikethewinterwillbehard.Theharvestthis of hungerorchildrenwithbigbellieslikeinAfrica.”But a faminein“slowmotion.I’veneverseenpeopledying Manager inHongKong,KathiZellweger,talkedabout Returning fromamissioninPyongyang,theCaritas exceptional case thatthe organisation has to leave. ties ofworkinginNorthKoreastilldon’tmakeitsuchan impenetrable natureoftheauthoritiesanddifficul- has beenavoidedbythedeliveryofinternationalaid.The Geneva, MarcelFortier,alsoconsidersthatacatastrophe in thecountrysince1995.TheProgrammeManager larly foodaidandblankets.It’sspent61millionfrancs provides medicalassistanceandemergencyaid,particu- firmly implanted in North Korea with seven delegates. It UN. TheInternational Federation oftheRedCrossisalso discourse isheldbysourcesclosetothisdossierinthe ism. It’simpossibletohideafaminethesedays.”Thesame they’ve fled.Wecannotimaginethatthere’sanycannibal- considers them “exaggerated.” They have to justify why As forthetestimoniesofrefugeesonborder,DDC A famine ‘in slowmotion’ our aid which isdestined for children.” going on”continuedthespokesman.“Wehavecontrolover travelling around,wehaveagoodglobalviewofwhat’s ten, amountingto20%oftheterritory.“Butwhenwe’re Pyongyang since1994,canaccessthreeprovincesoutof we’ve beenabletovisit.”TheDDC,whichhasanofficein ed, itwouldbe bettertobeclearandcallit economicaid. but giventhatthehumanitarian effectofthisaidislimit- to avoidarealcatastrophe. Maybe there’snoalternative, Pyongyang, formingpartofthe gradualtransitionneeded policy ofreformandopening upshouldbeencouragedin send a message: the world is not necessarily hostile. A considerations. However,aidprovidedbystatesdoes FJ: It’snotforanNGOtogetinvolvedinpolitical an extent, should states put astoptotheir aid? Le Temps:Ifcontrolisimpossible,astheUNrecognisesto expelled, more that we werethanked and dismissed. cal industry.That’snotourjob.Wecan’tsaythatwewere programme for rehabilitating their national pharmaceuti- plan this summer,the North Koreans asked us to finance a in NorthKorea. During the re-negotiations for our action over theeffectivenessofouraction,whichisimpossible the mostimportantissueisaccesstovictimsandcontrol FJ: We’relobbyingforhumanitarianaidtostop.Forus, Should everyone follow your example? Le Temps:MSFtalksofhypocrisyconcerningNorthKorea. in thesmall, disaster-stricken towns. the strategicsectorandarmy.Thefaminehitshardest food distributionandgivespreferencetotheworkersin elderly andchildren.Thestatehascompletecontrolofthe point of view. The most fragile victims are obviously the cally disloyalorwhohavenoutilityfromaneconomic parts ofthepopulation:thosewhoareconsideredpoliti- It’s averyvaguephenomenon,whichonlyaffectscertain sequence oftheregime’sobsessionwithself-sufficiency. (particularly thefocusonheavyindustry).It’scon- ical andeconomicchoicesmadeoverthepastfortyyears FJ: It’snotatraditionalfamine.clearlylinkedtopolit- Le Temps:Howwould you describethis famine? gradually formed anopinion. [...] not berepresentativeoftheentiresituation.Butwe’ve we can’t take all these accountsas gospel and they may FJ: We’vebeentotheSino-Koreanbordertwice.Ofcourse able? Le Temps:Andonthispoint,arethesetestimoniesreli- confirmed by theanalysis of researchers. on theborder.Wewerestruckbyhowtheseaccounts national experts,andfinallythetestimoniesofrefugees based onourexperienceinthefield,opinionofinter- the situationremainsveryobscure.Ourconclusionis FJ: Verylittleinformationcomesoutofthecountryand in North Korea? Le Temps:Whatallowsyoutostatethatthere’safamine Interview with François Jean don’t want togive it,” concludedthe spokesman. people. “Weneveraskforhumanitarianaidfromthosewho thwart internationalaidbeingdeliveredtotheKorean acts preparedbyantagonisticforcesthataretryingto accuses thewesternmediaof“trouble-making”basedon Natural Damage.GoingsoftlyonMSF,thisStateagency 143 MSF and North Korea 1995-1998 MSF Speaks Out

never kept. They were badly perceived by the Koreans who are very proud. In fact, the ECHO representative in the field “Concern to Spend £1.3m Helping North Korea,” was an ex-ACF. He had always pushed for ACF to be in North from Conor O’Clery in Beijing, The Irish Times Korea and had kept a budget to one side for them. That’s (Ireland), 27 October 1998 (in English). why the Koreans accepted them, but it wasn’t their choice.

Extract: Medicaid, an American NGO, bombarded the country with Concern Worldwide is to carry out projects worth $2 mil- medicines and medical material. Our negotiating position lion (£1.3 million) next year in the Democratic People’s was very weak. We were sure of being replaced and this Republic of Korea, the Irish aid agency’s deputy chief turned out to be the case. Yet we’d passed the message executive, Mr Paddy McGuinness, said in Beijing yester- loud and clear and everyone agreed to not take over our day. This is more than double the amount committed by role or our place. But as soon as we’d gone, the Red Cross Concern in 1998 to the isolated communist country, which took over our place because the money was available. We has had several years of severe food shortages. “Millions discussed it a bit with ECHO, everyone was asking us to stay, of people remain vulnerable,” said Mr McGuinness, before to have real access. But on this point, I totally agree with returning to Ireland after a week spend in North Korea, the others. We couldn’t stay at any price, pouring millions where Concern operations are conducted by the agency’s and millions into a country with no proof of malnutrition. full-time representative, Mr Mike McDonagh. “We are in the How could we continue giving tonnes and tonnes of food DPRK for the long term,” he said. knowing that it was going to feed an army of 2 million soldiers? I’ve no issue with these soldiers eating too, but The funding will come mainly from the EU, the US and the we should at least have the opportunity of controlling Swedish government, and will help pay for schemes such the chain of food aid. I said to WFP people: ‘how do you as a food-for-work environmental improvement, experi- know where all these tons of rice you’ve given are going?’ ments with spring wheat and potatoes and greenhouse Normally there’s ‘food basket’ monitoring at the end of the construction. [...] Concern is one of seven aid agencies, week! This question really hurt them. ‘No no no, we trust five UN bodies and a number of US organisations working them!’ How could you discuss anything in these conditions? under one umbrella in North Korea. Its target area, the We shouldn’t play at prison guards, but there should be a hinterland of the northern city of Pyongsong, has a food minimum of surveillance. It’s what we always ask for, in all deficit of 30,000 tonnes and Concern hopes to make up our MSF programmes, whatever the country, and if we don’t 12,500 tonnes through introducing spring wheat, a prac- get it, the donors aren’t happy. But none of these rules tice not used before in North Korea. The food-for-work applied in North Korea. scheme will involve distributing wheat, rice, vegetable oil and sugar, supplied mainly by the EU, in return for work William Claus, MSF Belgium programme manager, in improving damaged agricultural land. Mr McGuinness (in French). said he was happy to be able to see with his own eyes that Concern’s efforts in helping North Koreans in practical ways were benefiting those in greatest need.

Recently the French organisation Doctors Without Frontiers From what we saw, we always had the impression left North Korea after 16 months because it said it had not that there were masses of aid, far more than required been able to negotiate free access to bring humanitarian for feeding this vulnerable population decently. On assistance to those most in need. the other hand, throughout the three or four years following MSF’s withdrawal, when I was following the dossier from 1998 to the end of 2003, the organisations present in North Korea never stopped reproaching us for speaking out and withdrawing like this, saying that we did them a major dis- This press conference didn’t confirm anything. It just service. We attended almost all the conferences on North served to air our frustrations a bit after having Korea over a five-year period and each time MSF was seen as worked 1.5 years without achieving anything. Our the big bad wolf. Our speaking out had an impact, it went withdrawal would have had a bigger impact if we hadn’t down badly, particularly with big organisations likes Caritas, been short-circuited by the French, and if the international who never really digested the drop in funding generated by communication had been closer to us. We were given lots of the criticisms of North Korea’s aid system. These organisa- promises; everyone said that what we were doing was so tions were in a development mode. They were convinced that brave. ACF took over the northern province when we left. sooner or later, this approach would have an impact and They reached the same conclusions as us two years later. I that they had to continue, even if they didn’t see any imme- discussed it with them a bit in Paris, they said: ‘yes, you diate results. We embarrassed them by obliging them to were right.’ But they stayed, and they had the same prob- explain their calls for funding to their donors. lems as us. They thought they could be a bit cleverer, that they wouldn’t have the same experience as we did. They did Our speaking out, despite everything, coincided with the 144 their exploratory mission; they made promises that were arrival of George W. Bush to the White House and he was had to beef up their justifications for funding. had aharmfulimpactonmostoperatorsbecausethey’ve they’ve posedalotofquestionsonthisfoodaid.Thishas Even iftheUnitedStateshascontinuedtosupportWFP, totally opposedtothe“softlanding”policyofBillClinton. several inquiries from MSF sections on further information 2) Followingthe updateI’vesentyoulast week,Igot USA) organised Mercy Corps, during 23-24-25October. at theMusgroveconferenceon humanitarianaid(Georgia, planned topresentareportof theAmsterdamroundtable diplomats in the week following the round table. It is also to organizeabriefingsessioninGenevaforjournalistsand no presspresent at the round table. However, we will try concerns among the involved organisations. There will be sible way.Wewilltrytocomeupwithalistofcommon are inKorea,andhowwecanrespondtothemarespon - organisations onwhatthenutritionalandmedicalneeds information andtrytocomeadiagnosiswiththeother decision. Moreover,theroundtableismeanttoshare working inN.Korea‘privatecircumstances,’onour table ispartlymeanttoinformtheotherorganisations process. Lastweekweinformedthemedia,thisround table isoneoftheevents‘MSFleavingN.Korea’ on NorthKoreaOctober21stinAmsterdam.Theround like toinformyouthatMSFisorganisingaround-table On behalfofMSFFrance,BelgiumandHolland,Iwould To updateoursupportingsections,thefollowingmessage. 1) Dearall, Extract: totalitarian regime in North Korea. on the role of international aid in maintaining the the MSF France President published in-depth analyses aid inNorthKorea.FrançoisJean(MSFFoundation)and eral roundtablesandsymposiumsabouthumanitarian Korea’ process.MSForganisedandparticipatedinsev- press conference,MSFcompletedthe‘leavingNorth the NorthKoreanregime.Inweeksfollowing international aid system that was being challenged by France. HeexplainedthatbeyondMSF,itwasthewhole lished anarticlebyPhilippeBiberson,PresidentofMSF On 14October1998,theFrenchdailyLeFigaropub- co-Coordinator, MSF Francein South Korea,January 2002 MSF France in China,January 1999 toDecember2001; Sophie Delaunay, Research officer, Foundation MSF network, 8October1998(inEnglish). volunteer inNorthKorea,toMSFKorea Swaan, Coordinatorround-table,previouslyMSF “ MSF RoundtableN.Korea,” France, June to August1998;Coordinator, Email fromCorien to October 2003. D155

to help those specialchildren. Korean government absolutelydidnotcooperate withus the fooddistributionand/or medical system,andthatthe children, whichfallthrough one wayoftheother,outside have proofofisthatthere are vulnerablegroupsamong which areveryworryingof course.Theonlythingwe the field.Weonlyhave interviews ofJeanFrancois, expats wehavenoproofofthatfromobservations was notthatthereisafaminegoingoninN.Korea.As interpreted thepressreleaselikethat.Also,ourmessage that). Ipersonallyregretthatquitesomejournalistshave rerouting offood/materials(wedon’thaveanyproof why wewereleaving.Sothiswasnotbecauseofthe The goalofthepressreleasewastotelloutsideworld the message that they can reopen negotiations if the want. Korea (ofcourseundercertainconditions),andleftwith stay). WestillwouldliketogivehumanitarianaidN. we alsocouldnotstay,althoughwouldhavewantedto expired and we had to leave (so not really kicked out, but mentation oftheoriginalproject),sovisasexpats of September(wegot2extramonthstofinalisetheimple- started. ThismeantthatourMoUexpiredinthefirstweek ing this. So the negotiations were stuck before they even them severaltimesthatMSFisnotanorganisationprovid- new; Marie RoseourHeadofMissionalreadyexplained with rebuildingtheirdrugindustry.Thisrequestwasnot they justaskedforrawmaterials,drugs,andassistance even goingintodetailofanyfurtherplansourside, Korean authoritiesatthebeginningofAugust.Without (MSF B,beingbackupsectionuntilSeptember)fortheN. A verypreliminarydraftwaspresentedbyWilliamClaus evaluation, but thatwas not evenbrought up yet). cal institutions(andwithbetterconditionsonaccessand in a smaller area with closer cooperation with the medi- started draftinganewprojectproposal,basedonworking Not beingverysatisfiedwiththecurrentprogramme,we is the interviews of Francois Jean, see attached file). confirm afamineinDPRK(andtheonlyindirectsource as well).Sothereforewestillwerenotabletodenyor going on(theofficialreportofthemissionisattached data, files,wards,etc.,togetabetterviewonwhatis and alsowedidnotgetenoughaccessintothemedical admitted malnourishedchildreninthenutritionalcentre, as medical doctor in N. Hwangae), we did not met many the countryisfacing.Duringourwork(myselfIworked more aboutthenutritionalproblemaridmedicalneeds to starttheproject‘beonground’andlearnthen this provincewasaddedfromFebruary1998.Ouraim county hospitals.AfteranassessmentinNorthHamgyong, materials, andtosetuptherapeuticfeedingcentresinthe year. We workedin3 provinces to distribute drugs and raw in N.Korea,withMemorandumofUnderstandingone To recapthesituation:MSFstartedtoworkinJuly1997 background information. information centre, I will try to provide you with some ing NorthKorea.AlthoughIamnottheofficialMSFKorea on thepressrelease(attachedfiles),andwhyweareleav- 145 MSF and North Korea 1995-1998 MSF Speaks Out

We left N. Korea, but we did not close the book. From is not known, but the expectation is a continuing malnu- outside, we try to keep the discussion going on how what trition at least of the vulnerable groups. the medical and nutritional needs are in N. Korea, and Health: the health care system has collapsed and the how humanitarian aid can be given in a responsible way. population is weakened, leading to re-emerging diseases and unnecessary mortality. [...]

Mercy Corps ‘Musgrove III: Humanitarian Aid to North “MSF Report on Humanitarian Aid Policy Towards Korea’ (Musgrove, Georgia, USA) North Korea,” Memo [no name, no date], probably from Corien Swan, probably November Participants were American NGOs working in North 1998 (in English). D156 Korea (among them CARE, CRS, World Vision and Mercy Corps), representatives of the US government (Congress, Extract: House International Relations Committee, US Dept. of Reports of meetings organised by WFP, MSF, and Mercy Agriculture, USAID and US Dept. of State), WFP, UNDP, Corps. WFP/NGO meeting on North Korea (Rome, 10/9/98): American Red Cross, epidemiological consultants from Present were WFP, OCHA, MDM, ACF, CRS, Caritas, DFRC, John Hopkins Institute and CDC Atlanta, and MSF. German Agro Action. Critical remarks were made towards WFP, what the value of the newest nutritional survey The discussions led to the following agreements: Overall would be, how representative its results are, and how it goals: to address immediate needs and to reconsolidate can be that such an influential organisation still cannot relations NK/USA. deny, nor confirm a famine. - Interaction will contact OCHA about principles in The main points which emerged were: humanitarian aid then the American organisation will look - The need for a strategic approach and collective think- further into them. ing. - PVO will try to get a liaison monitoring office in - Minimum criteria and standards of engagement should Pyongyang, serves as ‘clearing house’. be established - Information about access, monitoring conditions, and [...] Overall impression: the American participants were MoUs should be shared very optimistic on the changes in North Korea, and their - Common assessment by the humanitarian team, such as possibilities to intervene. Their aid/interest is more based that conducted after the floods, should continue under on long-term aid relations with North Korea; all small the humanitarian co-ordination mechanism improvements are already satisfying. The PVO will try to - International staff needs to be able to move more freely, get some better conditions in their MOU. [...] More atten- with fewer restrictions tion to structural, long-term, agricultural aid; the direct - Most organisations now working in DPRK are consider- humanitarian relief aid has less attention. Although they ing a move from vulnerable group feeding to agricultural regret the EU Delegation came to the conclusion that the rehabilitation. emergency is over in North Korea, ‘Europe needs to be re- informed again.’ It also was felt that the humanitarian aid has left the emergency phase and that mid- to long-term projects had 3. Conclusions to be proposed. There are difficulties to plan those proj- On the humanitarian situation: there are clear medical ects with only little information, and donors are reluctant and nutritional needs, but difficult to define to which to sponsor for the same reason. OCHA announced it will extent, information from the field and border-assessment facilitate the development of a common humanitarian is not enough information. There still are acute needs, action plan for the 1999 consolidated appeal. while long-term aid should start simultaneously. The North Korean authorities seem to have shifted the priority MSF Roundtable on ‘Experiences and Prospects of from acute medical aid towards long-term rehabilitation Humanitarian Relief in North Korea,’ Amsterdam, 21/10/98. of their medical supply (drugs factories). The attitude towards direct food aid has not changed, and they also Present were UN organizations, NGO organizations allow more long-term, mostly agricultural development aid (European and American), governmental donors and ‘Korea in. Vulnerable groups are difficult to identify, they are dif- experts’. From the discussions, the following conclusions ferent from the groups we normally consider as the one’s could be made: in need. Among them are probably the ‘non-producers’. It is necessary to get better understanding of the system. Needs: Although we don’t have exact data, the expecta- Also, the homeless and the non-institutionalised have less tion is that the situation is worse than we are allowed to access to care. The constraints MSF faced while working in see (e.g. as in the forbidden counties, information such Norm Korea in terms of assessment of needs and vulner- as that from the food refugees). able groups, and working according to humanitarian prin- Food: there will be a continuing food shortage, because ciples were the main problems other relief organisations of agricultural incapacity, insufficient redistribution and are dealing with as well. Most organisations therefore 146 economic collapse resulting in lack of funding. The extent feel the need to come to a common approach towards the the experience ofhumanitarianbodies,the workofaca- Despite theregime’s effortstomaintaina news blackout, State of famine emerging about conditions inthecountry. important thanever,inthe lightofwhatisgradually the imperativetomonitor distributionofaidaremore requirement foranindependentneedsassessment,and tion ofprinciplemightappeartobetheoretical.Butthe of thepopulationNorth Korea iscontending,thisques- Were itnotforthetragicsituationwithwhichasection ever, provokednoreactiononthepartofdonorcountries. Monde twomonthsago,forthesamereasons)has,how - This ‘quiet’expulsion(followingthatofMédecinsdu Médecins SansFrontièreswasforcedtoleaveNorthKorea. because ofitsinsistenceonapplyingtheseprinciplesthat that it is reaching the starving. And it was precisely and tomonitorfooddistributioninorderbecertain tarian action:theabilitytoevaluateneedsindependently guaranteeing observanceoftwokeyprincipleshumani- tinely. Despite their best efforts,they never succeeded in closely monitoredandforcedtodistributeaidclandes- organisations authorisedtoworkinNorthKoreawere years, MédecinsSansFrontièresandthefewhumanitarian sibility, ofhumanitarianactioninNorthKorea.Forthree trates thedifficultiesandambiguities,perhapsimpos- At amorefundamentallevel,thisforceddepartureillus- country’s pharmaceutical industry. after theyrefusedtofundaprogrammerevivethe it wasforceduponthembytheNorthKoreanauthorities there wasnothingvoluntaryaboutMSF’sdecisiontoleave: thousands ofKoreanswereenduringfamine.However, reasons forsuchadecision,attimewhenhundredsof that isolatedcountry.Italsoraisedquestionsaboutthe debate ontheextentoffamineanduseaidin Frontières waspullingoutofNorthKoreareopenedthe The announcementon30SeptemberthatMédecinsSans Extract: need for common principles is less. since the American NGOs are more on one line already, the get fieldrepresentativesinisstillahighpriority.Also, developments inworkingNorthKorea,andforthemto American NGOs in general are more positive towards the and therefore they are less flexible to commit themselves. (e.g. IFRC)havestartedalreadylong-terminterventions, OCHA principlestobemoreconcrete,otherorganisations Some independentorganisationswouldliketheproposed straints could beovercome. of humanitarianprinciples.Inthisway,somethecon- North Koreanauthorities,inordertohaveasetbaseline 14 October1998 (in French). President ofMSFFrance,LeFigaro(France) “Humanitarian Aid Frozen,” Philippe Biberson, D157

hunger, exhaustion and disease. ing the death of hundreds of thousands of people, and to late 1970s,testify to aterriblelackoffoodthat is caus- as in the case of Cambodia under the Khmer Rouge in the Reports by refugees, always valuable in murky situations, veil concealingthestrategybeingadoptedinNorthKorea. who havereachedChina,enableustoliftacornerofthe demic researchersandaboveall,testimoniesbyrefugees tion system and left to facestarvation unsupported. help revivetheeconomy,areexcludedfromdistribu- of devastatedcities, or workersinfactories unlikely to tile, becauseoftheirfamilybackgrounds,theinhabitants important factories.Atthesametime,groupsseenashos- the armedforces,andworkersemployedinstrategically and allocatedfirsttopartyfunctionaries,membersof is channelledthroughtheofficialdistributionsystem ness. International aid isnotexemptfromthisrule, but to criteriabasedonpoliticalloyaltyandeconomicuseful- been allocatedtothepopulationbystateaccording a meansofsocialcontrolforfiftyyears,resourceshave Under thisimpoverishedeconomy,inwhichrationingis Political criteria tragedy is theresultofconsciouspoliticaldecisions. survival ofasectionthepopulationbecausethishuman clear determination to put the regime’s priorities before the to meetpeople’sneedforcereals.Orrather,itreflectsa Korean economytogeneratetheforeigncurrencyrequired economic policies,andreflectstheinabilityofNorth political thanclimatic.Itisaconsequenceofcatastrophic One maysuspectthatthecausesofthisfaminearemore on theMSFUSAwebsite :http://www.doctorswithoutborders.org/ 9. TheEnglishversion (translatedfromFrench)oftheentire document isposted crisis triggeredwhenPyongyang threatenedtowithdraw In thespringof1995,several monthsaftertheendofa Extract: at openingup,istodayhitting a brickwall. international aid,whichissupposedtobeagestureaimed humanitarian effortsandtheregime’sthinking.Thisiswhy the victims.InNorthKorea,thereistotalconflictbetween organisations intheir efforts to obtaingenuine accessto donor countrieswoulddobettertosupporthumanitarian dating tothesepolicies,inthenameofshort-termrealism, without regard for people’s needs. Rather thanaccommo- aged bytheregimeaccordingtopoliticalconsiderations, being lefttotheirowndevices.Humanitarianaidisman- precisely thoseforwhominternationalaidisintended,are Everything suggests that vulnerable populations, who are D158 Esprit Director ofResearch,MSFFranceFoundation, “ North Korea:AFamineRegime,”FrançoisJean, (France) February 1999 (in French). 9

