Hunger and Human Rights:
The Politics of Famine

Much emphasis in the humanitarian and human rights community is placed on the integrity of monitoring. It is often assumed that if the monitoring system worked properly, better outcomes would follow. Yet a second way of gauging effectiveness is to look at surveys of health status. Unfortunately, precious little evidence exists on the actual impact of relief. UN-sponsored nutrition surveys that have been done to date, however, can be evaluated, as can a variety of other sorts of evidence that has not been fully explored in this context. This evidence includes refugee interviews, data on prices, and a consideration of the nature and evolution of access to and the distribution of food, including changes since the initiation of economic policy changes in mid-2002.3 With the usual caveats about the quality of information that the North Koreans allow outsiders to collect, one conclusion is clear: Although there has been some marginal improvement in nutritional status since the peak of the famine, the crisis is by no means over and any discussion of what to do about North Korea must begin by recognizing that the fundamental problem of food insecurity has not been solved.

The UN has supported a series of nutritional surveys, the most recent of which was conducted in 2004. The North Koreans impose severe constraints on the implementation of these surveys. The most recent one, for example, does not cover all of the counties the WFP serves. The methodologies employed leave much to be desired, and questions remain about the accuracy of the reported results. Moreover, because of differences in the methodologies and populations studied in successive surveys, it is difficult to draw strong conclusions about trends over time. Nonetheless, these surveys provide a stark portrait of the food and nutritional situation of the most vulnerable populations in North Korea, including particularly children.

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At the national level, the rate of stunting (measured height-for-age), signaling chronic malnutrition, was found to be 37 percent among children under the age of six. The underweight share (measured weight-for-age) was 23 percent. Wasting, a measure of acute malnutrition (measured weight-for height) was 7 percent. The share of the undernourished in North Korea's population puts it in the worst-off category in a recent FAO study, in the company of the very poorest countries including Sierra Leone, Ethiopia, and Haiti (FAO 2004).

The survey revealed considerable regional variation. For example, the stunting rate in Pyongyang (26 percent) was well below that in the eastern provinces of South Hamgyong (47 percent) and Yanggang (46 percent); similar results were found with respect to those found to be underweight, and even larger differences existed with respect to wasting. This evidence is consistent with the historical record, which indicates that privileged areas such as Pyongyang fare much better than more remote mountainous areas of the north and above all the cities and towns of the eastern provinces.

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This mixed assessment of progress does not mean that delivered aid is ineffective; although these levels of malnutrition are still acute, they show some improvement from the peak of the famine. But they demonstrate the uphill battle the humanitarian community must fight in a context where other features of the system make it difficult to be effective. Just as the closed nature of the North Korean system inhibits effective program design, implementation, and monitoring, it prevents effective evaluation as well. In particular, the evidence from the nutrition surveys shows very important regional differences. Considerable food price dispersion across regions also indicates that while the process of marketization is well under way, markets remain fragmented (Table 2). In this context, the USAID policy of preferentially targeting the north and east is an important counterweight to the allocational decisions of the government.