H R N K W. COURTLAND ROBINSON LOST The Health and Human Rights of North Korean Children, 1990–2018 GENERATION LOST GENERATION: THE HEALTH AND HUMAN RIGHTS OF NORTH KOREAN CHILDREN, 1990–2018 W. Courtland Robinson, Ph.D. Center for Humanitarian Health Johns Hopkins Bloomberg School of Public Health Contributing Authors Jiho Cha, MD, Ph.D. Soim Park, MA Casey Branchini, Ph.D. Daeseong Kim, MPH Seung Yun Kim, MD Taeyoung Kim The Committee for Human Rights in North Korea Copyright © 2019 Committee for Human Rights in North Korea Printed in the United States of America All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior permission of the Committee for Human Rights in North Korea, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law. Committee for Human Rights in North Korea 1001 Connecticut Avenue, NW, Suite 435 Washington, DC 20036 P: (202) 499-7970 www.hrnk.org Print ISBN: 978-0-9995358-5-1 Digital ISBN: 978-0-9995358-6-8 Library of Congress Control Number: 2019914948 Cover image sources: Nicor. “Children of North Korea.” Digital Image. Wikimedia Commons. September 15, 2012. https://commons.wikimedia.org/ wiki/File:Children_of_North_Korea.JPG. Pavelka, John. “School Boy.” Digital Image. Wikimedia Commons. May 1, 2010. https://commons.wikimedia.org/wiki/ File:School_Boy.jpg. Kilcullen, Justin. “In a kindergarten.” Trocaire, CORBIS SYGMA. June 17, 1997. Dedicated to Ang, Yani, and J.D. In memory of the countless numbers of North Koreans—men, women, and children—who have suffered and died from famine, exposure, overwork, imprisonment and torture, or malign neglect by their government. BOARD OF DIRECTORS Gordon Flake, Co-Chair Katrina Lantos Swett, Co-Chair John Despres, Co-Vice-Chair Suzanne Scholte, Co-Vice-Chair Helen-Louise Hunter, Secretary Kevin McCann, Treasurer Roberta Cohen, Co-Chair Emeritus Andrew Natsios, Co-Chair Emeritus Morton Abramowitz Jerome Cohen Rabbi Abraham Cooper Jack David Nicholas Eberstadt Carl Gershman Robert Joseph Stephen Kahng David Kim Robert King Jung-Hoon Lee Debra Liang-Fenton Winston Lord David Maxwell Marcus Noland Jacqueline Pak Greg Scarlatoiu, Executive Director I TABLE OF CONTENTS List of Tables ..................................................................................................................................................................................IV List of Figures ................................................................................................................................................................................ VI List of Acronyms ...........................................................................................................................................................................VII About the Committee for Human Rights in North Korea (HRNK) ............................................................................................. IX About the Author: W. Courtland Robinson .....................................................................................................................................X Acknowledgements ......................................................................................................................................................................... XI Foreword .......................................................................................................................................................................................XII Executive Summary .....................................................................................................................................................................XIV Introduction ......................................................................................................................................................................................1 Chapter 1. Population and Demography of North Korea ...............................................................................................................5 A. Overview ............................................................................................................................................................................5 B. "Famine in Slow Motion" or "Arduous March"? ...............................................................................................................6 C. The North Korean Famine and Its Effects on Children ....................................................................................................8 Methodology .............................................................................................................................................................8 Demographic Characteristics of Children ...............................................................................................................8 Temporal Patterns of Mortality ..............................................................................................................................13 Causes of Death Among Children .........................................................................................................................14 Childhood Mortality and Household Change, 1995–1998 ....................................................................................16 D. North Korean Population Change, 1990–2018 ...............................................................................................................20 Mortality .................................................................................................................................................................20 Fertility ....................................................................................................................................................................21 International Migration ..........................................................................................................................................22 E. North Korea Today ..........................................................................................................................................................23 Chapter 2. Nutrition and Food Security .........................................................................................................................................26 A. Food Security and Food Aid .............................................................................................................................................26 B. Food Security and Food Access ........................................................................................................................................29 C. Nutritional Status of Children, 1997–2017 .....................................................................................................................32 D. North Korean Refugee Children in South Korea ............................................................................................................35 Chapter 3. Physical and Mental Health .........................................................................................................................................36 A. The North Korean Health Care System: Collapse and Partial Recovery .......................................................................36 Limited or No Appropriate Medications ................................................................................................................37 Alternative Therapies and Coping Strategies .........................................................................................................38 Hospitalization and Healthcare Utilization ............................................................................................................38 Maternal and Child Health ....................................................................................................................................39 Immunization ..........................................................................................................................................................40 Communicable and Re-emerging Diseases ............................................................................................................42 B. Physical and Mental Health of Refugees and Migrants in China ...................................................................................42 C. Physical and Mental Health of North Korean Refugees in South Korea .......................................................................44 Physical Health .......................................................................................................................................................44 Mental Health .........................................................................................................................................................46 Lost Generation The Health and Human Rights of North Korean Children, 1990–2018 W. Courtland Robinson Chapter 4. Education ......................................................................................................................................................................48 A. Overview ..........................................................................................................................................................................48