147 MSF and North Korea 1995-1998 MSF Speaks Out

from the nuclear non-proliferation treaty, North Korea was ing - to wring the resources it needs to survive from its back in the headlines with a request for food aid. A disbe- friends, and now its enemies. lieving world thus learned that this tightly sealed nation, on the brink of possessing a nuclear weapon and long- For their part, the countries concerned have readily range missiles, was also a nation drained dry, incapable of responded to this request for aid, showering ever-increas- feeding its people and dependant on international aid for ing quantities of food aid on Pyongyang over the last four survival. North Korea has been on international life sup- years. The chief impulse for this involvement is fear of a port for four years now. The food emergency, first charac- North Korean implosion. For, while each of these nations terised by officials as the result of flooding in 1995-96, looks forward to the imminent end of this totalitarian then of drought in 1997, set in motion one of the largest system, they dread a sudden collapse. All analyses are food aid programs financed by the international commu- shaped by fears of instability and the spread of refugees, nity in the past decade. of political uncertainty and its strategic implications, and of the economic consequences of reunification. This For the past four years, the rare humanitarian organiza- is particularly so in South Korea, where the costs of tions authorised to travel in North Korea have speculated German reunification were studied with added concern on the dimensions of the crisis. Some speak of an acute because the demographic comparisons and economic gaps food shortage; others depict a situation of famine that, are more unfavourable by far in the Korean case. Seoul, according to estimates, would have caused anywhere from Beijing, Washington, and Tokyo dread the scenario of an several hundreds of thousands to more than three million abrupt North Korean collapse, leading to an ‘emergency deaths over recent years. The degree of uncertainty is a reunification’. For different reasons, therefore, each of clear consequence of the nation’s impenetrable facade. these countries has pursued a policy of ‘constructive The North Korean regime has now lifted a corner of the engagement’ aimed at preserving stability on the pen- veil, of course, in its request for international aid, but it insula and nurturing developments likely to facilitate a continues to conceal the gravity of the situation. In this soft reunification of the two Koreas. Ex-South Korean country, isolated from the world and wrapped in a siege president Kim Young Sam, comparing North Korea to an mentality, all economic and social data—even hospital airplane rapidly losing altitude, has said the goal is to patient registers—are considered state secrets. Moreover, avert a crash and encourage a soft landing. […] the few humanitarian organisations present in the country are subject to strict monitoring and unable to freely Betting on a soft-landing assumes that, confronted with evaluate the situation. They may on occasion see cases of this economic impasse, it would be in the interest of North acute malnutrition, but they can only observe what the Korean leaders to implement the reforms needed to get regime itself allows to be seen. Beneath such difficulties the economy started again. And that, in the short-term, it of assessment, however, speculations about the dimen- would be in the regime’s interest to feed the neediest in sions of the crisis reveal a deeper flaw in our perception order to avoid population displacements and expressions of the process of famine in North Korea. […] of discontent - even revolt. In sum, the countries involved are proceeding on the theory that their notion of avoiding A Policy of Engagement a crisis through a gradual opening up of society is con- North Korea has been dependant on international aid sistent with the North Korean regime’s priorities, if only for four years now. The regime has adapted itself quite because of a mutual concern over stability. The second well; after years of poor-quality grains it is once again assumption underpinning this policy of engagement is that importing rice, and in large volumes. Foreign food trade international aid might encourage a dialogue over exactly is still in balance and, now that free imports have taken the kind of political reforms the international community the place of imports at concessionary prices, the regime would be able to support during a transitional phase of the can still brandish the banner of food self-reliance. […] kind that would ease the system’s gradual evolution. Likewise, through nuclear blackmail, Pyongyang was able to obtain two light-water reactor stations in October 1994 For the North Korean regime, as well, the current situ- and, as they awaited activation, 500,000 tonnes of oil ation is deeply ambiguous. For, while it has once again per year would be conveniently balance the loss of Soviet demonstrated its unrivalled capacity for obtaining the imports. Again, acknowledging its ‘agricultural troubles’ means of its survival from abroad, the cut-off of aid permitted North Korea to receive sizeable amounts of from Eastern-bloc countries did cause the leadership to aid to replace - or rather to augment, since Beijing had turn to the “imperialist” nations. This fork-in-the-road resumed its program in the meantime - Chinese exports in its tradition of extortion poses a genuine challenge on preferential trading terms. Unprecedented though this to a reclusive regime that keeps its people in complete avowal of failure may have been, it is no radical departure isolation and draws legitimacy from how it deals with the from past form. It is consistent with the longstanding hostile, squalid world outside. Any prospects for reform practices of a regime gone beyond master in the tactics should be assessed in that light. Though it is quite likely of unpredictability. From nuclear threats to floods, from that some North Korean leaders are at least conceptually missile experimentation to famine, North Korea has con- aware of what reforms are needed to escape their predica- tinually exploited its nuisance capacity - be it as threat or ment, they do not appear ready to run the political risks 148 as vulnerable victim, on the verge of exploding or implod- involved. Just as Seoul attentively followed the German grain, apre-condition for joining the negotiations. of ever-increasing quantitiesoffood,or more recently other hand, tries to raise the ante by making the delivery aid justpriortotherenewal oftalks.Pyongyang,onthe the releaseinOctoberof1998 of300,00tonnesfood table and make concessions, as demonstrated yet again by carrot andstick to bringNorth Korea tothenegotiating denies it,theUnitedStatesuseshumanitarianaidasa years afterthetruceaccordofPanmunjom.Thoughit towards thepossiblesigningofapeacetreaty,forty-five and Beijingtoreducetensionsinthepeninsulawork multilateral talks between Pyongyang, Seoul, Washington, “international community,”particularlyinthecontextof diplomatic manoeuvringsbetweenNorthKoreaandthe Humanitarian aidhasthusbecomeakeyelementin towards the North. policy’ - provided a morefavourablecontext for initiatives the introductionofapolicyengagement-‘sunshine the otherKorea,beforeelectionofKimDaeJungand cerns clearedthepath-aftermuchhesitationforaidto United States. In South Korea as well, humanitarian con- this communistcountry,stilltechnicallyatwarwiththe the supportofaCongresshostiletoanyformaid 1984-5 Ethiopianfamine,madeitpossibletosecure starving child knows no politics,’, declared during the In Washington,particularly,theReagandoctrinethat‘a domestic reluctancetosupporttheNorthKoreanregime. ian labelenablesdonorcountriestosweepasideany own rhetoric.Thesecondreasonisthatthehumanitar- times, thatcertainofficialshavebeenconvincedbytheir the stiltedlanguageofUN-thereissense,at the remarkableparallelsbetweenregimepropagandaand ations. Nonetheless,onecannotavoidbeingstruckby climate, essentiallygeneratedbydiplomaticconsider- organisation aredoubtlessnotfooledbythisrhetoricof in UnitedNationsreports.Bureaucratsattheinternational Korea haveindeedbecomesomewhatofaregularfeature drought. And allusions to the natural disasters in North sequences ofthe1995-6floodingand,later,1997 international assistancewasmeanttoalleviatethecon- Korean authoritiesformulatedinthoseterms.Officially, first, becauseitcameinresponsetoarequestfromNorth form ofemergencyhumanitarianrelief,fortworeasons: International aidtoNorthKoreahaschieflytakenthe “Humanitarian Aid” weaken its control over society. […] no reasontobelieve it will commit to reforms that might vival. The regime’s primacy rests on ideology, and there is outside worldisviewedasakeyfactorinthesystem’ssur- a context,postureofisolationanddefiancetowardsthe the disappearanceofNorthKoreaviaabsorption.Insuch control wouldleadnotonlytothefallofregimebut row marginforerrorinthisdividedcountry;anylossof they derivedwereallthemorepointedgivenverynar- Union andtheeventsinTiananmenSquare.Thelessons Eastern-bloc countries led to the break-up of the Soviet perplexity, theninhorror-asthereformprocess reunification process,Pyongyang,too,watched-firstin in thismobilized society,isolatedfromthe world.But, comparative affluence—a newandcrucial development now circulates in North Korea, along with that of China’s magnitude oftheproblem.Word ofthefaminedoubtless of thecapitolanditsruling elitesinthedarkasto extent themanipulationof informationkeptresidents in theUSSRorChina,noone can sayexactly to what or deliberateconcealment. In NorthKorea,aspreviously hits, famine cannot spread without the aid of indifference Korea couldhaveavertedthefamine.Nomatterwhereit ter accesstoinformationandaquickerresponse,North that allowedittospread.Thereisnodoubtwithbet - Likewise, itwastherefusaltoallowaccessofanykind arose outofabreakneckpursuittotalself-reliance. This attitudeisakeyfactorinNorthKorea’sfamine.It Concealed Famine humanitarian issues, we willdo without international aid.” continue toimpedereliefNorthKoreabypoliticizing the MinistryofForeignAffairsstated:“Ifbiasedinterests attempts tomonitorfooddistribution.InJanuary1996 this fullwell;itreactsvirulentlyagainsteventhemildest further thepolicyofengagement.Pyongyangunderstands tries viewhumanitarianaidmerelyasaninstrumentto still littlepressureexerted,perhapsbecausedonorcoun- tral concern to the international community, but there is assessment andmonitoringdistributionisindeedofcen- in effect, economic aid to North Korea. The issue of needs ing groups. They have been reduced to managing what is, cannot guaranteehumanitarianaidistrulyreachingstarv- to freelymonitorthedistributionofaid.Asaresultthey assess needswithcompleteindependence,andtheability two core principles of humanitarian action: the ability to the countrysince1996haveneverbeenabletoimplement ing aid.Despiteeveryeffort,theorganizationspresentin the famineandarethereforereducedtoblindlydistribut- work inthecountryareunabletodetermineextentof ditions; thefewhumanitarianorganisationsauthorisedto North Koreaisadramaticexampleofaidundermurkycon- it goesto great lengthsto limit theirfreedom of action. dozen humanitarianorganisationsinordertoobtainaid, the regimehasbeenobligedtoacceptpresenceofa polluting’ effect,orweakenitscontroloversociety.While collective Trojanhorse,fearingtheywillhavea‘spiritually hand, seesthesesamehumanitarianorganisationsasa growing opennessinthecountry.Pyongyang,onother ground, will foster a climate of confidence and inspire a ence, togetherwithmoreandmutualcontactonthe countries arehopingthatanenhancedinternationalpres- ment ofpower,ortofeedthearmy.Furthermore,donor intended, andisnotusedbytheregimeasaninstru- to the‘floodvictims’trulyreachesthoseforwhomitis agencies andNGO’stointervenesoasensurethataid world, donor countries have encouraged United Nations nation inastateofparanoidrelationswiththeoutside ease theplightofneediestgroups.Facedwithaclosed son, entirelyabsent.Alltheparticipantshopeaidwill instrument, humanitarianconcernsarenot,forthatrea- Though internationalaidisfirstandforemostapolicy 149 MSF and North Korea 1995-1998 MSF Speaks Out

if cadres do understand the seriousness of the situation, seem unready to sacrifice the regime’s priorities to protect they will not speak frankly about it; they are creatures of a portion of the population. The problem in North Korea the system’s success. today is not so much the availability of resources as it is one of distribution. With international aid, it appears And international organisations, acting in response to North Korea now possesses the means to avert famine. If the narrative of natural disaster, observe cases of acute it does not do so, it is out of a conscious political choice malnutrition but are unable to identify which groups are to abandon a portion of the population to its fate, rather threatened. A few manage, nevertheless, to experience than have it exposed to foreign view and contact. some portion of the reality first hand, but dare not speak out for fear of losing access to the country. A virtual Scarcity and Rationing smokescreen is thus created, enveloping the identities When international aid arrives in North Korea it is turned of the starving and thwarting efforts to provide relief. over to the authorities; then channelled through the Public Information is useless unless it circulates—it congeals Distribution System (PDS). The lack of any real opportu- in bureaucratic jargon. In the course of its own famine, nity over the past four years to evaluate the situation and China revealed the devastation propaganda could produce; monitor distribution has fuelled questions and debate over it took three years - and thirty million dead - for the fog North Korea’s use of aid. The PDS’ effectiveness is not at of language to finally clear. The crisis never would have issue. For forty years it has supervised the flow of food attained such magnitude if leaders hadn’t been so deeply and supplies to the country’s entire population. Neither is ensnared in their own illusions. Nor would the famine ever the diversion of aid, so often noted in the army’s case, the have attained such intensity if realistic data had existed problem. Food continues to be distributed - as it always to offset the official rhetoric. has been - according to the regime’s priorities. What is really at issue is the assumption that the regime places Information circulates more freely in North Korea than priority on feeding ‘vulnerable’ population groups. Like it did in the China of the Great Leap Forward, however. questions about the scale of the famine, debates over Though the regime stubbornly endeavours to conceal the the regime’s use of aid demonstrate a profound misunder- seriousness of the situation, some problems were acknowl- standing of how the North Korean system operates. edged at length and international aid actively solicited, with clear success. Since 1995 Pyongyang has been the Rationing is both a standard operating procedure and a recipient of ever-increasing quantities of food aid - more means of social control in North Korea. In this closely than a billion dollars worth over four years - and the lat- supervised, perpetually mobilised society, the state pro- est appeal from the United Nations for a sum of $376 vides for all of society’s needs. Wages and taxes play only million dollars represents the second-largest international a marginal role, and the population is wholly dependant program of relief aid - after Yugoslavia - launched in on a planned, centralized system of resource allocation. 1999. At present, food aid and concessionary trade terms Each individual is dependent on his or her work unit for appear sufficient to bridge the food shortage. Trade with access to housing, clothing, education, health, cultural China and South Korea essentially serves as a supplement life, etc. Similarly, the entire population (except for peas- to international assistance. But the history of modern ant members of cooperatives) is dependant on the state famines shows that famine can come about under stable for the distribution of grain, according to a complex conditions, even where there is a food surplus, as was the scale that factors in social status, job, age, etc. North case in Bengal in 1943 and even in certain provinces of Korean society is probably one of the most hierarchical China during the Great Leap Forward. In other words, the in the world. As a police state it is certainly one of the defining feature of famine is not necessarily a shortage of most formidable, as well; its citizens are the objects of food - though that may be one explanation - rather, it is constant surveillance. Continually updated individual files the fact that some categories of the population have no determine each person’s social status and position. […] access to food. The central issue in a famine situation, Society is thus organised in concentric circles around then, is how resources are distributed to the neediest the Great Leader’s family, with the families of counter- groups. revolutionaries consigned to purgatory.

Governing authorities in democratic countries pin their At the Fifth Workers’ Party Conference in 1970, Kim credibility on their ability to implement redistributive Il-Sung introduced a system of classification that orga- policies and assist population groups threatened by cri- nized society into three classes - a core class, a suspect sis on a large scale. When information circulates freely ‘wavering’ class, and a hostile class, etc. with a total of - moreover when it is a basic component of a pluralist fifty-one categories. Since that time, the system has been political system, not only does government have data on modified during periodic phases of reclassification, but which it can act but this very data can force it to act, via every individual’s status is still determined by political pressure from the media, opposition parties, and public loyalty and family history. This complex hierarchy governs response. As Amartya Sen points out: “it is hard to cite an every aspect of social life. Obviously it determines oppor- instance of famine occurring in a country with a free press tunities to rise to senior positions in the party and the and an active opposition as part of a democratic system.” army - but it also affects access to material goods. Class 150 Nothing of the sort exists in North Korea, whose leaders membership leads not only to privileged access to educa- tored, andwhere onlytheprivilegedareauthorised tolive assigned towork units,wherealldisplacement ismoni- cally. First, because in a country where individuals are Nevertheless, thefamineis not circumscribedgeographi- these mountainousregionsin thenorthernlatitudes[…]. factories andclosedmines, subsistence agriculture -in important: theabsenceofanyeconomicadvantage-idle no importance,inthesetraditionalregionsofexile.Most ratchiks tosecuredistribution;ortoomanypersonsof the southwestofcountry;ortoofewinfluentialappa - distant from the capitol and the agricultural regions of and lackoffuelforsupplyingtheseprovinces,whichare are severalreasonsforthis:inadequatetransportation inhabited provinceswereamongthehardesthit.There but itwouldbenogreatsurpriseiftheseremote,sparsely these borderareaswehavelittledataonotherregions, Chagan. Becausemostoftherefugeeswerenatives 1994 onintheprovincesofHamgyong,Yanggang,and example, thedistributionofsupplieswassuspendedfrom of refugeeswhomanagedtoreachChinarevealthat,for distribution channels and left to their fate. The accounts certain regions,whichappeartohavebeencutofffrom facto decentralizationhadaparticularlysharpimpacton bilities devolvedtotheprovincialandlocallevels.Thisde allocation unabletocarryoutitsfunctions,responsi- entire population.Withthecentralisedsystemofresource tude, theregimetacitlyabandonedallefforttofeed system hitbottom.Facedwithshortagesofsuchmagni- As circumstancesworsenedinthemid-1990srationing Famine and the System categories. allocation had tragicconsequencesfor some population during the1990’s,thisunegalitariansystemofresource coincide. Intheclimateofacutescarcitythatemerged in remoteregions—moreoftenthannotthesethings tainted socially,orworkedforidlefactories,lived dropped fromthesystem,particularlythosewhowere and forcertainpopulationcategories.Somegroupswere the PDSceasedtofunctioncompletelyincertainregions even inPyongyangandthearmy.Then, in themid-1990’s, diminish intheearly1990’s.Later,rationswerereduced years. Withnograintodistribute,thePDS’srolebegan with drastic cuts ordered under the ‘hard march’ of recent deducted fromrationsinthe1970’sand1980’s,later conditions altered after a series of ‘patriotic withholdings’ fied ashostileandcondemnedtowasteaway.Hereagain, of poor-qualitygrainsforthosetrappedingroupsclassi- aviation, orseniorpartyofficials-to200gramsofamix grams ofrice-forworkersinheavyindustry,military gram. Inthe1970’sdailyrationlevelsrangedfrom800 (or, inthepast,fishormeat)allowancestovery class, suchasageortypeofwork.Thesedeterminegrain and is closely regulated. Other criteria enter in besides Food distributioninvolvesenormousdisparities,aswell, stores, heated apartments, health care, etc. also totheperksandprivilegestheseentail:cars,special tion andpromotionstopositionsofresponsibility,but China aretheonly NorthKoreanswithwhom itispossible These refugees or migrants who have been able to reach or work,andthenusuallyreturn tohelptheirfamilies. few months. They try to findfood, medicine, assistance, Some makeittoChina,where theystayafewdaysor society - they do not exist in the North Korean system. beyond reachofinternational aid,havevanishedfrom regime simplyavertsitsgaze;thesedisplacedpersons, these abandonedchildren,havebecomephantoms.The tolerated. Perhapsitisbecausethesemigrantsand,often, closely monitored, this mobility seems nevertheless to be where togo.Inasystemeverydisplacementis are availableoutsideoftheofficialsystem,nooneknows In acountrywhereneitherworknorrationallowances support and social standing, very few take to theroad. ing one’sfamilyandworkunitmeanslosingeverykindof turn tomigrationasalastresort.Insocietywhereleav - exhaustion. Others,oftensurvivorsofshatteredfamilies, their soup.Somedieinsilencefromhunger,illness,and which willjustbarelyprovidethemabitofcornstarchfor caloric trade-offstheregimepracticesinitstradeabroad, by onthesetransactions-akindofshabbyechothe who havebeen cut off.Butin the endmany cannot get authorities, hasbecomethemainalternativeforthose border. Thissmall-scaletrade,justbarelytoleratedbythe ucts fromChina-medicinesorclothingbroughtoverthe people aredrivenbypovertytosell.Therealsoprod- gathered hereandthere,furniture,anythingelse selling grainsatprohibitiveprices,plantsandshellfish a month,arenowhelddailyincitiesandatroadsides, markets, previouslyauthorisedtooperatethreetimes bartering andtradinghavebecomewidespread.Peasant had toimproviseinordersurvive;justafewyears for threegenerationsandisnowleft to fendforitself has This populationgroup,whichwasdependantontheState Starving fact. […] regime hasconstructed.Itisasocial,notgeographic, famine isdeeplywovenintothefabricofprivilege of social life is controlled by the regime. In North Korea, there wasnootherchoice,inacountrywhereeveryaspect may havereinforcedthisdiscriminatoryapproach.Perhaps official channelsrevitalizedthemtosomedegree,and Paradoxically, theflowofinternationalaidthroughthese the system’ssurvivalandfunctioningofeconomy. resources ongroupsthatwerethemostinstrumentalto the mostvulnerable,regimeconcentrated its meagre by importingfoodortryingtoestablishasafetynetfor Rather than undermine the dogma of food self-reliance to beundermined-ifanythingtheywerereaffirmed. adapted itselftoscarcitywithoutallowingitspriorities it hasnotcausedtodisappearentirely.Theregime virtually drainedthesystemofdistributiondry,but some smallamountoffood.Thefoodshortagemayhave favoured categoriesofcitizenshavecontinuedtoreceive most importantly,becauseeveninneglectedregions, and coincideswithpoliticalclassification.Second, in Pyongyang,geographiclocationoftenmerelymirrors 151 MSF and North Korea 1995-1998 MSF Speaks Out

