North Korea has long boasted of its universal health-care system. But interviews Amnesty International conducted with defectors from the country paint a far more gruesome picture.
Amnesty International interviewed more than 40 people who had escaped the oppressive regime of leader Kim Jong-il. They painted a picture of hospitals without electricity or heat, where doctors work by candlelight, lack essential medicines, and sometimes amputate without anesthesia.
In 2000, Hwang, a 24-year-old man from Hwasung in the country's North Hamgyong province, fell from a moving train, and had his ankle crushed. The doctor amputated from the calf down. "Five medical assistants held my arms and legs down to keep me from moving," he told Amnesty. "I was in so much pain that I screamed and eventually fainted from the pain. I woke up one week later in a hospital bed." Hwang reported that he knew of others who had also suffered similar operations. He attributed the high rate of amputations partly to malnutrition.
Others told Amnesty that, despite a government promise to provide free health care to all citizens, they were forced to buy medicines on the private market. Song, who left the country in 2003, explained: "Even if North Koreans don't have money, they still go to hospitals hoping for help and diagnosis. At the hospital, a doctor diagnoses your illness and then tells you what medicine you need to buy at the market. Hospitals no long stock medicines because doctors sell them to survive. There are also many former doctors or nurses who work at markets selling medicine because they make more money doing that than working at a hospital. They need to survive as well. So these vendors have medical knowledge."
The Amnesty report also addresses the long-standing problems of food shortages, and reasserts the claim that a famine killed more than a million North Koreans—from a population of around 20 million—in the 1990s. Around that time the government launched, according to Amnesty, a "let's eat two meals a day" campaign, and encouraged its citizens to forage for bark, roots, grasses, and stalks. A U.N. report from 1996 estimated that such wild foods made up around 30 percent of the average North Korean's diet. Food is still rationed, and those rations sometimes stop altogether in lean months.
From 2000 to 2004 the government allowed private food markets, easing the crisis. But later in the decade they cracked down on subsistence gardens, and prohibited women—who make up the majority of the growers and sellers—from working. Lee, a 39-year-old woman from North Hamgyong province, said her family of three had their food rations cut from 700g per day to 450g in the 1990s. "We received 15kg of corn and 1 to 2kg of rice per month," she said. "To stretch our income, we made alcohol from the corn. We also ate the sediments from the corn alcohol. It was difficult to eat because of the bitter taste, but we were hungry and had to eat them. There was no choice. The leftover corn husks were used to feed pigs, which we also raised to earn extra cash." Digestive problems and malnutrition are rife, while stories of deaths from starvation have been widely corroborated. But North Korea, known as the Hermit Kingdom, is notoriously closed to outsiders, so the situation remains difficult to confirm.
Meanwhile, the country's dictator Kim Jong-il is reported to enjoy an exquisite diet of delicacies imported from around the world, and is said to have a very discerning palate.