For much of the past year, international attention on North Korea has focused on its aggressive nuclear and missile programs and how to engage with the North in ways that will reduce the risk of armed conflict and eliminate nuclear weapons. Humanitarian engagement, which was a major element in the U.S. and South Korean relations with North Korea two decades ago, has significantly declined in importance. As we consider next steps in the relationship with the North, humanitarian engagement should definitely be one issue on the table.

The Need for Assistance in the North

There is little doubt that there is a need for humanitarian assistance for the North. Just over a month ago at the end of July, UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Mark Lowcock visited North Korea where he met with senior government officials and visited rural areas where he observed conditions first-hand. After that visit, he reported there is “very clear evidence of humanitarian need” in North Korea.

UN Under-Secretary-General Lowcock summed up just a few of the humanitarian problemsin North Korea:

• Half of the children in rural areas do not have access to safe drinking water.
• One-in-five children in North Korea suffer from malnutrition, which leads to stunting. Although there has been some progress, a study done almost a decade ago concluded that stunting affected 28 percent of children in the North and the latest estimate is about 20 percent. But malnutrition in one-fifth of children still is a very serious humanitarian need.
• Many critical medicines are in very short supply in the North. Adequate medicines are not available to inoculate children against dangerous childhood diseases.
• At one hospital the UN Under-Secretary-General visited, 140 patients had tuberculosis, but there was enough medicine to treat only 40.

North Korea has one of the highest tuberculosis rates in the entire world. A physician who regularly visits North Korea to supervise medical assistance reports that “TB is common in all provinces, in rural and urban area, and strikes down young people at every level of society. We also know that drug-resistant strains of TB have been increasing for some time, and that the North Korean health system, like that of other developing countries, is ill-equipped to deal with such a complex disease.”

One of the problems is that the serious humanitarian need in North Korea receives far less attention than other countries with similar difficulties. The problem is that its military bluster and nuclear and missile programs receive the attention of the international media but not its urgent humanitarian needs. “The deepening humanitarian emergency in North Korea is the least reported in the world,” according to a study by CARE-International that measured international media coverage of humanitarian crises around the globe.

Assessing the need for humanitarian aid can be difficult. The North Korean regime is paranoid about maintaining control and keeping outsiders away from sensitive areas inside the country, but they also have an interest in assuring assistance to their people. The United Nations reports that UNICEF officials have been permitted to visit some 100 counties throughout North Korea to observe and monitor. The UN World Food Programme has been able to visit some 1,800 food distribution locations and kindergartens where food is being provided, and they have been able to do gather data on food security.

North Korea has an inefficient and poorly organized economy that functions at very low levels. In terms of per capita GDP (a rough measure of a country’s resources and what it is able to provide for its citizens), North Korea ranks among one of the poorest developing countries in the world—just below Haiti and Togo and just above Sierra Leone and Eritrea. In dramatic contrast, South Korea is near the top of the per capita GDP list—just below the European Union and Japan.

Even if North Korea had the benefit of a wise, benevolent, and generous leader, its people would still need humanitarian aid. But the government in Pyongyang can be criticized for devoting scarce economic resources to nuclear weapons, missiles, and maintaining the fourth largest standing army in the world. It is hard to justify humanitarian assistance to the North in light of the choices its autocratic regime makes.

On the other hand, it is very difficult to argue that the people of a country should be forced to suffer because of the evil decisions and misguided policies of its government—particularly when that government is an authoritarian regime not put into place by the will of its people and there is little that North Korean citizens can do to change their repressive government.

Why We Should Aid North Korea

With the development of international law and international institutions over the last century, there has been a recognition and an acceptance of the “humanitarian imperative”—the principle that humanity has the right to receive and the obligation to give humanitarian assistance when it is needed. This is defined in the Code of Conduct of the International Red Cross, which most countries in the world have accepted. This is also a principle of most religious traditions—Christianity, Buddhism, Islam, and most others. Alleviating suffering by helping those in need is simply the right thing and the moral thing to do.

The United States has been among the most generous countries in the world in providing humanitarian assistance. The United States was one of the principal benefactors of North Korea in the late 1990s when North Korea suffered from a major famine caused by incompetent government policies and natural disasters, which resulted in as many as one million deaths. From 1995 to 2008, the United States provided some $1.2 billion in humanitarian food assistance, and during that same period, South Korea and China provided even greater amounts of aid than the United States.

In the United States, legislation requires that provision of international humanitarian assistance be based on humanitarian need, balancing competing demands for aid elsewhere, and observing overall limitations on funding provided by Congressional appropriation. Legislation specifies that humanitarian assistance is not to be used for political purposes. Nevertheless, providing humanitarian assistance to North Korea does have subsidiary political benefits for our policies toward North Korea. 

Government-imposed isolation and tight central control of media keep North Koreans poorly informed about what is happening in the wider world—in South Korea, Japan, and even in China. Misinformation and outright lies about the United States, South Korea, and the rest of the world limit the knowledge of North Koreans. It is still illegal in North Korea to listen to foreign radio broadcasts, and punishment can be draconian; the internet is not available; foreign films and television—particularly from nearby South Korea—are prohibited; and international phone calls by average North Koreans are almost impossible. 

One important benefit of humanitarian assistance is that North Koreans—from senior government officials to individual aid recipients in remote villages—have contact with U.S. citizens and with citizens of other countries. This helps increase the flow of information about the outside world in one of the world’s most isolated places. Yes, we should provide aid because it is the right thing to do, but there are also political benefits for doing the right thing.