to speak freely.25 They are doubtless not typical of the pening in Korea. What is the nature of the regime? How country’s population as a whole: first, because they often does aid fit in with the political and economic crisis, and so come from the border regions; second, because they have on. Unfortunately, he was the only one doing that work at left their families and work units, a step very few can the time. bring themselves to take. But they do accurately reflect the fate of persons cut off from support, those vulnerable In February 1999 he published ‘North Korea, a Famine population groups humanitarian organizations speak of Regime.’ We translated it and it was soon posted on our and for whom international aid is, in theory intended. website. François attended a conference in Florida with the There are perhaps - no one knows - five to six million Mercy Corps and other American NGOs, who were the most people cut off from support in North Korea, a quarter of belligerent advocates of returning to Korea. He continued to the country’s population. In recent years, they have died approach these groups at regular intervals. At MSF USA we by the hundreds of thousands. If nothing changes, they were not yet at that point. I confess that we hadn’t made will continue to die by the hundreds of thousands in the best use of all the discussions in order truly to understand years to come. where we could have got in step with them and genuinely put resources at the service of that research. I found a Korean PhD student at Columbia University. François had met him and had said: ‘he may be good, he’s prepared to give us a few hours’ work.’ But it wasn’t easy, because he And then, there was the round table. That was the didn’t quite understand MSF was doing. idea: ‘OK, we are leaving, but it doesn’t mean that we close the doors,’ that’s what we said. So we In September, October, November and December 1998, I thought: ‘what can we do?’ And the idea was born that all continued to be active in this NGO working group on North the organisations that worked in North Korea would come Korea. Once a month, there were meetings to which repre- together in Europe, and that we would step back from it and sentatives of WFP and similar organisations were invited. think: ‘what’s going on? What position do we take?’ And But in time I began to run out of steam, because I realised what came out of it is that all the organisations had the that since we were no longer in North Korea, MSF had noth- same constraints and that if we had the same policy to say: ing more to say. That was our last word on the subject. ‘we only want to stay under this and this conditions. then we could make a better position towards the FDRC.’ Antoine Gérard, Head of Programmes Department, MSF USA, (in French). We wanted to have some feedback, a better understanding: ‘what’s going on? What problems do we face and how do we approach them?’ Basically, it was a bit like facilitating the future for other organisations and also for ourselves, how to learn from it. I remember that the other agencies found it weird that we had to do such a big press release EPILOGUE as of 1999 … and they were not happy with that because it didn’t have an added value for WFP, or UNICEF. But from what I recall we were very angry, the NGOs were very critical towards the WFP because they just gave a lot and didn’t ask anything in return. Well of course, we wouldn’t mind, we wouldn’t be Throughout the end of 1998 and early 1999, the MSF unhappy if journalists went to the WFP and asked: ‘why do France team in China continued to develop all possible you stay? How do you guarantee your food is not ending contacts, explore opportunities to assist North Korean up with the military?” populations in flight to China from their North Korean counties, and in North Korea through cross border Dr. Corien Swann, physician, MSF Programme in DPRK, activities. January to September 1998 (in English). In April 1999, two members of the MSF team in China entered North Korea under the cover of a Chinese company on a ‘business trip’ from Beijing to Hamhung province. During their visit they managed to distribute To me, our withdrawal is entirely explicable, espe- some food aid to orphanages. cially when one begins to define the concepts of humanitarian space and direct contact with patients. From 3 to 6 May 1999, NGOs bringing assistance to Where I believe we were rather weak was after the with- North Korea met in Beijing. Several South Korean NGOs drawal. In the end, there was only one person who had a publicly asked MSF to resume its activities in North coherent position and that was François Jean, in the Korea. research he carried out after the withdrawal. François came here to meet groups of academics, those attending the con- 152 ference, in order to try to understand what was really hap- especially active on the China-North Korea border. of theKoreanSharingMovement,aBuddhistorganisation sequences ofourchangesmood,”saidMoonKyu-kang population andnottheregime,thatissufferingcon - Cross: caringevenfortheenemy.Itis[NorthKorean] in respectofhumanitarianaid,thesamespiritasRed is whatitis.Weneedtoknowthat,anddemonstrate, aid, especiallyin South Korea. “The North Korean regime which gavecomforttosectorsofopinionopposedsuch Korean NGOstoreconsideritsdecision(LeMonde,7May), changed nothing.Hence,theappealtoMSFbySouth in September1998;awidelypublicisedwithdrawalthat led tothewithdrawalofMédecinsSansFrontières(MSF) able sectionsofthepopulation.Thislackaccessibility humanitarian aidtotheDPRK:accessmostvulner- These vagrantchildrenillustratethegreatdilemmaof Extract: North Korean regime. “with greaterpatience”itsworkinaidtothevictimsof sion, theyurgedMSFto“understand”theneedpursue fact, allowedmillionsofpeopletogoondying.”Inconclu- the benefitofNorthKoreanarmy.“Thisinaction,in because oftheriskthattheiraidwouldbedivertedfor having, inthepast,takendecisionssimilartoMSF’s, the tragedyofNorthKorea.Thesignatoriesacknowledged human lives”,andofdiscouraginginternationalinterestin led toits“turningbackonthepossibilityofsavingmore ency inconnectionwiththedistributionofitsassistance, 1998, tosuspend its activities due to the lack of transpar- South KoreanNGOsmaintainedthatMSF’sdecision,in famine. Inatextpublishedatthecloseofseminar, activities tothepeopleofNorthKoreawhoweresuffering called onMédecinsSansFrontièrestoresumeitsaid humanitarian assistancetoNorthKorea,heldinBeijing, governmental organisationstakingpartinaseminaron From 3 to 6 May, the twenty-three South Korean non- Extract: graph intheprevious Secretary’sreport. This year,itis North Korea:this missionwasthesubject of alongpara- Extract: Philippe Biberson,President of Report to the Annual General Assembly, 28 May1999 (in French). French). Pons, “NGOs ArgueOverAidtoNorthKorea”, 7 May1999 (in French). Aid totheNorth,”LeMonde(France)Beijing, “South Le Monde(France),9May1999(in Korean NGOs Call on MSF to Resume its D160

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that something is changing. Let’s wait andsee. was deceived, and that is perhaps where the real hope lies certain isthattheauthoritiesallowedustodoit.Nobody ers, orsoldontheopenmarket?Wedon’tknow.Whatis they bedivertedtosomeorganisationsinfavourofoth - make agreatdifferencetothesurvivalofnation.Will to orphanagesintheprovince.Theywillanycasenot Fifty tonnesofflourandprovisionshavebeen“delivered ” local people?That‘sthequestionwearetryingtoanswer. “independent” route,oramorereliablewayofreaching the NorthKoreanprovinceofHamgyong.Isthereamore of a business trip, travelling with Chinese businessmen to mounted an“expedition”fromBeijing,underthepretext to thevictims.LastApril,Marcel,MarineandSophie famine; wesoughteverypossiblemeansofgainingaccess use ofaid.Butwenolongerdoubtedthereality tions toseriouslyandpubliclyquestiontheregimeon Médecins SansFrontièreswasoneofthefeworganisa- have been improper would have been to say nothing. use of many million of dollars in public aid. What would nise a press conference to report our doubts about the withdrawal weremistaken.Itwasnotimpropertoorga- expelled? ThosewhocondemnedMSF’s“highlypublic” left usfeelingveryuneasy.Didwewithdraworwere I mustalsosaythatthiswithdrawalfrom North Korea stories” emerge. less we hear about it, or only sporadically, when “personal more aidprovided–andtheamountseemsderisory afternoon’s debate,butitappearsthatinNorthKorea,the say too much more, because this is the subject of this Frontières toreturn to thecapital, Pyongyang. Ishallnot tions involved in North Korea called on Médecins Sans aid. AtarecentconferenceinBeijing,aidorganisa- had become even worse, and continued to call for more ease, coldanddestitution.Somepeoplesaidthesituation In NorthKorea,peoplecontinuedtodieofhunger,dis- followed protests, and silence. would servetomaintainthe“starvationmachine.”There aid (notonlythatprovidedbyMédecinsSansFrontières) ger. Onthecontrary,therewasariskthatthismassive no guaranteethatitwasbenefitingthosedyingofhun- explaining thattodistributeaid“inthedark”wouldoffer nity.‘ MédecinsSansFrontièresleftthecountryinOctober, wall ofsilencethe‘internationalhumanitariancommu- “inadmissible” proposals,andatthefarend,resigned listen, ontheothersideofstreet,ourprinciplesand was theblankimperviousnessofaregimethatrefusedto speaking, theyledusupablindalley:ononeside,there Korean authoritieswereinconclusive. Or more strictly surprisingly, the negotiations that we held with the North the (provisional)epiloguethatwehave to write.Notvery routes, because inearly1999,humanitarian aidhad with Marcel.To beginwith,theywerevery“official ” During 1999weexploredagreat numberofroutes 153 MSF and North Korea 1995-1998 MSF Speaks Out

slightly diminished. With MSF’s withdrawal in particular, and On May 1999, a DPRK official stated to WFP visitors the publicity surrounding it, the United Nations had increas- that 220,000 North Koreans had died from malnutri- ing difficulty in raising funds for North Korea; for years the tion between 1995 and 1998. country had not been in a very good state of health. At that time, Kim-Jong-Il authorised provinces to seek aid on their own account, and since Pyongyang was no longer redistrib- uting it, the provinces kept it for themselves. They were “North Korea Admits 220,000 Deaths due to the more or less left to themselves and it is was then that Famine,” Le Monde (France) Tokyo, 12 May within the framework of our networks we were approached 1999 (in French). D162 by the province of Hamgyong, asking us to try to bring aid directly to it. A deliberate dialogue of the deaf ensued Extract: between us. They were perfectly aware that we were MSF, For the first time, four years after the beginning of the and we were perfectly aware that they knew, but we did not famine, the Democratic Popular Republic of Korea (DPRK) say so, because they could not take it upon themselves, vis- disclosed that more than 200,000 people had died from a-vis the central government, of negotiating with MSF. But malnutrition. Jon In-chen, Director of External Affairs for in the meantime, they were in need of our aid. All this the committee responsible for handling the damage done remained unspoken throughout our negotiations. by the famine, told members of a delegation from the World Food Programme (WFP) who were visiting the region On their advice, we identified a Chinese company in whose of Komusan, about fifty kilometres from the Chinese bor- name all the invitations were issued, and the evidence sup- der, that between 1995 and 1998 the death rate had risen porting applications for visas and foreign currency provided. from 6.8 to 9.3 per 1,000. That would mean an increase of We were employed as consultants to this company, we went 55,000 deaths per year (or 220,000 people if we use the under our own names, but at no point did we say we were official population figure of 22 million). Experts are scep- MSF. We decided to use this company as a “cover” to make tical about this official report of the number of deaths. It life easier. But it was also easier for them because it would is well below the estimates made by international bodies have been difficult for them to justify the fact of having and non - governmental organisations providing assis- invited us to come, of welcoming or even meeting us. Our tance to the DPRK, who report three million deaths. These discussions were spread over several months, with trips to figures are disputed by Pyongyang. and fro. At one moment, they would say they would see. And so they would go back to North Korea, then there would be silence for several months. Then they would come back, saying: ‘agreed, but the people in charge of us demand such and such a thing.’ We did not negotiate directly with On 24 April 2000, while a meeting between North and the provincial leader, the Governor, but through an inter- South Korea Presidents is taking place, the US weekly mediary. Newsweek published an article by Marie-Rose Pecchio, former MSF Coordinator in North Korea, in which When we went over there, we brought aid, in particular, a she raised awareness about the fate of the ‘socially large consignment of rice. We organised small-scale deliv- deprived children’. She also stated that MSF was ready eries by road across the Chinese border. Later we worked to resume activities in North Korea, under the provi- together on a project for public canteens in the province, sion that its team could have access to those in need. which did not work out in the end. After a short time, trust broke down and then we said to ourselves that we shouldn’t go on. At the time, a team from MSF Holland was working in China. Dick van der Tak, its Coordinator, had been made “The Mystery Children,” by Marie-Rose Pecchio, aware of the issue, and we shared information. When Marcel Newsweek (USA), 24 April 2000, (in English). and I left under cover of a Chinese company in North Korea, D163 I told Dick about it, because I didn’t want the Dutch section to find itself in an embarrassing situation on account of the Extract: French section without knowing all the facts. The fact that Will the summit between Kim Jong II and Kim Dae Jung he had been kept informed meant that he could accept it help the North Korean people? Pyongyang’s record is not from us, whereas he could not have done so if he had been good. From July 1997 to September 1998, Médecins Sans kept in the dark. Nevertheless, they do not support our ini- Frontières worked in four provinces of the Democratic tiatives, and we will never work together operationally. On People’s Republic of Korea-South Pyongan, Kangwon, the other hand, we try to keep them informed, as we do in North Hwangae and North Hamyong. Our doctors were the case of MSF Hong-Kong. implementing a medical and nutritional project, aimed at helping the people who were starving throughout the Sophie Delaunay, Research officer, Foundation country. We ran into such bureaucratic brick walls that we MSF France, June to August 1998; Coordinator, eventually left the country in frustration. MSF France in China, January 1999 Our most upsetting experience was our effort to help 600 154 to December 2001 (In French) children with mysterious backgrounds. Most of the chil- North Korea.Shealsogavesome interviewstothepress. sive researchworkonthe flow ofinternationalaidto 10. FrançoisJeanpassed awayinDecember1999. [Jean] MSF FranceFoundation,followed ontheworkofFrançois ugees inChina.FionaTerry,DirectorofResearchforthe the China/NorthKoreabordertoassistNorthKoreanref - networks ofassistancewhilecollaboratingwiththemon Japan. Theycollectedinformationthroughrefugeesand Marine Buissonnière,DirectorofProgrammesinMSF manager, SophieDelaunay,CoordinatorinChinaand composed ofPierreSalignon,MSFFranceprogramme continued monitoringthesituationwithasetup After MSF’swithdrawalfromNorthKorea,MSFFrance in DPRKfrom 1997 to1998. Pecchio was head of the Médecins Sans Frontières mission hope thisNorth-Southmeetingwillopenthedoorforreal. North Korea,butwemusthaveaccesstothoseinneed.I Médecins SansFrontièresisreadytobeginworkagainin image ofa perfect communist world. children some help, but it was refused to protect the die now? Aretheyaliveordead?Wecouldhavegiventhese two years.Sowhataboutthesekids?Howmanyarethere As far I know, the economic situation has not changed in not economic collapse. to the government, people were hungry because of floods, we triedtoactuallyhelp,theyturnedusaway.According useful proof of famine for international visitors. But when ment cruellyuseditsstarvingchildren.Atfirst,theywere projects withnewfundingtohelpthesekids.Thegovern- of allchildren.Wesaidwewerereadytoundertakenew officials curtlyrespondedthatthegovernmenttakescare existed. Whenwesuggestedtheymightbestreetchildren, The authoritiesinPyongyangdeniedthatthesechildren These kids had clearly fallen outsidethe system. go toaftertheyleftourcare?Tore-educationschools? us littleaboutwhothesechildrenwere.Wherewouldthey ents haddiedinthefamine?Themedicalstaffwouldtell left to scrape an existence in the streets after their par- side shutdownfactoriesorrailwaystations.Hadtheybeen trains and cars, gangs of 10 or 20, standing around out- street children?Ihadseensuchkidsfromthewindowsof left togetherafteraweekortwooftreatment.Werethey to theelements.Theyarrivedtogetherand,curiously, suffered from serious skin diseases,suggesting exposure nutritional conditionwasworsethantheothers.They ing sporadically - we counted 600 without parents. Their Pyongyan province, we noticed groups of children arriv- in twohospitalsthecityofPyongsongSouth watching outforthem.Yetoverthe10monthsweworked with theirmothers.Theywerestarvingbuthadfamilies dren whocametoourtherapeuticfeedingcentersarrived 10

and supportedtheteamthrough exten- insist onseeing theNorthKoreanssolely aseconomic entangled in a dispute with the Chinese authorities, who been abletoinsertitselfin the regionbecauseitisstill Korean supportersfinancially penalised.UNHCRhasnot Koreans aresentbacktoNorth Korea andtheir Sino- of tolerance, counterbalanced by periodic raids, in which That said,intheChinesecontext itismoreaquestion ing prohibitingit. in Francechurchattendanceissolow,whentherenoth - equivalent terms,andtheyfindithardtounderstandwhy And so for them, liberty and the practice of religion are them newenergyandrestoringmeaningtosolidarity. religious beliefservedasameansofresistance,giving important torealisethatformanyofthepeoplewemet, and above this mercantile or moral aspect, it was also for permissiontocelebratemassinPyongyang.Over marketplace; forexample,abishophadtopay$150,000 engage inlarge-scaleevangelisation.Religionisalsoa it shouldbeborneinmindthatoneoftheiraimsisto These smallaidnetworksareessentiallyProtestant,and from this area, oreven sent toother countries. Intellectuals, who areseenasdangerous,removed local labour force and women are ‘married’ to Chinese men. enrolled ‘clandestinely’atschool.Manualworkersjointhe they arehousedinvarioustypesoforphanagesandcanbe treated differently: children aremore easily accepted: 150,000. Theyfallintointhreecategories,whichare in thisregionisthoughttobebetween100,000and the partof‘mafias.’ThenumberNorthKoreanrefugees which isinturnaccompaniedbyextensiveactivityon autonomy, linkedwithrapideconomicrestructuring, of China,thecommunitiesenjoyconsiderablepolitical over alengthofseveralhundredkilometres. In thispart around theChineseborder,whichcaneasilybecrossed food oraidtorefugees.Thereisinfactamicro-network nities toparticipateinsendingverysmallquantitiesof commercial networksthatwewereabletofindopportu- Jean-Hervé Bradol:IntheenditwasthroughChinese tion with China, JapanandSouth Korea. to explorenew ways of trying to do something, in associa- regime. Inviewofthegravitysituation,MSFhoped of geopoliticalforceswasnotfavourabletoachange of thefamineatseveralhundredayear,andbalance to haveimproved:estimatesputthenumberofvictims ment. Sincethen,thecountry’ssituationseemshardly sion resulted from the system established by the govern- not reachingthoseingreatestneedandthatthisdiver- Korea becauseitwasapparentthattheaidprovided In 1998,MSFdecidedtointerruptitsactivityinNorth North Korea(Jean-Hervé Bradol, FionaTerry) Extract: French). Directors Meeting,29September2000(in Minutes of from the MSF France’s Board of D164

