Hwaseong, South Korea – Like no other country, North Korea could do with help against COVID-19.
The country’s population is unvaccinated and susceptible to disease due to chronic malnourishment. Its dilapidated healthcare system lacks supplies of basic drugs and equipment.
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But even as North Korea faces the prospect of a humanitarian catastrophe amid its first officially confirmed coronavirus outbreak, Pyongyang is steadfastly refusing offers of international assistance.
The United States and South Korea have not received a response to offers to help tackle the outbreak, including by sending aid, according to South Korean officials.
The World Health Organization, which is “deeply concerned at the risk of further spread”, said the country had not responded to requests for information about the outbreak.
UNICEF said on Thursday it had proposed a “package of support that could help protect health workers and manage caseloads” but had not yet been able to contact its partners in the country.
At the same time, there are signs North Korea has turned to China, its neighbour and traditional ally, for assistance, although this has not been confirmed by either side. Air Koryo, the state airline, has operated several flights to China to obtain pandemic-related supplies in recent days, according to several South Korean news outlets, citing anonymous sources.
North Korea, whose dynastic leadership proclaims an official ideology of self-reliance known as “juche”, has long been known for its secrecy and hostility towards the outside world.
In January 2020, the country, which is ruled by third-generation dictator Kim Jong Un, became one of the first countries to seal its borders in response to coronavirus. Despite spiralling cases worldwide, Pyongyang repeatedly refused to accept offers of coronavirus vaccines from the international community, including the UN-backed initiative COVAX.
Until last week, the North, which is officially known as the Democratic People’s Republic of Korea (DPRK), had not reported a single case of COVID-19, a record doubted by many analysts given the virus’s transmissibility and the country’s long, porous border with China.
Since then, the number of people reported to have symptoms of “fever” has surpassed 2.2 million cases, although it is unclear how many of those tested positive for COVID-19.
Dan Chung, executive director of US-based Christian aid group Crossing Borders, described the country’s refusal of assistance as “telling,” given discussions he has had with North Korean defectors that suggest the country is in a “much worse condition than they are letting on”.
“It indicates that North Korea is either not ready to accept the vaccine because of limitations such as lack of refrigeration or because they do not want to show the world the dilapidated state of their outer regions,” Chung told Al Jazeera. “I would guess that is a combination of both.”
North Korea, where state propaganda proclaims “we have nothing to envy in the world”, has a history of concealing internal crises from the international community.
During a devastating famine in the mid-1990s, officials initially downplayed the severity of food shortages, and international aid workers reported being led on stage-managed tours of Pyongyang to keep them away from rural areas where starvation was rampant.
Despite Kim chiding officials for their “slackness” in responding to the COVID-19 outbreak, state media has claimed the crisis has turned the corner in recent days.
On Friday, the Korean Central News Agency said authorities were achieving “good results” in their pandemic fight despite recording more than 260,000 daily cases of people with feverish symptoms.
Official reports have also highlighted the use of home remedies and traditional medicine and efforts to ramp up the production of drugs and medical supplies.
‘Attempts to control its own people’
Alastair Morgan, who served as the United Kingdom’s ambassador to North Korea from 2005 to 2008, said the country’s reluctance to accept help could be due to fears of being seen as beholden to other countries or concerns about “hostile states” gaining access to information about the country.
“It is consistent with the increasing efforts to achieve autarchy following the failure of the Hanoi summit,” Morgan told Al Jazeera, referring to the failed denuclearisation talks between Kim and former US President Donald Trump.
“I think there are multiple reasons for this, to do with DPRK regime attempts to control its own people and their access to information about the regime and the external world and its attitude and attempt to manage the external world.”
While the true extent of death and disease inside North Korea is unclear, the country is all but certainly facing a humanitarian disaster.
Although authorities have reported only 65 deaths so far, a caseload of 2.2 million infections could be expected to result in tens of thousands of deaths in an unvaccinated population.
The highly infectious nature of the Omicron variant, the dominant strain worldwide, also means the outbreak is likely to grow considerably. In neighbouring South Korea, where more than 85 percent of the population has been vaccinated, almost one-third of the population, or 18 million people, have tested positive for COVID-19 since the start of the pandemic.
Kee Park, a medical doctor who has made over a dozen humanitarian trips to North Korea, said the country clearly needs outside help.
“Whether they will accept assistance from sources other than China depends on what, who, and how the aid enters the country,” Park told Al Jazeera.
“It would be helpful if the aid is offered with minimal or no requirements for monitoring. This is truly a health emergency. However, the deaths are preventable if the right medicines and supplies are able to reach those who need them in time. Conversely, ambivalence by North Korea will lead to unnecessary delays. Saving lives should be the most important consideration at this time and we should all act swiftly.”
The looming public health disaster is also likely to aggravate economic and food security crises that have been building since the pandemic began. Last year, the UN Food and Agriculture Organization estimated North Korea would fall 860,000 tonnes short of its food needs in 2021. Even before the pandemic, UN estimates suggested more than one-quarter of the population was malnourished.
“One issue is agriculture,” Morgan said. “This is the rice planting season. If mass activity is not permitted, or large bodies of labour are not available for planting – because of illness, lockdown or diversion to other tasks – then this could have an impact on food supply this autumn. I think food distribution is likely to be severely under strain already.”