Current Obstacles to Humanitarian Engagement

Humanitarian engagement with North Korea has been particularly difficult in the last decade. First, because North Korea is not seen a particularly sympathetic victim. The images of North Korea most often seen in international media are missile launches, nuclear weapons tests, and thousands of soldiers goose-stepping en masse across Kim Il-sung Square in Pyongyang. International attention over the last few years has focused on North Korean nuclear weapons and missile programs, with sanctions and condemnation coming from the United Nations and many leading countries. 

This makes it increasingly difficult to secure funds for humanitarian engagement. A report on declining assistance to the North notes, “While North Korea has struggled with food security for years, international aid organizations have had to battle the idea that Pyongyang has prioritized its nuclear and missile programs over its people’s welfare.” It is hard to generate support in the UN Security Council or in the U.S. Congress to provide needed humanitarian aid. 

Even private non-government aid organizations in the United States have suffered significant declines in available funding because of negative publicity on North Korea’s hostile military intentions. Private donors, as well, are less enthusiastic, and some organizations—which in the past have led humanitarian efforts in the North—have shifted their focus to other parts of the world where there is a need for charitable assistance and fund-raising is less difficult.

A second major obstacle limiting humanitarian engagement with the North is UN Security Council sanctions imposed on North Korea—ratcheted up since 2016—in response to its nuclear and missile testing. These sanctions were drafted to permit humanitarian activities in the North to continue, but sanctions enforcement has been uneven. China apparently stopped exports of certain medical equipment to North Korea due to small metal components, which could allegedly also be used in missile construction and would therefore be banned by sanctions. At other times sanctions have been only half-heartedly enforced.

An AFP interview with the UN official who is the resident coordinator of UN humanitarian efforts in Pyongyang is headlined “United Nations own sanctions hinder its humanitarian aid efforts in North Korea.” That story reported that UN assessments found some 10 million people in need of humanitarian aid, but because of difficulty getting resources into North Korea and of raising funds from UN member countries, only 7 percent of that number received help. The entire gap between need and available aid is not due to sanctions, but a significant portion is.

The United States has been the principal advocate for tough sanctions, but international reaction and negative publicity led the United Nations with U.S. government support to adopt guidelines to streamline procedures to get humanitarian aid to the North in early August this year. The changes are described by U.S. officials as an effort to establish a “clear and uniform process” for humanitarian exemptions to “guard against any activities that would undermine existing Security Council resolutions.” These are minor tweaks, not major changes, and thus far there is no indication that it will ease the ability of humanitarian workers to provide needed aid.

Another significant obstacle to humanitarian aid has been the ban on travel by U.S. citizens to North Korea, which was imposed by the U.S. government in 2017. The principal precipitating event was the detaining of four U.S. citizens by North Korea in 2016. The effect of the travel ban has been significant for organizations involved in humanitarian and educational engagement with North Korea. The travel ban allows an exemption for U.S. citizens engaged in humanitarian work in the North, but that exemption has been interpreted very narrowly. U.S. citizens providing medical assistance seem to be receiving permission to travel, though receiving permission is a slow and painful process. 

U.S. citizens involved in English language, education, and agricultural programs have not been permitted to travel. The American Friends Service Committee, a Quaker humanitarian organization involved in encouraging better agricultural practices in the North, concluded: “Travel bans and sanctions obstruct humanitarian efforts in North Korea.” Particularly hard hit is the Pyongyang University of Science and Technology (PUST), which provides college-level English language instruction in economics, business, medicine, and other subjects. A large proportion of their faculty are U.S. citizens, but they have not been given permission by the U.S. government to carry on their activities in North Korea.

The U.S. Department of State extended this travel ban for another year on August 31, 2018. This action is largely a reflection of the concern of senior U.S. officials that little if any progress has been made on North Korean denuclearization following the high-profile Singapore summit between U.S. President Donald Trump and North Korean leader Kim Jong-un. The concern is that Chinese enforcement of UN sanctions against the North already appears to be easing, and the summit has not provided leverage to move North Korea toward denuclearization. To ease the travel ban now would put the United States on the path of easing-up on the North before any real movement toward denuclearization by Pyongyang.

One of the most serious consequences of the decline in support and funding for humanitarian aid to North Korea was the decision announced earlier this year that the UN Global Fund to Fight AIDS, Tuberculosis, and Malaria was suspending help for tuberculosis and malaria to North Korea as of June 30, 2018. In light of the seriousness of the tuberculosis problem in the North, this decision is extremely serious. There were no allegations of problems with program operations in North Korea—in fact, the Global Fund rated North Korea as “exceeding expectations” in a formal grant assessment. Some have suggested that the United States, which provides significant financing for the Global Fund, may have urged an end to the program in North Korea. The North will have serious difficulty dealing with its tuberculosis problem, and this will likely have a serious negative impact on neighboring countries.

The North Korean regime makes it difficult to provide humanitarian help for its citizens. But it can be done. As the Special Envoy for North Korea Human Rights Issues, I negotiated several times with North Korean officials in Pyongyang and Beijing in 2011 and 2012 to reach an agreement with the North on how we might satisfy U.S. legal requirements for assessing need and monitoring distribution of nutrition assistance for preschool children. The discussions were intense at times, but we reached an agreement that satisfied U.S. requirements but was also acceptable to the North Korean government. The death of Kim Jong-il and his replacement by his son Kim Jong-un led to a shift in internal dynamics, and the new leader sought to consolidate his internal position. The aggressive nuclear and missile program that followed did not allow us to move forward with aid. 

I believe that we can—and we should—carry on humanitarian engagement with North Korea, and we can do so in a way that does not further its military capabilities and ambitions. There is a genuine and urgent need for this assistance. Furthermore, we can provide help to worthy and needy recipients, while our government and private efforts help to break down barriers between the United States and North Korea.