155 MSF and North Korea 1995-1998 MSF Speaks Out

migrants and most important, not as refugees. For the to assess what the needs of patients are as well to be able time being, MSF is giving small amounts of financial aid to help (North Korean) doctors. But we were never able to to these Protestant micro-networks, with all the contra- do this,” she said. “We are not interested in just delivering dictions that presents for us, but its primary objective is drugs to hospitals. We are interested in contact.” Terry said to increase the number of visits, in order to gain a better that when MSF members questioned North Korean doc- understanding of what is happening, when that is hard to tors, they seemed to say only what they had been told to discern, given the clandestine nature of these initiatives. say, mediated through official translators. “If we asked a question or spoke about something that the (North Korean) Fiona Terry: I have just come back from a fifteen-day visit government was not happy about they just didn’t translate,” to these Christian networks. In our estimation, among the she said. “I would like to see the Japanese government try- groups of active people whom we met, the desire to help ing to understand what ‘humanitarian’ means a lot more.” the North Koreans was greater than the wish to convert them. A proposal is therefore being studied whose purpose We very soon realised, after the mission to Seoul and on is to offer short courses of medical training (a doctor the border in summer 1998, that the core of our activity would spend three weeks there every three months) and – if we had to have one – would take place with refugees. to give financial support for food provision. The training It is too difficult to carry out activities openly in North aspect would enable us to form practical links, to test the Korea. We continue to pursue it for form’s sake, but we opportunities for working together and to continue to know that we will never be completely comfortable with document the aid system in North Korea. that kind of approach. There are two countries, China and Japan, in association with whom we are trying to explore Marc Le Pape: I am worried, and I am wondering whether operational alternatives. Japanese NGOs are involved in aid the people we are working with and who carry the Bible to North Korean refugees. In Japan and China, we are trying with them are not discriminating on religious grounds to explore operational avenues. I have been taken several between Christians and non-Christians. times to meet partners in South Korea, since most of the networks are in South Korea. In Paris, the work of François Fiona Terry: We do not underestimate this risk, because [Jean], later continued by Fiona [Terry, Director of Studies it is a real one, and can be seen particularly clearly in at the MSF France Foundation] is to document, and to the favouritism shown toward Koreans as against Chinese, encourage speaking out. As we often go to the border, we though they are not necessarily in greater need. interview refugees and as soon as we have enough material we send it to Paris to be integrated into their research work. During the winter, we took Fiona with us to the border. We worked closely together at that time. “Group Questions Motive Behind North Korean Aid,” Ko Hirano, The Japan Times (Japan), 10 Sophie Delaunay, Research officer, Foundation March 2001 (in English). MSF France, June to August 1998; Coordinator, MSF France in China, January 1999 Extract: to December 2001 (in French). Terry said, however, that the aid is more likely to help Japan achieve its goal of normalizing ties with North Korea than alleviating food shortages in the country, unless Tokyo is able to “independently assess the needs of the population and give aid directly to people and monitor We wondered how to renew our activity. There were and evaluate the impact of that aid.” Tokyo and Pyongyang discussions with François Jean on the idea of writing have held a number of talks on opening diplomatic ties a comprehensive article, and then gradually, in late since 1992, most recently in October. But the two sides 1998 and early 1999, we said were going to try to work remain at odds over several issues, including Pyongyang’s outside the country, and to pursue our work with China. demand for an apology and compensation from Japan Little by little, contacts were made with other NGOs in for its colonial rule of the Korean Peninsula and Tokyo’s Japan, and that led us to act with South Korea, Thailand demand for action on its allegations that North Korean and Cambodia. Sophie and Marine did everything. They were agents abducted a number of Japanese in the 1970s and very creative in the operational area. 1980s. A Japanese government official said Japan can do little about tracking the distribution of its rice aid Pierre Salignon, MSF France programme manager, because Tokyo and Pyongyang do not have diplomatic from October 1997 on, then MSF France Executive ties. “But we believe it is necessary to conduct a survey on Director from January 2004 on (in french). how our assistance is distributed in North Korea in the near future,” he said, without giving details. Terry, an Australian, said the Nobel Peace Prize-winning MSF withdrew from North Korea in 1998 because the North In June 2001, the Chinese authorities organised a Korean government did not respect its with to work direct- major crackdown on refugees on the North Korean bor- 156 ly with local people. “We want to see patients and be able der. In July 2001, MSF called on the Chinese govern- 10,000 to500,000.MSFsaysitisprobablyabout200,000. the numberofNorthKoreanrefugeesinChinarangefrom 550-mile border as conditions deteriorate. Estimates of explanation isthatitfearsasurgeofrefugeesacrossthe has chosenthismomenttoactisuncertain.Onepossible pressure, sotheyarerunningoutofoptions.”WhyChina that, thepeoplewhoaresupportingthemcomingunder go outtowork,theycannotevenbeg.Ontopof means theyhave to gointoeven deeper hiding - theycannot afraid tomeet,”theMSFvolunteersaid.“Thecrackdown the refugees.“Peoplearescared.Theyafraidtotalk, This prospecthascreatedanatmosphereofterroramong visited the border said.[...] networks havebeengiving,”anMSFvolunteerwhohasjust impossible tocarryouteventhesilentkindofsupportlocal large numbersofpeopleinjeopardyandmakingitalmost seen andheardisthatthereanewpolicyputting at the attitude of the Chinese authorities. “What we’ve Frontières hasbrokencovertovoiceits“graveconcern” tion deteriorating every day the aid agency Médecins sans ated, manytofacedeathorimprisonment.Withthesitua- ber ofaidworkersarrestedandfinedrefugeesrepatri- campaign whichhasinvolvedasharpincreaseinthenum- pressure sinceJunewhenChinalauncheda“StrikeHard” These covertreliefoperationshavecomeunderintense food, clothing, medicine andshelter. international aidagenciestoworkundercoverprovide This hasforcedchurchgroups,Sino-Koreanfamiliesand the Pyongyangregime,treatsthemasillegalimmigrants. 1m people.China,whichmaintainsfriendlyrelationswith have fledafamineestimatedtokilledmorethan two countries.Inthepastsix years manyNorthKoreans tens of thousands sheltering along the border between the against acrackdownbyChinawhichthreatensthelivesof North Koreanrefugeeshavebrokentheirsilencetoprotest Aid workerswhohavebeensecretlyhelpingstarving Extract: national aid by the DPRKregime. continued todenouncethemanipulationofinter- tarian assistancefortherefugees,andsimultaneously ment toceaseforcedrepatriationandallowhumani- to North Korea faced reprisals ranging “from interroga- The report, citing refugees’ accounts, said those sent back Extract: Refugees” “China StepsUpRepatriation ofNorthKorean 23 July 2001 (inEnglish). Jonathan WattsinTokyo,TheGuardian(UK), “Criminals…Like RatsRunningAway,” Post (USA),23July2001(inEnglish). by JohnPomfret, D165 The Washington

D166 by by of rewards,to report onthepresenceofNorth Koreans,”it “The Chinesepopulation isbeingmobilized, with theoffer systematic search,arrestand repatriationpolicy,”itsaid. are livinginconstantfearof beingcaughtinthenetofa verify residence permits, the report said. “North Koreans identity papers,andconducted house-to-housechecksto have entered factories and other workplaces to inspect document theidentitiesofpeopleinminibusesandtaxis, North Korean refugees. Police have set up checkpoints to people that they would be severely punished for helping posted thismonthinthebordertownofLongjingwarned region, the Doctors Without Borders report said that signs Citing commentsbywitnessesandinterviewsinthe nuclear warhead. Korea wasalsobelievedtobeworkingonadesignfor a gram todevelopintercontinentalballisticmissiles.North 1998, promptingwidespreadconcernthatithadapro - Korea firedatwo-stagerocketoverJapaneseairspacein Korea maintainsitsmoratoriumonmissiletests.North this practicebecausetheirmainconcernisthatNorth said Westerngovernmentshavebeenreluctant to criticize maintain KimJongII’sgovernment.Someaidagencies Party, themilitaryandworkersconsiderednecessaryto it insteadtofamilies tied totherulingKoreanWorkers’ to be distributed to the neediest people, but channels the NorthKoreangovernmentrefusestoallowfoodaid poorest people.SeveralWesternaidagencieshavesaid 2000 whenitwasdeniedaccesstosomeofNorthKorea’s Doctors Without Borders pulled out of North Korea in early repatriation, which Chinahas signed. covenant protectingU.N.-designatedrefugeesfromforced U.N. refugeeofficialsaccusedBeijingofviolatingthe that theywouldfacepersecutionifweresenthome. family; evenafterU.N.refugeeofficialshaddetermined year, ChinaforciblyrepatriatedanotherNorthKorean to 2 millionto die out of a population of 22 million. Last North Koreansince1994,causinganestimated1million by badagriculturalandeconomicpolicieshasravaged China, mostlyinsearchoffood.Afaminecaused past.” Tensofthousands of NorthKoreanshavefledto ated hereeveryotherday,comparedto20perweekinthe the border cities reports that 50 people are being repatri- the campaign,”reportsaid.“Aresidentlivinginoneof of arrests and forced repatriation since the beginning of “Refugees andaidworkersreportanincreaseinthenumber May, but thegroupestimated that itis in thethousands. people have been repatriated since the campaign began in of its human rights record. It is not known how many speculation thatthedecisionwasmadetomutecriticism cessful bidtohostthe2008SummerOlympics,prompting South Korea.Chinamadethedecisionrightbeforeitssuc- family toleavethecountry,andtheyultimatelywent Under intenseinternationalpressure,Chinaallowedthe uge attheU.N.refugeeagency’sBeijingofficelastmonth. its climaxafteraNorthKoreanfamilyofsevensoughtref- ment.” The report said the repatriation campaign reached tion, re-educationandimprisonmenttocapitalpunish- 157 MSF and North Korea 1995-1998 MSF Speaks Out

added, saying that fines for helping refugees ranged from with the distribution of its aid, saying that most of it $500 to $4,000. went to members of the ruling Workers Party, the army or senior officials and not the most vulnerable population from whom it was intended.

“China Accelerates Repatriations of North Koreans,” Mark O’Neil, Beijing, The South China Morning Post (China), Beijing, 25 July 2001 (in “Engineered Famine in North Korea,” Philippe English). Grangereau, Libération (France) 30 July 2001 (in French). D167 Extract: The government of the northeast China province of Jilin Extract: has increased forced repatriations of North Korean refu- North Koreans are continuing to die of hunger despite gees as part of the “Strike Hard” anti-crime campaign and the massive international aid delivered to the Pyongyang refused the offer of humanitarian aid for them, Médecins government by the United Nations, because the govern- sans Frontières (MSF) said yesterday (Tuesday). [...] In ment is leading international organisations by the ear, and an interview in Beijing, an MSF volunteer back from the diverting a proportion of that aid. Those are the conclu- North, said that this month his organization had for the sions of Fiona Terry, Director of Research at Médecins Sans first time asked the Jilin government to provide assistance Frontières (MSF) who presented them to Libération. In order to the North Koreans there because MSF was concerned to find out what was happening in the land of the ‘Great about the refugees’ health conditions. “It was difficult to Leader’, where the regime excludes all independent news- obtain meetings on this subject. When we had meetings, gathering, MSF carried out a study in China, which lasted with officials in public health, civil affairs and foreign several weeks. It was based just across the border with affairs, they said that there were no North Koreans there North Korea, where between 100,000 and 200,000 North and therefore no problem.” “They know the reports in the Koreans are seeking refuge from hunger and repression. international press and accuse it of lying,” he said. Fiona Terry used these testimonies in her description of MSF is active in six provinces and regions of China, with daily life in the world’s last ‘Stalinist’ dictatorship: “The about 30 expatriate staff and 120 local employees. “We Mercedes of the North Korean elite drive back and forth are warmly welcome anywhere but in Jilin,” he said. In through Pyongyang, while ordinary citizens are reduced to late June, China allowed a family of seven North Koreans digging up the grass along its five-lane boulevards in search who had taken refuge in the Beijing office of the United of edible roots and plants. The public distribution system, Nations High Commissioner of Refugees to leave China and on which three quarters of the population depend, provides go to South Korea, via Singapore. This led to hopes that rations only on important dates such as the birthdays of Kim Beijing would change its policy and consider the North II-sung and Kim Jong-Il, and for the rest of the time leaves Koreans as political refugees but officials later said that people to get by as best they can. The testimonies of North this was not a precedent and that its policy of forced repa- Korean refugees in China collected by local organisations triation remained in place. The MSF volunteer said that, suggest by extrapolation that 3.5 million people may have following the family’s departure, the authorities in Jilin died of hunger and from diseases linked with the famine of had stepped up the level of such repatriations, as part of 1995-1998.” the “Strike Hard” campaign, with arrests, house-to-house searches and fines of aid workers who mainly consist in A shock? The situation has hardly improved since then. Korean-Chinese Christians and Buddhists. “The refugees still speak of people dying of hunger, but less […] In one night in late June, 4,000 people, including frequently, reports MSF’s representative. They say that the North Koreans and illegal Chinese migrants, were arrested weakest – the old, the very young and the sick – are already in Yanji city. dead, which leaves fewer mouths to feed with the little that is available. Imagine the shock if one day we discover that “For the past two years, we did not wish to talk too much there are not 23 million North Koreans, as the government about this, to protect both aid workers and refugees. But states, but only about fifteen million, as some North Korean our silence was vain. It is unacceptable to pursue the starv- ex-officials who have fled to China believe.” ing North Koreans and send them back.” The minimum punishment they face is one month of prison and interro- MSF left North Korea in 1998, after working there for four gation, rising to long sentences or death if they are shown years, followed by Médecins du Monde, Action Against to have had contacts with Christians or South Koreans who Hunger and Caritas. These NGOs believed that food aid are all regarded as ‘spies’. “China cannot admit their refu- was not going to those in direst need: “Our teams realised gee status. If it did, it would have to recognise the failure that the regime was putting on show whatever it wished of the North Korean system,” he said. humanitarian workers to see: malnourished orphans (when it wanted increased food aid) and healthy children to reas- MSF withdrew from North Korea in September 1998 after sure donors of the effectiveness of the actions that had 158 working there for three years because it was dissatisfied been undertaken”, reported MSF. This type of manipulation “In mid-Julywe expresslyaskedtheChinese government as ‘ of theserefugees,whomithoundsdown,describingthem Pyongyang, hasbeenintensifyingtheforcedrepatriation several weekstheChinesegovernment,inconcertwith ing to China arenot out of the woods. MSF notes that for ‘ system of oppression. ” guilty ofaggravatingsufferingmakesitanelementinthe save lives,buttoentrustitsdistributionagovernment Terry seesit,“Thegoalofhumanitarianaidmaywellbeto orrhage ofrefugeesintoChinaandSouthKorea.AsFiona ment thatcouldleadtomilitaryactionorcauseahaem- Korea wishtoavoidthecollapseofregime,adevelop- reasons,” claimsMSF.TheUnitedStates,JapanandSouth this ‘transfusion’forpolitical,economicanddiplomatic governments andaidorganisationshavegivenNorthKorea “Although theiraidisdescribedashumanitarian,donor respond with what we observe in thecountry itself.” on thediversionofaid“isgroundless,anddoesnotcor- spokeswoman, CatherineBertini,retorted,“thestatement secret servicesandtheNorthKoreangovernment.”WFP’s between 1995 and 2000 was “diverted by the army, the Jean Ziegler,whostatedthatthebulkofaidsupplied by theUN’sSpecialRapporteuronRighttoFood, MSF. ThefingerhadalreadybeenpointedatWFPinJune from suchaid.“Nobodyknowswhathappenedtoit”,says refugees interviewed by MSF say they had never benefited Koreans thoughttobemostvulnerable.Butmanyofthe supposed to be meeting the needs of the 8 million North the world?Forseveralyears,WFPhasofficiallybeen making thatcountryoneofthemostheavilyassistedin supplied NorthKoreawithamilliontonnesoffoodyear, bodies suchastheWorldFoodProgramme(WFP),which how arewetoexplainthesilenceandpassivityofUN survived, sothatavictorioussocietycouldberebuilt.”But in 1996that it wouldbeenough if 30%of the population no longersurprisedher.“KimJong-Ilevendeclaredpublicly do without”–anextremeformofsocialDarwinismthat those judgedhostileorwithoutuse,whichitbelievescan categories: thoseseenasloyalorusefultotheregime,and she “understoodthatPyongyangdividesitspopulationinto A caseofsocialDarwinism?FionaTerryfurtherstatesthat exclusively by ‘natural disasters’. official positionis,infact,thatthefaminewascaused of floods,inexpectationaUNinspectionvisit.”The excavation workswiththepurposeofaggravatingeffect tion visit.Otherssaytheyweremobilisedtotakepartin ies fromarmy depots justbefore the arrivalofaUNinspec- persists. “Somerefugeesreporttransportingfoodtonurser- tion, re-education camps, prison, and even the firing squad. tion, re-educationcamps,prison, andeventhefiringsquad. average from10to25aday.Those deportedfaceinterroga- past fewweeks,transfersacross theborderhaverisenon nomic migrants’,refusestogivethemrefugee status.Inthe through thestreets’.Beijing, which atbestcallsthem‘eco- ing peopletoreportthem,comparesthem‘ratsrunning Rats’. Those North Koreans whoescape the famine by flee- criminals’ . Apoliceleafletissuedon21May,encourag- Salignon. “We are awaiting its reply.” gees inChina”,reportedMSF’sprogrammesofficer,Pierre for permissiontobringhelptheseNorthKoreanrefu- - Absolutely, and itistrueoftoomany placesinthe lation depends on internationalaid? military expenditureandthe factthatathirdofitspopu- - Isn’tthereacontradiction betweenthisregime’shigh of 44out211.Whatishappening there?Wedon’tknow. cannot alwaysgo,officiallyfor reasonsofsecurity,atotal able togo.Ourworriesaremore forthedistrictswherewe succeeding inhelpingpeopletheplaceswhereweare and transparent?Itcertainlyisn’t,butwearesure see the children’s progress. Iseverything always honest speak of‘set-ups’whenwegobacktothesameschoolsand were being‘setup’whentheywentthere.Butyoucannot hospitals becauseourmonitorshadthefeelingthatthings - Wevisitmanyplaces.havestoppedsendingaidto - MSF speaks ofmanipulation, of ‘set-ups’ child the chance togrow up. our operationin1995,istoguaranteeeveryNorthKorean And that’sourmission.Ouraim,sincethebeginningof - Ifyoudon’tacceptthem,can’tfeedthechildren. - Whyaccept the North Korean government’s conditions? that reason, aid isbeingdiverted, is wrong. would wish,thatisnotthecase.Butthentosayfor never saythatourverificationsystemisworkingaswe same accessthatwehaveinothercountries.Iwould - Yes,wedothat;thegovernmentdoesnotallowus tions. you are going. That is not the case with other WFP opera- - Butyouarestillobligedtoannounceinadvancewhere are goingto school thantwo or threeyears ago. But theyareinreasonablygoodhealthandmoreofthem they werenotreceivingfood,wouldshowtheeffects. indeed reaching those for whom it was intended. [...] If actions andstatedthatfoodaidhandledbytheWFPwas with ‘system ofoppression’( WFP showedthatitwasconnivingwiththeNorthKorean reaching thoseforwhomitwasintended,andthatthe by refugeesarrivinginChina,statedthataidwasnot Sans Frontières(MSF),onthebasisofpersonalreports aid areinbetterhealth.Lastmonth,however,Médecins situation thisyear,evenif,individually,thosereceiving there would be no improvementin the country’s food of aid,emphasisedthatinviewtheseveredrought, Programme (WFP),whoisresponsibleforthedelivery Catherine Bertini,DirectorGeneraloftheWorldFood Passing throughBeijingonherreturnfromNorthKorea, Extract: Libération inBeijing,CatherineBertinidefendedher (France), 30 July2001(inFrench). Haski, Beijingcorrespondent,Libération General of the World Food Programme, by Pierre interview “It isWrongtoSayThatAidBeingDiverted,” withCatherineBertini,Director Libération 30July).Inaninterview D168

159 MSF and North Korea 1995-1998 MSF Speaks Out

world, not only of North Korea. But if we decided that we last 3 years, the necessity of protecting local aid workers aren’t going to help them because we don’t approve of and their beneficiaries, combined with the opacity of the their military budget; that would be an immoral position. border, has made it difficult to address the issue of forced - Is your position then, that whatever they do, as long as repatriation and lack of humanitarian access. Following the we feed the children, we’re morally correct? Guilsu incident at the end of June 2001, rumours spread - I’m simply saying that the idea that we should allow about a major crackdown on the Sino Korean border. these children to die of hunger because we don’t like this government is an immoral idea. It is an idea that no We took the decision to go to the border in order: humanitarian individual would defend, nor, for that mat- a) To crosscheck info about increasing number of forced ter, any humanitarian or government in the world. From repatriations. Bangladesh to Canada, I have never met anyone who said, b) To present an official request to the Chinese local “Let these children die because we want this government to authorities for assistance to this population. This field change.” Never. And if the leading donors (United States, trip provided substantial evidence that the crackdown on Japan, South Korea) think aid has been diverted, do you NK refugees had indeed taken place and that the hunt think they would continue to pay? That is not the case. was being pursued. Requests made at official levels were - In your opinion, is the Pyongyang government taking unfruitful, the Chinese authorities denying the existence the smallest measures to avoid being permanently depen- of NK refugees, and therefore the need for any kind of dent on food aid? MSF involvement. - No. North Korea will remain dependent on food aid for the foreseeable future. Circumstances and scope of MSF public position: Media At the beginning of July, we presented the outcome of our investigation and proposed to address the issue publicly “Update MSF and NK,” Email from MSF Beijing and in MSF name. Paris supported this idea, and other to MSF Belgium and MSF Holland North Korea sections involved in operations in China (Holland and network, 3 August 2001 (in English). D169 Belgium) agreed on this initiative. Then the following strategy of communication was decided: Extract: 1. Express MSF concern regarding the lack of access to NK Dear all, refugees and forced repatriations Thanks to all of you for your interest and great support 2. Target a panel of reliable journalists with whom we on the NK issue. You will find in this email a bit of back- have already been dealing, on this issue. ground info on our strategy for this very sensitive NK 3. In order to protect existing operations in China, avoid story, as well as an update on the latest development, so mentioning field people’s name or the nature of MSF activ- as to facilitate communication among ourselves and have ity on the border but rather express MSF general position. you share a bit of the ‘local’ atmosphere. Summary of MSF 4. Interviews with the designated journalists were to be background on the NK issue since 1998. made either by Pierre, Fiona, Marine or Sophie, who are the 4 persons involved in this issue. 1. Since MSF withdrew from North Korea in 1998, actions 5. Since radio interviews require naming the interviewee, have been taken from MSF Japan and MSF China to identify they would be made by Pierre or Fiona in Paris. some alternative ways of assistance and keep document- We favoured a gradual approach. Our idea, as a first step, ing the sanitary situation inside the country. Through was to address our message publicly in a (rather) smooth contacts made at field level (Sino Korean border), and and controlled way in order to push for a dialogue with the in the region (Japan, China, South Korea, Thailand), we Chinese... avoid being kicked out right away. To prevent have gradually gathered information about the conditions as much as possible our message from being distorted, we inside NK and on the border and investigated on the made a point to brief individually all the journalists that general environment conducive to the crisis. Today, this we had identified. operation is run by Sophie (MSF China) and Marine (MSF Japan), under the supervision of Pierre Salignon in Paris. The following media reported MSF statements: The Info collected has been systematically transferred to Paris, Guardian, Asahi Shinbun, The Washington Post, The South and Fiona Terry (MSF Foundation) is in charge of research China Morning Post, Libération, AFP, Japan times, the work. On a regular basis, testimonies of refugees have also Chosun Ilbo. Articles are still to be released in Le Monde, been given out to reliable journalists in Beijing, Tokyo or and Sankei Shimbun in the coming days. Pierre did some Bangkok, but until the month of June, we did not feel the Radio interviews as well. Pierre and Fiona have been need of having MSF quoted in the press. invited to a French TV broadcast ‘des racines et des ailes’ [roots and wings] due to be broadcasted in September. 2. As time passed by, we have got to know more and more about the situation of the NK people, especially of those Other actors who try to escape from their country and seek asylum Before making our appeal, we met with the President of and assistance in China. Although the Chinese repression China Charity Federation in Beijing and asked for his sup- 160 toward NK refugees has existed continuously over the port in helping us find a space for assistance. He is work- Marine and Sophie All the best! or questions to both ofus. gap andlossoftime,pleasesendacopyyourcomments sharing allinformationonthismatter,buttoavoidany opments. Pleasefeelfreetocontactusbyemail.Weare again. Wewillkeepyouinformedaboutthecomingdevel- time, therewillalwaysbetimeinSeptembertostrike a newstrategyofcommunication.Augustbeingvacation of august,wesuggestdiscussingamongstourselvesabout If thereisnoimprovement,noranyprospectsbytheend Chinese officials again and test their capacity of response. would liketohaveafewweeks’breakapproachthe 3. Beforedecidingtointensifyourpublicstatement,we keep claiming for discussion. tarian concern, which is strong enough, and allows us to rejected. Wehaveuntilnowmanagedtofocusonhumani- for the Chinese and if addressed as such is doomed to be is not a criticism, but the HR issue is an epidemic one eager to bring and join the MSF message. This of course, 2. ItseemsthatHR[humanrights]relatedmediaisvery our message. 1. ItisobviousthattheChinesehavealreadyreceived of our message. Thereasons are: diluting MSF’sappealandtaketheriskoflosingcontrol 6. Atthispoint,wedonotfeelcomfortableinfurther MSF delegate offices. interviews arereceivedalmosteveryday,mainlythrough ever beenquitereactiveandrequestsforinformation humanitarian assistanceinsideNK.Thepresshashow- and wishestoshareourinformationregardingtheuseof Seoul hasexpressedgreatinterestinMSFstatements, Chinese government yet. The SK Ministry of Unification There hasnotbeenanydirectorindirectreactionfromthe Impact of MSF appeal next week. of theUNSecurityCouncil.Anothercontactistobemade briefly theissueinNewYorkwithChineseambassador Fiona). Thisweek,CatherineHarperfromMSFUSAraised Salignon andAlexParisel)UNHCRGeneva(Pierreor issue wassupposedtobeaddressedinECBrussels(Pierre to Brussels).Simultaneouslywiththepressapproach, move further(exceptECwhichproposedtosendamemo expressed greatconcernbutshowednowillingnessto Embassy in Beijing were approached as well. All of them ing onit.UNHCR,EC,Frenchembassy,andSouthKorean Korea, thelast bastionofStalinism,isin the gripofan home, million of thispeoplearestarvingto death.North of weaponsfromRussiaat the weekend.Meanwhile,at Kim Jong-Il,NorthKorean leader, bought£300mworth Extract: D170 Guardian (UK)6August2001(inEnglish). Researcher forMédecinsSansFrontières,The “Feeding the Dictator,”

by Fiona Terry, hit northernprovinceswhereWFPconcentratesitsaid. they neverreceivedthisfood,despitebeingfromthehard- hit northernprovinceswhereWFP concentrates itsaidsay the elderlyandsick.YetrefugeesinChinafromhard- Korean: school children, pregnant and lactating women, (WFP), supposedlytargets8mofthemostvulnerableNorth mostly channelledthroughtheUNWorldFoodProgramme in theworld–almost1mtonnesannually.Thisfood, Korea receivesoneofthelargestallocationsfoodaid meagre foodavailable. All thistakesplacewhileNorth young andthesick–leavinglessmouthstofeedfrom say that the weakest have already died – the elderly, the border, althoughwithlessfrequencynow:therefugees and 1998. Reports of deaths continue to permeate the died fromstarvationandrelatedillnessbetween1995 in Chinasuggestthatupto3.5mpeoplemighthave Extrapolations fromtestimoniesofNorthKoreanrefugees understand that North Korean government categorises its understand that NorthKoreangovernment categorises its damage inpreparationfora UN inspection.MSFbeganto speak ofbeingmobilisedtodig upareastoexacerbateflood military storagetonurseries before aUNvisit,andothers nies corroboratethis:somereport havingcarriedfoodfrom reassurance that food aidwas doing good. Refugee testimo - aid wasdesired,andwell-fed childrenwhendonorsneeded to see:malnourishedchildreninnurserieswhenmorefood government fabricated whatever they wanted aid workers and 1998,butwasunsuccessful.Theteamsrealisedthatthe necessary toworkdecentlyinNorthKoreabetween1995 these restrictionsandcreatethe minimum conditioning Médecins SansFrontières(MSF)endeavouredtoovercome tions deemed controversial are leftuntranslated. translator accompaniesthemwherevertheygo,andques - little contactwithordinaryNorthKoreansasagovernment kindergartens orschoolsareallowed.Aidworkershave one weekinadvance;norandomvisitstohouseholds, “monitor” theaid,butmustannouncemonitoringvisits the government’sdisposal.Aidagenciesarepermittedto strengthening oneofthemaininstrumentscontrolat government-run publicdistributionsystem,effectively whom itisintended.Allaidchannelledthroughthe access necessarytoensurethataidisreachingthosefor the North Korean regime does not allow aid agencies the even theorganisationsinchargeofdistributingit,because What ishappeningtothefoodaid?Nooneknows,not the birthdays of KimII-sung or KimJong-Il. for food,onlyprovidesrationsonimportantdates,like system, onwhichthree-quartersofthepopulationdepend lining the five-lane boulevards.The public distribution citizens digforrootsandedibleplantstothegrassstrips the rulingeliteplystreetsofcapitalwhileordinary by hand over with livestock. Mercedes Benz belonging to areas haveabandonedtractorsandrevertedtoploughing case capital,Pyongyang,arewithoutelectricity.Rural Kim IIsang,arefloodlit,apartmentblocksintheshow- tesque personalitycultofKimJongIIandhisdeadfather, 11 m-strongdefenceforce.Whilemonumentstothegro- the country.Yetregimemaintainsbudgetforits economic crisisthathasprovokedfamine in manyparts of 161 MSF and North Korea 1995-1998 MSF Speaks Out

population according to perceived loyalty and usefulness to the regime, and those deemed hostile or useless were expendable. In fact, in 1996, Kim Jong-Il publicly declared In these notorious provinces where international aid that only 30% of the population needed to survive to recon- is supposed to be arriving en masse and reaching the struct a victorious society. With no possibility of directing most vulnerable (on paper at least), we continue to aid to those most in need, MSF withdrew. gather reports from people who have seen no international aid apart from what they have transported to stores, to sup- Although they label their humanitarian aid, donor govern- ply the army’s needs. United Nations bodies and certain ments and aid organisations keep North Korea on life sup- humanitarian organisations declared they had brought port for political, economic and diplomatic reasons. The assistance to the most vulnerable, in kindergartens, mater- US, Japan and South Korea are pursuing a “soft-landing” nity clinics and hospitals, and to the elderly – in other words policy aimed at avoiding an implosion of the regime which to all categories of vulnerable people. But it is obvious that could trigger military action or refugee flows into China assistance has not reached those who have gone to China. and South Korea. Food aid is aimed at opening dialogue and trust to pave the way for controlled reunification. Many a time, we (and other people in MSF as well) had Other governments, such as Australia, hope to improve exchanges with Catherine Bertini, WFP’s representative at ties with the regime for future trade benefits. Most that time, and with various WFP officials of different grades. members of the EU – including Britain, which opened an They told us that the most vulnerable were being helped, embassy in Pyongyang last month – have re-established because they were providing food to this or that body in full diplomatic relations with the regime, thereby bestow- which those people were supposed to be found. ing legitimacy on Kim Jon-Il and his clique. While political and diplomatic engagement provides the only real We then went back to see them with a list of interviews with means to influence the regime, using food aid to do so in refugees who had come from such or such a place – places a country beset by famine is reprehensible. The purpose supposed to be covered by the WFP – and told them that of humanitarian aid is to save lives. By channelling it these refugees had received nothing. In the case of WFP through the regime responsible for the suffering, it has people, we very quickly found ourselves having a surreal become part of the system of oppression. discussion. When we showed them the names of the institutions in which aid from WFP was officially said to have been distributed, we realised that they had no list of the institutions they were supposed to cover. In fact, to the best of my knowledge, they still did not have one very recently. In Raids on North Korean refugees take place regularly, this situation, it is hard to say that the most vulnerable are and we are keeping a close eye on these questions. being reached, or to know where the assistance is going. It At certain points, we find it is important to react is problematic! and we take advantage of it in order to raise the question of aid in North Korea again. Fiona is doing a huge piece of We had the results of the famous UNICEF-WFP 2002 enquiry work on WFP and we are trying to show that WFP’s aid is into nutrition in North Korea analysed by Epicentre. We almost in excess of needs and that there should therefore be were trying to identify possible biases in the methodology. no famine. We show that the combined aid of WFP, China We went back to see UNICEF and the WFP with this mate- and all the various actors should be broadly sufficient to rial, in an attempt to have a thorough discussion of our feed the whole of this population because the statistics understanding of the nutritional situation in North Korea. provided officially are underestimates, say the refugees we When we came to the representative’s office, as soon as have interviewed. Fiona will focus on this subject for two or we raised the first question, she stopped us right there three years. For these three years, finally, we will not speak and told us we were certainly right in terms of our mate- out in directly denouncing North Korea. We believe there is rial taken as a whole, because ultimately that enquiry had no more to say to North Korea, no lessons to offer them, only been undertaken for publicity purposes, and was not since we are not even present inside the country. On the based on epidemiological data. We therefore had an almost other hand, we continue to offer lessons to WFP, because we philosophical discussion on the usefulness of proceeding in are documenting aid. WFP tells us that it is providing mil- that way. She explained to us that the way they reconciled lions. Our answer to them is that we have refugees who themselves with the idea that in the short term they were come from such or such a city or province where the WFP is certainly not reaching the most vulnerable was by convinc- supposed to have distributed aid, and those refugees have ing themselves that the more aid there was, the better the received nothing for three months. It is Fiona’s job to col- chance that what was not used by the authorities in normal late WFP’s declarations with the statements of the refugees, times would reach the most vulnerable. on the basis of the interviews we are carrying out. Marine Buissonnière, Director of programs, Sophie Delaunay, Research officer, Foundation MSF Japan, April 2000 to September 2001; MSF France, June to August 1998; Coordinator, Co-Coordinator MSF France in South Korea, MSF France in China, January 1999 February 2002 to November 2003; (in French). 162 to December 2001 (In French) the Congress of theUnited States ofAmerica. Relations Subcommittee on East Asia and the Pacific of and in China, to the House Committee on International regarding theplightofNorthKoreansinsideDPRK Coordinator forNorthKoreadeliveredatestimony On 2 May 2002, Sophie Delaunay, the MSF Regional Beijing and Tokyo and lobbyingonall possible fronts. international media’scorrespondentsbasedinSeoul, tion aboutthesituationofrefugeeswith South Korea.Theycarriedonsharingtheirinforma- Korea. TheMSFteamestablishedtheirofficeinSeoul, other AsiancountriesintheirattempttoreachSouth North KoreanrefugeeswhowerefleeingfromChinato In 2002,MSFFranceextendeditsprogrammetoassist going. NorthKorea hasbeenoneofthelargest recipients they haveaccess tothepeopleandknowwhere theaidis reporting thataidissaving millions of lives, and that assurances of the World Food Program (WFP), which is with theserefugeeswouldfind itdifficulttobelievethe United Nationsprogram.Anyone whohassatandtalked includes thosebelongingtothe targetbeneficiariesofthe interviewed saytheyhaveneverreceivedfoodaid.This To thisday,thevastmajorityofrefugeeswhoMSFhas pendently assess humanitarian needs. government ontheabilityofaidorganizationstoinde - was duetotherestrictionsimposedbyNorthKorean not beobservedbyitsteamsoperatingintheDPRK.This by therefugeesthatMSFmetonChinesebordercould gence whenin1998,theextentoffaminedescribed for thepast7years.MSFitselfexperiencedsuchadiver - This has been a characteristic of the North Korean crisis gees aboutwhetheraidisreachingitsintendedtargets. North KoreaandaidworkersassistingKoreanrefu- crepancy ininformationbetweenaidagenciespresent common people.”Hiscommentillustratesthestrikingdis- “You cannotreachpeoplelikethis…Youcan’tthe listening tomyexplanation, he smiledatmeandsaid, refugee howMSFusedtoprovideaidinNorthKorea.After In October2001,Idescribedtoa40year-oldNorthKorean North Korea To International Aid • Lack of Access of the Most Vulnerable Populations Inside assistance cross-border providing workers Aid • countries third in defectors Korean North • North Korean refugees inChina tarian situation in North Korea from the following sources: […] MSFderivesitscurrentunderstandingofthehumani- Extract: (in English). Coordinator forNorthKorea,MSF,2May2002 Washington, D.C. by SophieDelaunay,Regional Subcommittee onEastAsiaandthePacificin House CommitteeonInternationalRelations Refugees,” MSFTestimonyDeliveredtothe “ North Korea:TheHumanitarianSituationand D171

Once outside North Korea,challengesremain forNorth Refugees The Lack of Protection and Assistance for North Korean and independentmonitoring by operating agencies. needs assessments,independent distributionmechanisms, needed can only be improved if there are independent like toreiteratethataccessbythepopulationaid and understandingoftheNorthKoreansystem,MSFwould staged, bytheNorthKoreanpartners.Fromitsexperience tions overthewayfieldinspectionsareorganized,ifnot witnessed UN visits and their testimonies raise ques- the transparencyoffieldinspections.Somerefugeeshave purposes appears to be impossible, calling into question from making spot checks. Random access for assessment beneficiary institutions and WFP teams are still barred North Koreastilldoesnotprovidethecompletelistof North Korea,monitoringconditionsremainunacceptable. After 7 years of massive international assistance to The Quality of Monitoring Food Aid on major national holidays. virtual standstillinthelate90’swithmeagredistribution ways toobtainfood.Erraticforyears,thePDScamea PDS fortheirsurvivalandareforcedtofindalternative interviewed, ordinaryurbanresidentscannotrelyonthe politics insteadofneeds.[…]Accordingtoindividualswe government discriminationofitsowncitizensbasedon assistance, organizations are collaborating in organized nature. ByusingthePDSasdistributionchannelfor tance channelledthroughthePDSwasdiscriminatoryby As early as 1998, MSF denounced the fact that any assis- The Public Distribution System aid. food monitoring of quality The • nel foodaid; and, • The use of the Public Distribution System (PDS) to chan- the aidsystem. Those weaknesses are: programs favourexclusionofvulnerablepopulationsfrom From ourpointofview,twomajorweaknessesintherelief way humanitarianassistanceisdeliveredinNorthKorea. North Koreanrefugeesraiseseriousquestionsaboutthe food atprimaryschool.[…]ForMSF,thetestimoniesof recently arrivedinChina.Noneofthemhadeverreceived Korean children between the ages of 6 and 15 who had tion. InFebruary2002,anMSFteammetwith12North the WFPforassistance,arebeingdeniedfooddistribu- women, andtheelderly,whoarespecificallytargetedby Even populationgroupssuchaschildren,pregnant survivors and onlythe strongest have learned tocope. food shortageinthecountry,thosewhoremainare in NorthKorea.Intheirownwords,afteradecade-long situation remainscriticalformostoftheordinarypeople According totherefugeesMSFhasinterviewed,food to crossintoChinainsearchofthemeanssurvive. Koreans, mostlyfromthenorthernprovinces,continue food. Despiteincreasedbordercontrols,someNorth still agreatchallengeforvulnerablepopulationstoaccess of foodaidintheworldforanumberyears,yetitis 163 MSF and North Korea 1995-1998 MSF Speaks Out

Koreans seeking refuge outside their country. Most North Korean refugees do not even contemplate reaching South Korea. Instead, they cross the border into China in search Minutes of the MSF France Board of Directors’ of food for their families, or a temporary job that will Meeting, 30 August 2002 (in French). D172 allow them to buy medicines or other essential goods needed at home. These refugees live in a precarious Extract: situation in China and are in urgent need of assistance. Presentation Jean-Hervé Bradol [President] Considered illegal migrants by the Chinese authorities, The campaign of repression by the Chinese authori- they live in hiding and face the risk of being arrested ties (encouraging and rewarding informers, surrounding at any time, forcefully repatriated, and subject to severe embassies with barbed wire, etc.), launched over eighteen repercussions in North Korea. Border rules posted along months previously, was now targeting small networks, in the Tumen River in Chinese and Korean stipulate that, “It order to break them up. These aid networks are mainly is forbidden to financially help, allow to stay, harbour, denominational, made up of Protestants, or more rarely, or aid in the settlement of people from the neighbouring Buddhists. We maintain relations with these networks on country who have crossed the border illegally.” matters such as shelter, food and health. We decided to contact the Chinese authorities to find out if there was a Fines and rewards discouraging Chinese citizens from space for aid to refugees at the border. Sophie Delaunay assisting North Korean refugees and recent arrests of (HoM Seoul) and Jean-Hervé went to Beijing to meet the NGO workers illustrate how impossible it is to adequately President of the Chinese Charity Federation and a group provide effective humanitarian assistance. Only a handful of senior officials of the Ministry of Civil Affairs. The of refugees manage to reach a third country, where they response was: “there isn’t a problem, we are dealing with it, continue to face the risk of being arrested anytime as ille- and it’s going very well,” or “we are not authorised to speak gal migrants during their 3-to-4-month screening process. on that subject.” After statements of that kind and despite Up to now, none of the 1988 North Korean defectors who attempts to reopen the discussion, there was no further have been resettled in South Korea have been granted possibility of addressing the subject. How are we to inter- refugee status. pret a meeting like that? No hostility was expressed about the fact that MSF was expressing an interest in the sub- Numerous discussions between MSF and the United ject. Our feeling was that the authorities had known about Nations High Commissioner for Refugees (UNHCR) about our interest in the subject for several years and continued the need for protection have not proved fruitful. In July to be pragmatic in the answers they gave us. 2001, MSF called on the Chinese authorities to cease forced repatriations and allow humanitarian assistance In order to keep track of the refugees, it seemed impor- for the refugees. These calls have gone unanswered. The tant to be present in South Korea. In order to do that, we ongoing repression of North Korean refugees and of those decided to open a small office there. Sophie and Jean- who assist them limits the scope of any humanitarian Hervé had interviews at the Ministry for Reunification and operation on the Sino-Korean border. There may soon be with the director of the national centre responsible for no more refugees to tell you about North Korea. accommodating refugees for a period of two months fol- Conclusion lowing their arrival in South Korea, in order to encourage The need for assistance to the North Korean people their ‘integration’ into the country. There are not many is widely acknowledged. Testimonies of North Korean refugees, but their numbers are increasing every year. refugees confirm that despite massive international relief The director of this centre suggested that we work in the going into the country, a significant segment of the institution’s medical departments. We also had discussions population remains in a precarious food situation. These with the chief psychiatrist, who had an interest in North testimonies also suggest that humanitarian assistance is Korean refugees. In his view there were some people who not primarily directed at, nor reaching, the most vulner- were ill, but that the refugees tended not to seek this type able populations. of care, of which they have a negative image.

MSF expresses its grave concern over the endless suffer- Discussion ing of the North Korean people and urges aid agencies Sylvie Lemmet: Why is the South Korean government invit- operating inside North Korea to improve their monitoring ing us to work with this organisation? and be responsible for the populations they are entrusted Didier Fassin: After all, France has asked the Red Cross to to assist. A second concern addresses the dire plight of go to Sangatte – because that’s humanitarian! North Koreans seeking refuge in China. Médecins Sans Jean-Hervé Bradol: The South Koreans are open-minded Frontières urges UNHCR and the Chinese government to and think that in a democratic society our presence makes open a dialogue leading to ensuring protection of North sense. They are putting resources into this programme, Korean refugees in China, and to authorizing the provision which does not have the feel of a prison environment; of emergency assistance to the refugee population. on the contrary, there emanates from it a sense of care for patients – for example, they have proper activities: sewing, use of computers, and training, e.g., “what is a 164 bank?” Olympic games wasbeingsettledandChina was determined closest ally.In addition,in2001,thematter ofthe2008 to abandonNorthKorea,given thatitpresenteditselfasits refused to do. For China, this was therefore not the moment go downtheroadofnegotiations, whichChinastubbornly the USAovernuclearissue, andRussiawastryingto At thattime,Koreawasin a sensitivepositionvis-à-vis ties of friendship between China andNorth Korea. prohibit theprocess,inviewespeciallyof inability to government. Eventhosepeopleclearlysignifiedtoustheir Tienanmen Square, progressives who were now closeto the authorities, peoplewhohadbeenactiveintheuprising to Beijing,trymeetthemoreopen-mindedcentral refugees clandestinely; we knew they existed. We went right denying theproblematverytimethatweweremeeting no problem,andthateverythingwasfine.Everyone they hadneverseenNorthKoreanrefugees;thattherewas northeast China.WehadseentheRedCross,whostated province inNorthKorea,andthoseofthethreeprovinces route available.WehadmettheauthoritiesofHwangae already triedeverything.Firstthemostthoroughlylegal saying: ‘that’senoughofMSF.’Atthatpoint,wehad the end of the year the Chinese began to dig in their heels, During 2001,wespokeoutpubliclymorefrequently,andat by name.ItwasawayofprotectingtheChinaprogramme. Most ofthetime,weagreedthatMSFwouldnotbequoted sensitive aspects ofits activity. supports theactivityofin-countryteam,including Consultative opinionoftheboarddirectors:The Conclusion may be happening. Jean-Hervé Bradol:Somenetworksofactiviststhinkthat ‘boat-people’ did? Thierry Durand:Arepeoplefleeinginthesameway Tibet. renew ourpassportsfortheprovinceofXinxiangand Virginie Raisson:Formuchlessthanthat,theyrefusedto back! Jean-Hervé Bradol:Yes,it’slikefleaonanelephant’s the insignificance of thepart we areplaying. is moreindifferentthanoptimistic,mayalsoremindusof Didier Fassin:ThisreceptionbyChineseauthorities,which order to collect food. manently, andmanyhopetocrossatregularintervalsin strategies; theyarenotalltryingtostayinexileper- erty. The North Korean refugees employ many different connected witheconomicdifficulties,sicknessandpov- Jean-Hervé Bradol:Peopleareoftenfleeingforreasons be measured. China islow,andwemustassumethattheriskcannot Virginie Raisson:Thetransparencyofthenetworksin and activiststothem,theywrotetheirstories. whom wegaveinformation;introducedrefugees In China we had a large network of journalists to South Korean society. see howtheywereornotbecomingreintegratedinto was thereforeimportanttomonitorthemonarrivaland Korea, and that they were all affected psychologically. It a longexperienceof displacement before arriving in South with therefugees,werealisedthattheywereundergoing from South Korea.And then, in the course of our meetings the bulk of the assistance to North Koreans was now coming South Koreannetworkshadbecomehighlydeveloped,and to proposeswitchingthemissionKoreawasfact China, whichwasourintention.Anotherreasonthatledus no timedidthatendangerdangertheFrenchsectionin co-Coordinator] andIshouldstopgoingtotheborder.At sages thatMarine[Buissonnière,MSFFranceinSouthKorea to far.Theythensentus,throughintermediaries,clearmes- carry onrightuptothepointwhentheyfeltweweregoing not troublethematall. At ithappened, they allowed us to the samewithMSFChina.Contradictionsofthatsortdid expelling theMSFKoreateamwithoutbeingobligedtodo lem totheChinese,becauseitgavethemoptionof which we could intervene in China. That presented no prob- to ParisthattheyopenaprogrammeinSouthKorea,from China, weriskedlosingeverything.Wethereforesuggested too visibleandifwetookonmuchinthenameofMSF ing aidtoNorthKoreawentthroughChina,butifwewere treatment. Atthetime,onlypossibleroutesforbring- Guangxi provincewerefinallyreadytoagreeouroffering After thislongperiodofnegotiation,theauthoritiesin project at Nanning. exploratory work,wewereintheprocessofopeninganAIDS China. It so happened that at that time, after three years’ be abletoacceptit,andwouldforcedexpelusfrom put theChineseinanimpossibleposition;theywouldlonger public positions,fromChina,inthenameofMSF,wewould for us.Ourthinkingwasthatifwecontinuedopenlytotake immigration problem.Thetimingwasthereforenotgood border wasabsolutely“watertight”andthatthereno to hostthem.Itwasthereforeimportantshowthatthe ed whentrying toleaveChinaforSouth Koreaand release 48North Koreanrefugeesthathad beenarrest- asking UNHCRtourgethe Chineseauthoritiesto On 19January2003,MSFSeoul issuedapressrelease organisations to give assistance to therefugees. arrested anditbecameincreasingly difficultfortheaid ing thembythehundreds.Localaidworkerswerealso North Koreanrefugees,huntingandforciblyrepatriat - one of its cyclical surges of repression against the As ofDecember2002,theChineseauthoritieslaunched MSF France in China, January 1999 toDecember2001; Sophie Delaunay, Research officer, Foundation MSF co-Coordinator, MSF France in South Korea, January 2002 toOctober 2003(inFrench). France, June toAugust1998;Coordinator,

165 MSF and North Korea 1995-1998 MSF Speaks Out

three humanitarian workers that were assisting them. humanitarian aid workers or North Koreans remain com- On 24 January 2003, Marine Buissonnière delivered a monplace. Predictably, in this context, support for North testimony to the Japanese Parliament regarding the Korean refugees in distress is diminishing and assisting plight of the fleeing North Koreans, being victims of them has become a challenge that increasingly few aid a massive campaign of repatriation organised by both organizations, crushed by this sanction policy, are able the Chinese and the North Korean authorities. to undertake.

As international attention is now turned to Pyongyang’s regime for a separate crisis, the fate of North Korean refu- “Urgent Appeal for the Protection of North gees remains resolutely ignored. Neither China’s repeated Korean Refugees in China” MSF Press release, violation of international conventions nor desperate Seoul, 19 January 2003 (in English and French). attempts by hundreds of North Koreans to seek asylum D173 in foreign representations have resulted in measurable progress on the question of the protection of North Extract: Korean refugees in search of asylum. The United Nations On January 18, 48 North Koreans, including families with High Commissioner for Refugees (UNHCR) in Beijing, children, who were about to leave China by sea and seek approached repeatedly on this matter, has simply been asylum either in South Korea or Japan, were arrested by unable to ensure their protection. the Chinese security services in Yantai City, Shandong Province. Three aid workers who assisted them were MSF earnestly urges the UNHCR to demand from the arrested as well. The detained North Koreans, as do thou- Chinese authorities access to the North Koreans under sands of their countrymen, face the risk of being severely arrest and to examine their asylum requests. MSF asks that interrogated by Chinese security services and forcibly in accordance with international law, the North Korean repatriated to North Korea where a grim fate awaits them. detainees not be repatriated and that they be protected. As for the three aid workers, they may be subject to MSF asks that the humanitarian volunteers be freed. long-term imprisonment in China. The case of this group MSF vigorously condemns the repression and the forced of 48 North Koreans is most revealing: it unveils the repatriation of North Koreans in China. It denounces the distress of the North Korean refugee population in China Chinese measures aimed at criminalising the humanitarian and the urgent necessity to provide them assistance. assistance directed to the North Koreans. It graphically illustrates a human tragedy that will not be solved through repression. The international medical humanitarian organization Doctors Without Borders /Médecins Sans Frontières (MSF) can only condemn the “MSF Pushes for Rights of Fleeing North Koreans,” arrest of these asylum seekers and denounce the recurring Testimony delivered to the Japanese Parliament non-observance of the right to flee of asylum seekers and by Marine Buissonnière, 24 January 2003 (in the persecutions they are subjected to. English). D174

Within the past three years, China has arrested and forc- Extract: ibly repatriated thousands of North Koreans in flight from Today, we would like to address three fundamental con- their own country in search of asylum and assistance. cerns regarding the disastrous humanitarian situation of Since early December 2002, as a way to definitively North Korean asylum seekers: eliminate the embarrassing question of North Korean 1. The lack of protection for North Koreans fleeing their refugees, China has launched a new manhunt in collusion country with North Korean security services. As of mid-January 2. The criminalisation of humanitarian aid to North 2003, 3,200 North Korean civilians in China have already Koreans in China, leading to a shrinking space for assis- been repatriated as a result of this so-called ‘100 day tance campaign’. 1,300 others are awaiting their repatriation in the detention centres of Tumen and Longjing. The 3. Lack of political willingness to acknowledge and guar- systematic and organized dragnet taking place in China antee the basic rights of North Korean asylum seekers. leaves North Korean refugees no other alternative than a The United Nations High Commissioner for Refugees desperate flight to a third country, at the risk of their very (UNHCR) mandate is to promote the right of refugees and lives. The humanitarian aid workers who attempt to rescue to monitor the implementation of the refugee convention North Korean refugees also face the brutal determination by its state parties, including China. Having been pres- of the Chinese authorities, which deem the assistance of ent in China for years, UNHCR has failed to engage in a North Korean refugees as a criminal offence. In addition constructive dialogue with the Chinese government on the to facing jail terms, deportation and fines for assistance, status of North Korean asylum seekers. Numerous discus- Yanbian residents who are suspected of being humanitar- sions between MSF and UNHCR about the need for pro- ian aid workers are now forced to take a written oath to tection have not proven fruitful. The countries involved the effect that they will not provide assistance to North in the region, including China, Japan, South Korea, the 166 Korean refugees. Bounties for the identification of either US and the European Union (EU) all share a responsibil- (Thailand, Russia, Vietnam, Cambodia). helping NorthKoreanasylum seekersinthirdcountries port orattemptingtodoso, todifferentorganisations kilometre journey.Theteam alsocarriedongivingsup- arriving inSouthKoreaat theendofthousand psychological assistanceto theNorthKoreandefectors opened aprogrammeaimedatbringingsocialand and thoseofUnitedNationsagencies.MSFFrance visiting severalofficialsofdifferentwesternnations South Korea organised a targeted lobbying campaign, From 27 Februaryto 27 March2003, the MSF team in you for your attention. Korean refugeesandinpromotingtheirprotection.Thank stimulating aninternationaldebateontheissueofNorth that theJapanesegovernmentwillplayaleadingrolein ence forthebenefitofNorthKoreanrefugees.MSFhopes power intheregion,Japanhasadutytoexerciseitsinflu- concern overtheNorthKoreanasylumseekers.Asamajor relief andprotection.TheJapanesesocietyisshowingits tions withChina,whichwouldincludeasecuredspacefor in theregionshouldthereforenegotiatepracticalsolu- humanitarian assistanceisimpossible.Countriesinvolved guarantee theirbasicrights.Inabsenceofprotection, involved toprotectNorthKoreansinsearchofasylumand a clearpoliticalwillfromthecountriesandinstitutions in China.Therefugeecrisiswillonlybesolvedifthereis the endlesssufferingofNorthKoreansseekingrefuge Médecins Sans Frontières expresses its grave concern over very lives. a desperateflighttothirdcountry,attheriskoftheir leaves North Korean refugees no other alternative than refugees andaidworkers,whichhasintensifiedinChina, repression. Thesystematicandorganizeddragneton trates ahumantragedythatwillnotbesolvedthrough necessity toprovidethemassistance.Itgraphicallyillus- North KoreanrefugeepopulationinChinaandtheurgent Koreans ismostrevealing:itunveilsthedistressof The recentfailedasylumbidofthegroup48North What isthe responsibility for thecountries concerned? North Korean refugees insearch of asylum. measurable progressonthequestionofprotection seek asylum with foreign representations have resulted in nor desperateattemptsbyhundredsofNorthKoreansto China’s repeated violation of international conventions North Koreanrefugeesremainsresolutelyignored.Neither Pyongyang’s dictatorshipforaseparatecrisis,thefateof government. Asinternationalattentionisnowturnedto tion ofEUrepresentatives,EuropeanstatesandtheUS conditions ofrefugeeshasalsobeenbroughttotheatten- calls havegoneunanswered.Fieldinformationonthe itarian assistancefortheNorthKoreanrefugees.These authorities to cease forced repatriations and allow humanity inthiscrisis.MSFapproachedrepeatedlytheChinese V7 (Japan, US, UK…) […] lar resolutionsinfrontofvariouscountries’parliaments to gatherenergyfromvariouscountriesbringinsimi - - AtParliamentlevels,itseemsthatafewMPsarewilling North Korean Human Rights abuses. North Korea.EUmemberstatesaltogetherdenouncedthe silence.” Villepin urged the UN Commission to focus on where anentirepopulationissufferinginoblivionand the Commission looks intothe situation in NorthKorea, at theUNHumanRightsCommission:“itishightimethat MoFA [MinistryofForeignAffairs](Villepin)wasveryvocal - AttheFrenchgovernmentlevel,itseemsthat for the first time the TPS option for North Korean refugees - AttheUNHCRlevel,itseemsthattheyareconsidering past few months hasnot been completely in vain: pressure put by various organizations and activists in the bying efforts.However, a fewsignsclearlyshowthatthe It isdifficulttopreciselymeasuretheimpactofourlob- […] Conclusion: where dowegofrom here? gees andput politicians infront of their responsibilities. to bringforwardoncemoretheissueofNorthKoreanrefu- lobbying effortsandusethepre-Iraqiwarwindowtotry ation inChinaontheissue,weresolvetoincreaseour Chinese authorities.Pushedtoextremitiesbythesitu- powerless ininitiatingaconstructivedialoguewiththe confront Chinaontheissue,andUNHCRhasremained ensured. Nostateshavesofartakenuponthemselvesto at ourlevelunlessminimumprotectionfortherefugeesis problem ispoliticalandthattherenotmuchwecando those whoprovidethemassistance.Wereallyfeelthatthe country astheChinesehuntthemandarrestcriminals, ciently assistNorthKoreanrefugeesinflightoftheirown At thispoint,ithasbecomevirtuallyimpossibletoeffi- a drasticrestrictionoftheirspaceassistanceinChina. organisations workingwithNorthKoreahavehadtoface deteriorated overthepastfewmonths,MSFandother As thesituationofNorthKoreanrefugeeshasseverely Rationale and objective Extract: withdrew due to alackofaccesspeople inneedand requests. Active inNorthKoreafrom1995 to1998,MSF Koreans heldbyChinaand toexaminetheirasylum Commissioner forRefugees to demandaccessNorth ers assistingthem.Iturges theUnitedNationsHigh North Koreansandrepression ofhumanitarianaidwork- MSF continuestocondemnChina’s forcedrepatriationof Extract: English). Marine Buissonnière,MSFSouthKorea(in 27 March2003,ReportfromSophieDelaunay, “Lobbying/Korea Mission,” (in English and French). “ MSF International Activity Report 2003,” D175

D176 27 February2003to

167 MSF and North Korea 1995-1998 MSF Speaks Out

no independence to carry out its programs. Nonetheless, To that end, this research explo’s objectives are: MSF continues to assist North Koreans. In 2002, MSF pro- 1. To review and summarise the situation that led to the vided food and medical aid to around 900 people: shelter, MSF withdrawal from DPRK in 1998. clothing and food for those in hiding along the Chinese 2. To make an inventory of the organisations currently border; help with resettlement and medical care for some working inside DPRK and consider the constraints upon who made it to South Korea; medical care upon request their operationality. in China and third countries; and assistance to several 3. To establish a plan to approach the Go [government] families and occasional aid supply in North Korea itself. DPRK for possible in-country explo/ intervention. MSF also collects refugees’ accounts to raise awareness of Recommendations and annexes will follow each objective their situation in the media and with governments, UN taken in turn. […] agencies, and human rights organizations. CHAPTER 3 […] Has operational humanitarian environment in North Korea changed in a meaningful way such that a MSF mission is feasible? MSF Holland carried out a ‘North Korea research Explo’ - The short and simple answer is no. in order to evaluate the feasibility of a new MSF mis- - However, if one is to change the premise of the ques- sion inside North Korea. In October 2003, the MSF tion, the answer may be yes. book “In the Shadows of Just Wars” was published. One of the chapters, written by Fiona Terry, was dedicated Firstly to review why the short and simple answer is no. to the North Korea. It was titled: “North Korea: Feeding Since the departure of MSF in 1998 the Go [government Totalitarianism”. of] DPRK has not permitted freedom of movement, not allowed independent assessments; in the main, has not permitted contact with ordinary North Koreans or beneficiaries (with the exception of ICRC who necessarily meet ”North Korea Research Explo – Report Draft 3 - the people who require prosthetics) and has not permitted July 2003,” Tim Pitt, MSF Holland, July 2003 agencies to evaluate their programmes. From this one can (in English). D177 see that standard humanitarian programmes with measurable humanitarian objectives are not possible. One may Extract: bear in mind at this point that this is especially so for Introduction an organisation like MSF which highly prizes the direct This report has been motivated primarily by an impression contact between patient and doctor, diagnosis and follow gained from the public media prior to October 2002 that up. Nonetheless, agencies that pursue other programmes the leadership in North Korea may have changed or is which structurally or ethically do not necessitate such changing its regard for the outside world. It has also been intimacy with the local populations, while sympathetic recognised within the MSF H Amsterdam HQ while North to MSF concerns, seem to have less of a moral problem Korea remains a significant humanitarian crisis in which with their own work in North Korea. Agricultural reform, one should be at least fully informed if not operationally Food delivery, developmental projects that target infra- active, that a generation had past in the office of those structure are programmes that seem to have a less bumpy who dealt directly with the aborted mission in 1997-1998 road. Indeed, within the Juche ideology, humanitarian and no one had any direct insight into this unusual coun- assistance is difficult to reconcile while developmental try. With both these points in mind, a research explo was assistance is easier to hide from the local population and deemed worthwhile to examine, again, if a MSF mission also propaganda-wise easier to explain. may be feasible inside North Korea. Since the international mission of MSF stopped activities and withdrew And so secondarily, if we are to adjust the premise of the from operations in September 1998, there has been no question, there may be an affirmative answer to the core substantial effort to pursue renewed operations inside question. North Korea. This has been mainly due the lack of respect To find an answer yes, one would need to accept that the by the North Korean regime for standard humanitarian real objective of a programme was outside the normal mea- operating principles. surement of success for a MSF programme. In one sense the required shift may be away from humanitarian objec- The offended principles of humanitarian action which tives, where the MSF doctor would relieve directly the suf- prompted the departure of MSF from North Korea were: fering of a particular group or individual. The recalibrated little or no basic information on health infrastructure and objective would have to be more developmental more. population numbers, zero direct access to beneficiaries and no capacity for benchmarks, monitoring and evalu- What kind of programme? ation. As such, a proper humanitarian mission to answer - Medical equipment distribution morbidity and mortality was not possible. And so the -Training (although packaged in a more ‘orientation’/ question that lies at the heart of this research explo: refresher course fashion) has operational humanitarian environment changed in a One can look upon such a programme pragmatically in the 168 meaningful way such that a MSF mission is feasible? following way. gramme but can Amsterdamidentifyan experienced 2. Human resources: Likely not an expat intensive pro- to keep quiet fortheduration of anew effort? 1. CanMSFHgetFonline? AndCanMSFHgetF learned as well asthe more recentlessons learned … More immediatelyandbearing inmindthe1998lessons “Internal questions” HQ needtobeanswered and all in theaffirmative. Korea. ThenimportantandveryrealquestionsinAmsterdam instructive lessonsforwhatcouldbeasimilareffortinNorth One shouldexploreiftheearlyyearsofeffortinBurmahas Firstly onewillwanttoexaminetheMSFHBurmaexample… How to approach this? testimonials that one currently finds on the web. the currenttonetakenwithMSF’sarticlesofoutrageand may be of greater value and effect for North Koreans than forward onidentifiedproblems.Thiskindoftémoignage years to achieve dialogue and to get answers and to move tunities. However one must recognise that it may take more? Thiskindofengagementmayaffordfurtheroppor- do you do if y and z happen? Should we think about this example: Doesxappeartobeaproblem?Whynot?What Koreans cometounderstandthatthereisanotherway.For is, oncecouldposeSocraticquestionsthathavetheNorth than simplymakingstatementsabouthowbadapractice the formofpolitelybutsharplyphrasedquestions.Rather resentatives, akindoftémoignagecouldtakeplacein 3. Insuchcontacts,andevenincontactwithFDRCrep- afford opportunity toaskmedicalquestions,ofsomesort. necessitate contactamongstmedicalprofessionalsand with theMoPHandsupportedinpartbyWHO,would anecdotal insight,adistributionprogrammeifpartnered have foundunexpectedopportunitiesforconversationsand circumstances. Bearinginmindthatotherorganisations very limited)investigationofthehealthandhumanitarian would atleastgivethepossibilityoffurther(recognisably gramme wouldaffordapresenceinNorthKorea,which 2. Secondly,onecanpragmaticallynotethatsuchapro- with medical staff is required. for theNorthKoreans.Furtherconsiderationofthispoint comfortable for MSF. This could be a deal-breaking point bution inNorthKoreawouldbeveryloworderto Likely thelevelofsophisticationmaterialfordistri- competence of the people who would utilise the material. was knownaboutthehealthsystemandlevelof admittedly thesewereinlocationswheremoreofcourse are precedentsforthiskindofprogrammeinMSFthough not beabletofollowtheitemsinimplementation. There the poorqualityofmedicaleducationandthatMSFwould would haveminimalopportunityformisapplicationgiven would havetodesignadistributionlistofitemsthat treatment oftheirpatients.InsuchaprogrammeMSF would arguethatallthemedicalstaffarecorruptintheir Not eventheharshestcriticsofNorthKoreanregime system providesomebenefitfortheNorthKoreanpeople. actually helpanunder-resourcedandantiquatedhealth 1. Firstlymaterialfromadistributionprogrammemay may be over doingit… Pyongyang getsthesamemessagetwice)althoughthis meet officials(2embassiesbythesamepeoplesothat embassies inEuropetoexpressformallyourdesire in NorthKoreaonourbehalf.Possiblytoapproach2NK simultaneously circulaterumoursthroughConcernorSCF who wouldspeakinformallyonourbehalf.Possiblyto to approachtheUNSpecialEnvoyinNewYorkorGeneva specifically how to avoid the FDRC as a counter part. Then achieve theMinistryofPublicHealthasacounterpart; gramme andmostimportantlytogaininsightonhow to discusstheirimpressionsandreactionsuchapro- Then approachWHO/OCHArepofPyonyangandGeneva - WouldtheUnitedNationsbeinterestedtosupportMSF? discuss “programmes.” programme, stimulatethegovttoinviteusmeetand if asadonorwouldbeinterestedtofunddistribution port MSF?ToapproachECHO,ideallyPaulFiller. Sort out - Wouldthemostimportantdonorbeinterestedtosup “External questions” forward!! these is not feasible, then the effort should not move !! Eachoftheseisakillerpre-condition.Ifanyone before judgement on success or failure? 3. Amsterdam:CanAmsterdamallowalong-termtimeline good negotiation skills? average MSFage who hasasharppoliticalantenna and medical line manager, preferably someone well above the responded tothe crisis,butreachedthelimits ofhumani- ness between 1995 and1998alone.Aid organisations of theircompatriotsdiedfrom starvationandrelatedill- Korean refugeesinChinasuggest thatuptothreemillion erbated thesufferingof NorthKoreanpeople. can belabelled.Overthelast decade,faminehasexac- which anyactofdefianceor disrespect,howeversmall, North Korea’sgulagforhavingcommitteda‘statecrime’, and 200,000peoplearebelievedtobelanguishingin Kim IlSungandhisson,Jong-il.Between 150,000 grotesque personality cult of its dead yet eternal leader, the mostbasicfreedomsinacountrycontrolledby world’s most deprived and oppressed peoples, lacking even the lastbastionofStalinismonplanet,areamong the ‘imperialistaggressors’.ThecitizensofNorthKorea, 1.1 millionstrongarmypermanentlymobilisedagainst reunify thePeninsulabyforce,andNorthKoreakeepsits are stationedinSouthKoreatodeteranynewattempt last ColdWarconfrontation.Some37,000Americantroops (1950-53), the Korean Peninsula remains the site of the Half acenturysinceanarmisticeendedtheKoreanWar Extract: October 2003(in English). Weissman, MSF–C.Hurst&CoPublishersLtd, Shadows ofJustWars,”editedbyFabrice Totalitarianism,” byFionaTerryin“Inthe Chapter II–1“ North Korea:Feeding D178

169 MSF and North Korea 1995-1998 MSF Speaks Out

tarian action in this totalitarian state. North Koreans trip at the same time, which faced obstruction and inflex- continue to suffer and to die in spite of the largest food ibility, it remains to be seen what the reality will be dur- aid program in the UN’s history. ing the assessment. It is possible that: -DPRK officials are always ‘nice’ on the first visit, and become nasty as soon as you have your small toe inside the door. -The theory about the influence of liaison officers is cor- From 18 to 22 May 2004, Michiel Hofman and Dick Van rect, and we were just lucky with ‘our’ minder. der Tak, from MSF Holland, visited DPRK. The invita- -There is some hidden reason why they are particularly tion had been negotiated through the DPRK embassy eager for MSF to re-engage with DPRK, so we get more in Bern, Switzerland. The objective of the visit was leeway. to negotiate a further MSF medical assessment in the country. The conditions for this visit were discussed In spite of doubts if our experiences with access to patients with all the people interested in the issue within the and flexibility of choosing your own areas of intervention MSF movement. is a real indication of change, there is enough secondary evidence of other actors (WFP, SCF-UK, ECHO, Merlin) that some sort of ‘Glasnost’ has occurred in the past year with regard to humanitarian assistance, allowing more freedom ‘Trip report - Democratic People’s Republic of of movement, access to beneficiaries and choice of inter- Korea,’ Michiel Hofman, Dick Van der Tak, 18 – vention areas to justify an MSF assessment mission. This 22 May 2004 (in English). D179 mission needs to have a certain level of ‘give and take’ to make it work, without loosing sight of the minimal condi- Extract: tions for MSF to work – hence the suggestion to assess one Objectives of the visit of the Government suggested provinces balanced with two The main purpose of the visit was to negotiate terms proposed by MSF – and this logic needs to extend to the & conditions for an MSF medical assessment In North micro-level during the actual assessment as well. Korea. Before the trip a brainstorm session was held in Amsterdam with all interested parties inside MSF, including desks for North Korea programmes from Paris (Gaelle) and the Previous Head of Mission for the North Korea Comments on the Trip Report by Marine programme (Marine) to determine what the ‘bottom line’ Buissonnière, MSF International General was for MSF on conditions for this explo: Secretary, July 2004 (in English). D180 Non-negotiable: •The definition of a (possible) programme is based on the Extract: needs assessment; Comments on the conclusions: •Access to patients and expats involved in diagnosis & I believe that an additional explanation to the apparent treatment; flexibility of DPRK counterparts may come from the fact •We will listen to Govt. recommendations for areas of that MSF did not ask anything outrageous, only asking to intervention, but will also make our own suggestions; go to areas/hospitals where they had no problems for us •We will not bring a major donation – we work needs to go – and where we had worked in the past. DPRK offi- based only cials are ‘nice’ as you say, but they have constraints and •We choose the composition of the explo team. a very clear understanding of where one should go or not Highly beneficial: go, ask or should not ask. So I guess it is premature at this •Bring our own translator; stage to come to the conclusion that we have demonstrat- •Changes in itinerary possible; ed our ability to reach the places where the most vulner- •Horizontal or vertical programmes; able are – but it is certainly worth trying! In that spirit, I •Cross borders in North Korea; perfectly understand that any explo would be a give and •MoH involvement; take process, but I also would like to re-emphasise that The invitation to visit DPRK for discussions with the Ministry we should put all the chances on our side and that in this of Health and FDRC were negotiated through the official context the importance of choices of geographic location, channels of the DPRK Embassy in Bern, who also holds the nature of institutions accessed, and presence of MSF’s own diplomatic representation to the Netherlands. Medical dona- Korean translators would be central. If I am convinced tions of any kind were not part of this visit. […] that it is worth giving it a try, I am also convinced that for North Korea more than any other place, the challenge Conclusions is not to go back in per se, but what you can do once you A clear effort was made during this visit to appear as are there, where it is so easy to be manipulated into car- ‘flexible’ as possible – allowing changes in the pre-set ing for those that the system considers worthy, and not programme, allowing pick-and-choose drop-ins in the for those who need it the most. patients wards. As this experience was not echoed by the 170 other two organisations that were making an assessment don’t know whatit is. I’mclueless; I have no idea. something wrong since they slammed the door again. But I ary. So,Idon’tunderstand.Stillthinkwemusthavedone let us lookaround; they accepted the changes in our itiner- American spies,etc.Itdidn’thappenatall,asIsaid.They North Koreansystem,andhowtheserubbishNGOsareall to bebulliedabitandlecturedaboutthesuperiorityof have tosaythevisitwasquitenice.Youbeprepared why theyinvitedusback.Theydidn’tinvitefortea.AndI visit. Inmysimplethinking,theremusthavebeenareason was veryclear,clearlycommunicated.Stilltheyacceptedthe it asanorganisation, our viewshavenotchanged.’That movement, thisiswhatwedidandyou’llhavetodealwith the positionin1998.Theanswerwas:‘no,weareone that itshouldbeMSFHwhohaddistancedthemselvesfrom assessment, theexitin1998cameup.Therewasarequest know verywellMSF’sposition.Inthenegotiationsbefore To behonest,Idon’tknowwhywewereinvitedback.They also assess the working conditions in North Korea. on thegroundtomakeaproperassessmentofneedand exploratory missionsothatwecouldputpeopleforlonger objective whattonegotiateatwo-threemonthslonger to thinkthatwecouldimmediatelystartaproject.Sothe considering everything,itwouldhavebeenoverlyambitious Korea itisimpossibletodoanythingmeaningful.Andalso, atory mission.Itwasveryclearthatin4-5daysNorth back. Thesecondobjectivewastonegotiatealongerexplor- borders. Wehadnoclueonwhattoexpectwhencoming shake handsandfirstofallmendfences, and alsotest the cumstances. Tokeepitsimple,ourfirstobjective was to options forMSFtogobackandworkunderacceptablecir- ferent people,differentopportunitiestolookintothe people changed,timepassedon.Thentherewouldbedif- North Korea?”Peoplekeptawarethattherewereneeds, wrong. Butconversationscontinuedtosimmer:‘whatabout speaking, therewasnofeelingofhavingtomendwhat impossible tocontinueunderthosecircumstances.Generally buttons willstart beeping, the machinesstartsmoking! Marine’s nameisputinacomputer inNorthKoreaallred ment team.I’mnotsuretheyputMarineandmaybeif Rowan [Gillies,MSFInternationalPresident]intheassess - [Buissonnière] MSFInternationalGeneralSecretary]or movement andoneoftheproposalswastoputeitherMarine Etc.’ Sotheproposalwasalsodiscussedininternational right? WhatconditionsMSFHollandiswillingtoaccept? was particularconcernsespeciallyinParisabout,‘isthetime everybody agreedtoMSFgoingbackNorthKorea.There Basically theconclusionisthatnobodyhasaclue.Not January 1999 toMay2000;MSF Holland HADadviser, Dick van der Tak,Coordinator MSF Holland in China, July 2000 toJune2003;MSF Hong KongExecutive Everybody understood and accepted that it was decision to leave North Korea the wrong decision?’ In Amsterdam,therewasnodebatelike:‘the Director from 2003on(in english). Extract: by thecentralgovernment.It’sdifficultformetoimagineit. is somethingthatinmyopinionnotabouttobeaccepted involving directinterventionwiththepopulationsconcerned, human level, which Biberson wished to see in the mid-1990s, with minimalcontrol.Itisclearthatanapproachatthe ties; intheenditistoobtainresources,largevolumesofaid situation. WeknowwhatintereststheNorthKoreanauthori- I amnotsurprised.MédecinsduMondewasinthesame best ofmyknowledge,therewerenofurtherdevelopments. tional office]ifithadbeenpossibletogoback.Butthe [at thetimeMarinewasGeneralSecretaryofMSF’sinterna- international approach, since I was on the list to go there toring mission, which should really be the subject of an dispute anditwasamatterofsendinganexploratorymoni- MSF’s internationaloffice.Later,thatbecameapointof tour overthere.Innowayatallweretheymandatedby then handed over tolocalauthorities. the provisionofpsychological assistancetorefugeeswas years of theMSFmental health project.Responsibility for discuss therapeuticapproaches tocareandreviewthethree collaboration withtheUniversity ofPsychiatry,Seoul,to health professionalsattended aconferencemountedin they leavethetransitcentre.InApril2006,150mental logical supportforNorthKoreansbothwithinandafter South Koreanauthoritiestoprovidemuch-neededpsycho - bying by MSF, positive measures have been undertaken by MSF psychologicalsupportin2005.Followingstronglob - cope withsymptomsoftrauma-over200patientsreceived mental healthcareactivitiesinHanawontohelprefugees months uponarrivalinthecountry.MSFhasdeveloped where NorthKoreanrefugeesareplacedfortheirfirstthree present inthetransitgovernmentalcentreofHanawon, Korea. InSeoul,MSFhasbeentheonlyforeignorganisation Korean refugees through projects operating out of South need itmost.In2005/2006,MSFprovidedcaretoNorth assistance directlyinsidethecountryandreachthosethat sible toprovideindependentandimpartialhumanitarian The presentconditions in North Korea make it impos- South Korea. In January 2006, MSF France closed its programme in sentation inSwitzerlandtoobtainvisasanddoa cial. IbelievetheywenttotheNorthKoreanrepre- The visitbyMSFHollandin2004wasentirelyoffi- (in English - inFrench). ‘ MSF InternationalActivityReport2006,’ Marine Buissonnière, Secretary General of MSF International, 2004 to2007(inFrench). D181

171 MSF and North Korea 1995-1998 MSF Speaks Out

We could tell ourselves stories, but the real periods In March 2007, Marine Buissonnière and Jean-Fabrice of famine and death in North Korea, which were Pietri, ex-ACF responsible for North Korea carried linked with the lack of food distribution to certain out an exploratory mission in Far East Asia for MSF groups, were the years from 1995 to 1998. Later, North Switzerland and looked into the possibilities of devel- Korea was the country receiving the largest quantities of oping cross-border assistance operations inside North food in the world. We were no longer faced with the human- Korea and/or to North Korean refugees. itarian dilemma of an organisation trying to provide aid. It was no longer the same thing. The North Korean system had protected itself; it had succeeded in breaking up the escape networks that had been established – the whole system ‘North Korea: Can we help ?’ article by Marine around the embassies, and so on. We may look critically at Buissonnière, published in TAG, Internal the way MSF may have played a part in that, and perhaps Journal of MSF Switzerland, August 2007 (in also allowed networks to be identified without realising it. French). D182 We must simply agree to tell ourselves that things change. In this case, it was up to a human rights organisation to go Extract: and try to gather personal testimonies. But it was no longer Mr Lee is aged 45, but he could easily be taken for 15 a question of providing assistance. Otherwise, we choose to years older. We met him in a large city in northeastern help to reconstruct the system. But there are already NGOs China, where he had been living in hiding for several over there, funded by the European Union, who are trying years. Despite the daily risk of being reported and arrested to bring about an increase in local production by the Chinese police or North Korean agents, he could not bring himself to leave the border zone. He had left Pierre Salignon, MSF France programme manager, his daughter in North Korea, and if he attempted the from October 1997 on, then MSF France Executive dangerous journey to a third country, he would have to Director from January 2004 on resign himself to abandoning her forever. He was a war orphan, a former bodyguard of Kim Il Sung, and fled his country after opposing the central government with violence in summer 1996 – that bloody summer when he had had to bury a third of the citizens in the village My cause for regret is the poor way in which we for which he was responsible. And while the signs of the integrated this mission into MSF’s wider structure. famine in 2007 may seem to recall those of 1996, Mr Lee The fact that Marine and I had personal responsibil- underlines a fundamental difference: the survivors know ity for this project, and that we were personally supported first-hand the horror of famine, and are not prepared to by Pierre [Salignon, programme manager, then Executive re-live it. Discontent appears to be increasing in Korea’s Director] and Jean-Hervé [Bradol, President] enabled us to northern provinces, where the prospect of new periods of move very fast, without being held back. But in another food-shortages, combined with outbreaks of measles and respect this had a rather harmful effect on communication cholera, is driving those living near the border to make around the project. It coloured the way the team leading it desperate pleas for help. Appeals for food aid are increas- was perceived, and affected opportunities for the French ing on the part of North Koreans who have come to beg section, and for the MSF movement to take ownership of it. illegally in China for the aid they will never receive from The situation was complicated because we could not say in the central government, which long since chose to sacri- public that we were working with refugees – we had to be fice them for the survival of the regime of Kim Jong Il. careful about informers. But internally, inside MSF, we should certainly have shown greater skill in persuading the There are dozens of Mr Lees hiding in China, often with operations department to “own” the mission, so that it did the assistance of clandestine aid networks, mainly of a not remain exclusively Pierre and Jean-Hervé’s baby. They religious nature, who try, with their slender resources, to gave us carte blanche, but after other volunteers had taken offer them food and shelter. Some have come to look for over, they did not support them as much as they had sup- a means of subsistence and have not wished, or not been ported us. Other sections were also annoyed. We must have able, to return. Others have fled imprisonment, or even a looked like a pair of conspirators. We should have held brief- death sentence. Unscrupulous brokers, providing brides ing meetings, suggested “Korea days,” and published arti- in rural areas and supplying the sex industry, have sold cles. It is for those reasons that I ceased work in 2003; women at the border. Children are born of these unions, because I said to myself that if we wanted to give this ‘bastards’, with Chinese fathers and North Korean mothers, project a chance, it was time to go, and to let somebody but nobody takes care of them once their mothers have else take over. been forcibly sent back to Korea. The number of North Koreans in China is currently estimated at 400,000, half of Sophie Delaunay, Research officer, Foundation MSF them in the border zone. China considers them illegal eco- France, June to August 1998; Coordinator, MSF France in nomic migrants, and during the run-up to the Olympics, China, January 1999 to December 2001; is constantly arresting them and those who assist them, co-Coordinator, MSF France in South Korea, and sending them back to the North, where for a few 172 January 2002 to October 2003. months they will join the 1.2 million people held in the a regime’sbenefit. Butatthesametime,rarely couldthe room forhumanitarian action,orgreatermanipulation to rarely had there been a situation in which there was less and theimpossibilityofmeasuring theimpactofaid; total controlordeceptionover accesstobeneficiaries, vulnerable, thelackoftransparency indistribution,the the impossibilityofmeasuring needsortargetingthemost Given theextremebiasinselectionofbeneficiaries, helping topropuptheregimethatwasoppressingthem. help was not reaching the most vulnerable, but that it was MSF leftNorthKoreain1998,convincednotonlythatits trying to develop an appropriate programme of assistance, among NorthKoreanrefugees,andafterthreeyearsspent Armed withtheresultsofdetailedresearchcarriedout prices by the wivesof officials. international aidre-soldontheblackmarketatexorbitant the resthavetobecontentwithfakes,orscrapsof are reservedexclusivelyfortheprivilegedclass,while health servicesworksonthesameprinciples;medicines the restofpopulationonnationalholidays.Accessto effort, andfinallyamiserableamountwasdistributedto priority, then supplies were stored tosupport the war party cadres, the army, workers in key industries) received had alwaysprevailed:loyalelements(centralauthorities, ment andwerenaturallydistributedonthepatternthat onwards were channelled through the central govern- Korea bytheinternationalcommunityfrommid-1990s The tonnesoffoodandmedicinessuppliedtoNorth sufficient convictionoverthedeathofKimIl-Sung! tors werelandowners,orwhosemotherdidnotweepwith of subsistenceforhimself.Acurseonanyonewhoseances- convict minerinthenortheast,andtofindingmeans “hostile” class (27%), willbecondemnedtothe life ofa children touniversity.Anyoneelse,whobelongsthe the systemofpublicfooddistribution,andsendingtheir can dreamoflivinginPyongyang,beinggivenpriority belong totheclassof‘faithful’(11%population) system, alsodeterminestherighttoassistance.Thosewho the organisationofregime,basedonanOrwellianclass gramme insidethecountrywillbeinconceivable.Infact, criteria of social usefulness and political loyalty, any pro- ment, whichchoosesthe‘beneficiaries’ofaidaccordingto tional assistanceintheDPRKischannelledbygovern- it? Formypart,itseemstomeaslongofficialinterna- country andamongthosewhohavesucceededinescaping health andnutritionalneedsareenormous,bothinside be giventothissufferingpeople,whosemedical,public So thequestionforMSFis,whatappropriatehelpcan a wholefamily waiting to followhim. every refugee whosucceedsat the riskofhis life, thereis is morewidelyavailablethaneverinNorthKorea,andfor to crosstheborder.Informationaboutwaysofgettingout dogs byborderpatrols,andsoon),therefugeescontinue checks, rapidrotationofofficialsonguard-duty,use ing (encouragementandrewardsforinforming,intensified measures ChinaandNorthKoreataketostopthemescap- North Koreanprisonsystem.Nevertheless,nomatterwhat been more clearly visible. and forwhomdailylifeisanunremittingstruggle–have tions ofterrorthatonlythestrongestmanagetosurvive, needs ofthemajorityNorthKoreans–livingincondi- that in the endresourceswillreach the most vulnerable. on “fungibility”:themoreaidthereis,likelyitis Others (liketheUN,foralongtime)haveputtheirmoney an adequatespaceinwhichtoworkinsidethecountry. ing thatitwillbepossibleforthemgraduallytoopenup and politicalloyalty.Somehavemadethatchoice,believ- Korean governmenthasselectedfortheirsocialusefulness oriented towardssectionsofthepopulationthatNorth via thecentralgovernment,andtodevelopaidoperations sible forhumanitarianorganisationstobuytheirwayin soon floodNorthKoreawithfoodstuffs.Itisthusstillpos- Korean superiority by the western powers, which would Kim JongIlwascrowingoveracknowledgementofNorth international community.Asearlyasmid-March2007, fears, toextractdonationsoffoodandenergyfromthe the bogeyman of the nuclear threat, and by renewing its is trying–andwillcertainlysucceedonceagaintouse cussions oftestingitsnuclearmissiles,thegovernment Recently forcedintoacornerbysanctionsandthereper- tem, theirranksclosedaroundKimJongIlinPyongyang. tional supportofthe‘faithful’whobenefitfromsys- changed. Theregimeisstillproppedupbytheuncondi- analysis ofthesituationhasnot,inmyview,fundamentally just made to northeast Asia (Korea, Japan and China), our After someyears,followingtheexploratoryvisitwehave clandestinely. It isthereforeacomplex operation, and without which MSF cannot gain access to people living area, alsorequiresthebuilding ofmutualconfidence, works, whicharethemeans ofentryintothisthorny responsive. Workinginclose collaborationwiththenet- choice of operations that are discreet, flexible and highly long-term investment,anda clear-mindedandreasoned Such operations,aimedatpeopleinNorthKorea,require ing these people, and who need medical support from MSF. close collaborationwithlocalaidnetworkswhoareassist - escaping theregime.Suchworkcanbeenvisagedonlyin South-East Asia,servingpeoplewhohavesucceededin shelter) andofmedicalaidinChinathecountries -To envisage setting up a programme of first aid (food and could arise if thesituation deteriorated. it should be in a position to seize the opportunities that should followcloselyhowthefoodsituationdevelops,and in border provinces. In the coming critical months MSF options existforbringingassistancefromChinatovillages right tofamilyvisitsbyethnicallyChineseKoreans,real Chinese businessmentradingwiththeNorth,and cross-border aidtoprovincesonthefrontier).With Korea thatwouldby-passthecentralgovernment(e.g., -To exploretheopportunitiesforassistanceinsideNorth responsibility) for anorganisation like ours: remains, then,thepossibility(andtomymind, me tomeetthecriteriaforproperlyimpartialaid.There From MSF’sperspective,thatoptiondoesnotseemto 173 MSF and North Korea 1995-1998 MSF Speaks Out

an unorthodox one for an organisation like ours. But at a time when it is difficult to fit a regime like that of North Korea into our standard typology of crises, it seems more With hindsight, I believe that MSF’s speaking out in important than ever to remain involved and to try to bring 1998 was justified and pertinent. My conscience assistance to the victims of a totalitarian system whose would have been less clear had we done nothing, ferocity passes all understanding. It is right that MSF is rather than take this position, which was a courageous one. remaining in Iraq, continuing its efforts in Chechnya and We paid a high price for it in humanitarian circles, above all taking a renewed interest in Afghanistan. Is it not also in our subsequent inability to provide assistance to North time for us to concern ourselves again, in the Far East, Koreans at the very time when we were certain that they with the fate of the most vulnerable sections of the popu- needed it. This was the hardest thing for me, and I still lation living under the implacable regime of Kim Jong Il? don’t have the solution. Later, we did in fact provide assistance to several hundred North Korean refugees, but the problem is still there today, and it requires a quite dispro- portionate expenditure of energy to reach these people and to support them in the way they need. I regret the fact that One element of this exploratory mission – I was we did not find a second route, an operational alternative, genuinely open-minded towards it – was to try to and that we did not go further forward in the direction in understand whether or not there was a space that which we started, an initiative involving networks that had we could occupy inside the country, and whether that had to be innovative. I see the problem of North Korea as being changed. After my visit in April 2007, I take a position very similar to that of Chechnya. In terms of North Korea, similar to that of the mid and late 1990s. Today we are we should have made greater efforts to identify local actors facing a regime that relies on a class system, combined with on whom we could have relied. We did not succeed in North terror, a system of repression and informing on others. In Korea because the only local actors were Chinese, and in contrast with those opened up by China in the 1980s, under China nobody would have taken the risk of going against Deng Xiaoping, the special economic zones that this regime party policy, it was too great a risk. is beginning to establish are completely closed and controlled, and serve only to generate income; their sole aim is We knew that our operational impact was limited and that to reopen [the flow of dollars] to a country whose national it could come to an end overnight. When you are working economy is at rock bottom. Kim Jong-Il, surrounded by a clandestinely, you cannot take the risk of putting people clique of generals and leaders of the army and the Korean or organisations in danger. We were extremely careful, and Workers’ Party who manage to live by operating in “mafias,” we were ready to take the decision to close a shelter at cannot, in my opinion, allow himself to slacken his grip and very short notice. We wanted to maintain a link with these open up any further, or he risks losing power. I have no people, to be an observation post, to continue to monitor faith that the situation will gradually evolve. The few people what was happening inside the country, so that we could who know North Korea well, such as Jasper Becker and oth- react, document, continue to speak about it. That is what ers, have come to the same conclusion: even if currently distressed me, seeing that the networks were not being kept there is dissatisfaction inside the country, especially in the alive. We were working on a ridiculously small operational northern provinces, the system’s ability to resist [change] scale in comparison with what MSF is doing today [in other and its behaviour are such that the key is the army, and as programmes]: 100,000, euros which is nothing. At the same long as the army lives by the system, nothing will change. time, it demanded a tremendous expenditure of energy on our part, but at least we had constant information about Marine Buissonnière, MSF Switzerland events inside the country. I am very pleased that MSF exploratory mission around North Korea, Switzerland wishes to carry on the work. It’s like Chechnya, March-April 2007 (in French) interviewed in 2007. or Afghanistan; you have to preserve contact. You don’t have to bring out the big guns or set up a huge programme, you can just keep watch.

Sophie Delaunay, Research officer, Foundation MSF I was always very supportive of MSF France‘s activi- France, June to August 1998; Coordinator, ties in relation to North Korea, because it’s some- MSF France in China, January 1999 to December 2001; thing that MSF could do. And I think that maybe co-Coordinator, MSF France in South Korea, January 2002 someday the regime in North Korea will have collapsed and to October 2003 interviewed in 2007. we will have to answer questions: ‘what did MSF do for the North Korean people?’ And we need to have answers to these questions and be able to say that at least we tried.

Dik van ver Tak, Coordinator MSF Holland in China, January 1999 to May 2000; MSF Holland HAD adviser, July 2000 to June 2003; MSF Hong Kong Executive 174 Director from 2003 on interviewed in 2007. MSF and North Korea 1995-1998 MSF and North Korea

CHRONOLOGY OF EVENTS 1995-1998

The main purpose of this chronology is to help the reader by reconstructing MSF’s actions and public statements in regional and international news reports of the period. It is intended as a tool for this specific document, and not as an academic reference.

175 MSF Speaks Out

International North Korea MSF

1905 Japan takes over Korea.

1945 Japan’s defeat – Korean peninsula split in two by the 38th parallel. Soviet administration and troops to the North and the US to the South.

1948 2 separate Korean governments are established: the pro-Soviet North (Kim Il Sung as Prime Minister) and the pro-USA South.

1950 June Southern invasion by northern troops claiming to reunify Korea.

1950 Korean war: North backed by USSR and 1953 China, South backed by UN forces (mostly US).

1953 27 July 1953 Ceasefire in Panmunjon: no armistice.

1972 Kim Il Sung President of the Democratic People’s Republic of Korea (and Secretary General of the Labor Party).

1990 Early 1990 End of Soviet aid to North Korea leads to energy shortages, lack of hard currency- producing industries, and mechanised farming ground to a halt. Military budget maintained.

1992 Beginning of food shortages.

1994 7 July Death of Kim Il Sung – his son Kim Jong Il becomes the new leader. 22 July USA and North Korea agree to resume talks

21 November North Korea announces a freeze on its nuclear reactor program.

1995 23 April North Korea threatens to reactivate its nuclear program.

13 June USA and North Korea agree on deal for nuclear reactors. SK will provide 2 nuclear reactors to North Korea. 176 International North Korea MSF

28 August

Extensive floods in North Korea; 1995-1998 MSF and North Korea government appeals for international aid.

4 - 9 September MSF exploratory mission in North Korea.

3 October Press release by MSF Belgium, France/Holland: “MSF responds to North Korean government appeal for international aid.”

5 October MSF operational sections meeting to organise international intervention operations in North Korea.

21 November AFP “North Korea Devastated by Floods, Humanitarians Group Reports” (MSF quote).

11 December WFP director says North Korea faces danger of famine.

Late December End of agreed MSF 3 month programme in North Korea. New programme negotiations with the government begin.

1996 4 January January South Korean President Kim Young Sam No agreement between MSF and reports concerns over a possible famine North Korean government on a nutri- in North Korea. tional survey. MOU not extended.

8 February North Korea tells foreign relief agencies not to organize new appeals for flood victims.

Late February - Last MSF expatriate leaves North Korea. - MSF coordinator to the press: “we can’t yet talk about a famine but the situation is potentially serious and must be taken into consideration.”

April DPRK representative in Paris (M. Kim) invites MSF to visit North Korea again. 177 MSF Speaks Out

International North Korea MSF

1996 16 April Clinton’s visit to South Korea – He proposes four-party talks for a permanent peace agreement replacing the 1953 armistice. 20 April - 22 May MSF International exploratory mission in North Korea.

15 May US and Japan rule out sending food aid to North Korea. 17 May MSF HQs declines the explo team’s suggestion to implement a programme in DPRK with no expats.

29 May IFRC appeal on famine in North Korea

31 May MSF France Board discussion on North Korea: some members opposed to “collaboration with a totalitarian regime.”

11 June Japan and South Korea pledge aid to North Korea.

Late July Storms and floods in North Korea; authorities report starvation

25 August US Congressman visiting North Korea says it is in desperate need of food and asks USA for more aid. 11 September MSF named laureate of the Seoul Peace Prize.

30 September North Korea and American-led consortium agree to the elimination of North Korean nuclear arms program and the construction of 2 new reactors.

In 1996 Kim Jong Il publicly declares that only 30% of the population is needed to survive in order to reconstruct a victorious society. 178 International North Korea MSF

1997 26 January

Signs of a thaw between North Korea 1995-1998 MSF and North Korea and South Korea; preliminary talks on formal end to Korean war.

3 February North Korea says floods have cut grain supply in half.

23 February US Secretary of State Madeleine Albright visits American front-line near demilitarized zone (DMZ), which separates the two, and declares peace is dependent on North Korea. 25 February - 8 March MSF barley seeds delivery programme.

4 - 26 March ECHO visit to North Korea; small scale nutritional assessment reveals seriousness of nutritional situation.

29 March North Korea officially requests food aid from SK and USA.

8 April North Korea makes deal to buy US wheat. 20 April MSF proposal to North Korean representative in France to send a medical team to assess medical and nutritional aid needs.

8 May Japanese officials say USA and South Korea will not give substantial food aid to North Korea unless it agrees to join peace talks.

12 May South Korean Red Cross announces ship- ping of 15,000 thousand tonnes of food to North Korea. 14 May North Korean representative in Paris tells MSF that North Korean government doesn’t want any more assessments but wants concrete aid.

179 MSF Speaks Out

International North Korea MSF

1997 24 May - 4 June MSF exploratory mission in Ichon, Unpa, Pakchon, Huichon and Pyongyang maternities.

5 June Start of a one month programme: Unpa, Pakchon and Huichon counties with MSFF as the lead programme manager.

18 June North Korean Ministry of Armed Forces spokesperson says that Pyong Yang is ready for the final battle against the USA and South Korea.

June MSF France food unit visits NK to assess the barley crops.

1 July North Korea agrees to hold talks with SK, USA, and China to negotiate peace.

3 July MSF signs an MOU with the government of North Korea valid for 1 year: large- scale nutritional rehabilitation, drug and medical equipment distribution, and training in South Pyongyang, North Hwangae, Kangwon.

15 July USA agrees to donate $27 million worth of surplus grain to help North Korea cope with food shortages.

5 August Relief teams say North Korea faces vast drought emergency.

6 August North Korea joins talks with South Korea, USA, and China to formally end war and ease tensions in Korean peninsula.

8 August NYT Editorial says USA should take lead in famine relief efforts for North Korea.

9 August UN says 80,000 children are dying in North Korea.

180 International North Korea MSF

1997 14 August

US congressmen visit to North Korea: 1995-1998 MSF and North Korea - say some food aid diverted to military, - will seek measures to ensure future US food aid goes to hungry people, - agree on more food aid.

20 August Western nations give North Korea two nuclear reactors. North Korea gives up older reactors that could be used to make nuclear arms.

15 September World Vision reports North Korean famine may be killing 15% in towns.

3 October - 11 November William Claus (programme manager MSFB) visit to DPRK.

9 October Kim Jong Il new Secretary of Peoples’ Labour Party.

Late October-Early November Intersectional debates on geographical extension and possible external communication.

22 October Decision of explo mission in North Hamyong to extend the programme under MSF B (with FDRC agreement) but MSF F/H disagree.

24 November Extension officially authorised: 59 counties, 12 expatriates.

November MSF team discovers socially disabled children.

Late November Early December Eric Goemaere, MSF B Executive Director, visits North Korea.

7 December Press conference with Eric Goemaere in Hong Kong – press release : ”The Health System in North Korea has Collapsed - Help is Needed Urgently but Needs Careful Distribution and Training of Staff.” 181 MSF Speaks Out

International North Korea MSF

1997 9 December Press conference with Eric Goemaere in Brussels.

December MSFF China team starts receiving information on the North Korean refugees on China-North Korea border.

1998 7 January January WFP appeals for $378 million to feed Argument within MSF about an article nearly a third of North Korea’s people. on North Korea in MSF France internal newspaper.

31 January MSF France Board advises an evaluation of programmes in North Korea.

5 February February USA announces $75 million food aid to Letter from Tony Hall, US Congressman 1/3 of North Korean population. to MSF asking for support of his campaign to increase US food aid to North Korea.

February February First massive arrivals of North Korean MSF programme starts in North refugees on the North Korea/China bor- Hamyong province. der. Korean Buddhist Sharing Movement publishes North Korean refugees accounts reporting a large- scale famine in North Korea.

11 February MSF Hong Kong suggests an assessment on the China/North Korea border and in North Korean hospitals where MSF is working.

3 March North Korean officials say food stocks will run out by mid-March and risks of famine.

8 March Start of MSF/DPRK negotiations on possible activities after end of current MOU.

10 - 20 March MSFF’s Pierre Salignon, programme manager and Philippe Biberson, President visit North Korea. They announce to DPRK that MSF will not continue working under the current 182 conditions. International North Korea MSF

1998 Last two weeks March

MSF China team collects testimonies 1995-1998 MSF and North Korea from refugees on the China/North Korean border – report transmitted to press correspondent in Beijing.

Late March Pim de Graaf, MSF Holland Director of Operations visits North Korea.

Late March Draft of external communication plan on North Korea by MSF B and MSF International - finally abandoned.

1 April ‘North Korea, a Manipulated Famine’ in Libération quotes Philippe Biberson, MSF F President.

8 April Refugees’ accounts transmitted to MSF F programme manager, then to MSF B&H programme managers.

9 April Programme managers decision to stop distribution and to renegotiate programmes and freezing of refugee accounts circulation.

9 April MSF Belgium Executive Director’s letter to DPRK: “this news is not produced by any official MSF press release.”

11 April Refugee’s accounts published with MSF quote in South China Morning Post (Beijing), Le Figaro (Paris), cannibalism mentioned.

13 April New York Times MSF statement on North Korea is more dire than WFP.

23 April US NGOs ask MSF for more coordination on North Korea and blame its statements.

24 April FDRC letter to MSF disagrees with MSF statements.

183 MSF Speaks Out

International North Korea MSF

1998 24 April MSF China coordinator report to MSF F Board. Decision “MSF stays and speaks out.”

29 April Programme managers decision that MSF must stay, support the team, and follow up the issues raised by refugee Late April accounts. North Korea principle agreement on WFP, UNICEF, and ECHO nutritional assessment.

May - MSF B&F directors visit donors (EU) - François Jean (MSF France Foundation) starts research on food aid to North Korea

16 May MSF F President gives detailed annual report to the annual general meeting on 19 May North Korea. WFP director announces aid to North Korea will stop if there is no access to the entire country.

29 May MSF F Board discusses North Korean strategy to be applied.

9 June MSFF Foundation conference on North 14 June Korea. WFP and FAO say that food situation in North Korea remains precarious and that authorities don’t distribute food aid. Mid-June: Médecins du Monde MOU not renewed – MDM leaves North Korea.

23 June Seoul seizes suspected submarine from North Korea.

Early July William Claus drafts proposal to DPRK for working in a smaller area with closer 184 cooperation. International North Korea MSF

1998 In July

MSF team discovers “27/9” status 1995-1998 MSF and North Korea earmarking people “rejected by society.”

20-21 July MSF North Korea team discusses achievements and prospects of the programmes.

24 July MSF receives a one-month extension on the MOU and proposal from DPRK to deliver raw materials to rehabilitate North Korean pharmaceutical industry.

29 July MSF Holland group recommends that MSF continue to try and gain access to the most vulnerable and create a threshold for departure.

10 August MSF North Korea coordinator’s plan to close the mission.

13 August Programme manager decision to close the mission at the end of the current MOU.

19 August 19 August After a 4 days’ visit in PY, US congressio- Programme managers and Comms nal delegations state that since 1995, departments reflect on an external 300,000 to 800,000 people died from communication strategy regarding hunger every year. MSF withdrawal from North Korea.

18 - 25 August MSF F China team collects refugee accounts on China /North Korean border.

24 August DPRK letter asking MSF to consider the proposal to help rehabilitation of pharmaceutical industry. 26 August Stormy weather ruins north Korean crops.

31 August - North Korea fires a missile over Japan. - Japan suspends all food aid to North Korea (lifted in Dec 1999). 185 MSF Speaks Out

International North Korea MSF

1998 September 9 September Kim Jong Il gets full power. - refugee accounts with allegations of cannibalism published in South China Morning Post, MSF quoted. - MSF USA challenged by UN agency and US NGOs.

11 September Circulation to authorities and aid agencies of the Report on "socially deprived children".

15 September US calls North Korean rocket a failed satellite.

20 September Programme managers put an embargo until 30 September on MSF message regarding withdrawal from North Korea.

21 September Start of a nutritional survey by UNICEF and WFP; they will not be able to enter 1/3 of North Korea. 28 September Letter of MSF B/F/H executive directors to FDRC informing that MSF will issue a press release to explain its retreat from NK.

30 September 30 September - Last MSF expatriates leave North The USA : Korea. - Promise to provide more oil to DPRK. - Leak in Liberation (France) and The - Ask The NK authorities to solve the International Herald Tribune (USA) issue of access in order that MSF can of refugee accounts collected by MSF. resume its activities. 1 October MSF press conference in Hong Kong and MSF press release: “MSF Calls on Donors to Review their Policy in DPRK - Urgent Needs in North Korea but MSF Forced to Pull Out“.

2 October UNICEF/WFP statement: there is no evidence that aid is mishandled. 5 October DPRK statement: “MSF statement is not consistent”.

186 International North Korea MSF

1998 13 October

WFP Deputy Executive Director says 1995-1998 MSF and North Korea Nortk Korea denies UN workers access to many counties.

14 October “Humanitarian Aid Frozen“ by Philippe Biberson, MSF F president in Le Figaro (France).

20 - 25 October Peace negotiations between North Korea and South Korea in Geneva.

21 October MSF round table on North Korea in Amsterdam.

1999 February “North Korea a Famine Regime” by François Jean, MSF F Foundation in Esprit (France).

April MSF F China team ‘business’ assessment trip from Beijing to Hamhung province (North Korea).

3 - 6 May South Korean NGO meeting in Beijing asks MSF to resume aid to North Korea.

12 May DPRK acknowledges 220,000 deaths due to famine.

2000 24 April “The mystery children” by Marie- Rose Pecchio, ex-MSF coordinator in North Korea in Newsweek International (USA).

29 September MSF F Board meeting update on North Korean refugee programme.

2001 10 March Interview of Fiona Terry, MSF Fondation, on North Korea in the Japan Times (Tokyo).

June The Chinese authorities organised a major crackdown on refugees on the North Korean border.

187 MSF Speaks Out

International North Korea MSF

23 July The Guardian (UK) and The Washington Post (USA) articles on MSF appeal to Chinese government to stop crackdown and forced repatriation of North Korean refugees.

25 July South China Morning Post (China) article on MSF appeal to Chinese government to stop crackdown and forced repatriation of North Korean refugees

30 July Libération (France) - Interview with Fiona Terry (MSF F Foundation) on the manipulation of the famine in North Korea. - Interview with Catherine Bertini (WFP).

6 August The Guardian (UK): Interview with Fiona Terry (MSF F Foundation) on the manipulation of the famine in North Korea.

2002 February Opening of MSF F office in Seoul, South Korea and gradual extension of the programme toward North Korean refugees in Asia.

2 May MSF F co-coordinator in South Korea (Sophie Delaunay) testimony to the US House Sub-Committee on International Relations for East Asia and the Pacific, regarding the plight of North Koreans inside DPRK and on the fate of North Korean refugees in China.

30 August MSF F Board decision to support the refugee activities (including the sensitive human rights aspects) of MSF South Korean team (in China).

December The Chinese authorities launched a surge of repression against NK refugees.

2003 19 January MSF South Korea press release “Urgent Appeal for the Protection of North Korean Refugees in China.”

188 International North Korea MSF

2003 24 January

MSF F Co-coordinator in South Korea 1995-1998 MSF and North Korea (Marine Buissonnière) testimony to the Japanese Parliament “MSF Pushes for Rights of Fleeing North Koreans.”

27 February - 27 March MSF F in South Korean campaign of humanitarian diplomacy toward western politicians and international agencies.

June-July MSF H “North Korea research Explo” document.

October Chapter on North Korea by Fiona Terry in MSF F book: “In the Shadow of Just Wars.”

2004 18 - 22 May MSF H’s Dick van der Tak and Michiel Hofman visit North Korea.

2006 January Closure of MSF F programme in South Korea.

2007 March - April 2007 MSF CH exploratory mission on China/North Korea border and Far Eastern Asia: decision to open a programme for North Korean refugees.

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