On May 12, North Korea reported the country’s first COVID outbreak, a significant public admission after two and a half years of stringent lockdowns and border closures. Since then, the country has seen its infection rates soar with over two million cases of “fever” recorded.
North Korea has remained unyielding in its stance towards foreign aid, declining COVAX (the global vaccine sharing scheme) and providing no response to the offer of medicines and vaccines from South Korea. While its leader, Kim Jong Un, has declared that the virus is under control, the true scale of North Korea’s cases remains unclear.
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Daily case numbers released by the government are related only to “fever” and rely on symptomatic screening. Omicron, the variant behind North Korea’s outbreak, is estimated to be asymptomatic in close to 40 percent of cases and there is concern that asymptomatic patients, who can still transmit the infection, are being missed.
Experts speculate that the situation may be far worse than the official reports, considering the tight-lipped policy of the country. According to the official account, the death toll since April is 68 which could be explained by Omicron’s low mortality rate compared with other variants. However, certain reports by the news agency Daily NK, suggest this might not be the full picture and highlight the severe consequences of COVID.
In September 2021, the Daily NK reported 45 soldiers among the corps (specialised military forces stationed in provinces of North Korea), had died from suspected COVID infections, although there were no official reports confirming this. Soldiers from the front line, second and third corps were among the victims. Recent news reports from the Daily NK also suggest many deaths among children of military families residing in the headquarters of the third corps following a suspected COVID infection. Worryingly, the underlying cause of death has been attributed not just to the virus but also to poor nutrition and the prescription of drugs like paracetamol and dimedrol at dosages higher than recommended for children.
North Korea lacks a stable healthcare system and vaccination service dedicated to children, which is undoubtedly worsening the crisis. While the assistance from United Nations agencies and non-governmental organisations has helped improve child nutrition in North Korea, close to 20 percent of children are still chronically malnourished, affecting their physical development and damaging their learning capacity.
Critically, malnutrition does not just affect North Korea’s children but its entire population. In 2021, the Food and Agricultural Organization and the World Food Programme revealed that 10.9 million North Koreans (42.4 percent of the population) were food insecure and in urgent need of assistance. There is a strong affinity between COVID and malnutrition; the disease has directly and indirectly impacted malnutrition worldwide.
Hospital figures reveal that the malnutrition prevalence among critically ill patients with the virus is as high as 50 percent, and the chances of mortality among COVID patients with malnutrition are 10 times higher. Studies suggest that countries with a high malnutrition burden have experienced markedly higher COVID fatality rates generally. Malnutrition is also associated with increasing lengths of hospital stay and longer duration of mechanical ventilation, which is both a strain on the patient and the health system.
North Korea’s COVID outbreak, therefore, has the potential to get a lot worse before it gets better. The country has been facing a dire economic and food security situation for a very long time. UN sanctions on North Korea in 2017 led to a ban on all major exports and a rigorous restriction on imports. Its geographic and weather conditions are not conducive for agriculture. Economic reforms introduced by the government have also failed.
With few international allies, North Korea has previously looked to China for support during times of economic crisis and was provided with massive food assistance from Beijing in 2019-2020. However, in 2021 climatic disasters, rising prices and border restrictions limited this aid, aggravating food scarcity in the country.
The government, anticipating more food shortages, has since resorted to instructing North Korean citizens to start farming their own food. Yet, with a pandemic outbreak that shows no sign of slowing, the availability of labour for agriculture and achieving necessary food production targets is now questionable.
The decision-making capacity of the government in North Korea highlights consistent short-sightedness. With the early closure of borders, the country prevented the spread of the disease in the last two years. However, it failed to equip the health system for a future outbreak, leaving the population susceptible to fatal consequences.
North Korea’s health system now needs to focus on identifying the high-risk categories susceptible to infection, especially among the malnourished population, and ensure continued monitoring and action to prevent mortality. Health services need to be integrated with food supplementation to ensure optimal nutrition levels among patients and a better immune response to the infection.
The health system will also have to strengthen its infrastructure and tertiary care facilities to handle critically ill patients. Economic packages should be provided to people who are too sick to work. North Korea will also have to reassess its strategy regarding vaccinations as the virus spreads further and continues to threaten the health system.
In the longer term, it is vital that North Korea improves its agricultural sector to achieve sustainable provisions for the population. UN sanctions, when implemented, were not intended to have adverse humanitarian consequences for civilians. However, these sanctions have led to food insecurity. It is high time that the UN reassessed these sanctions and acted on supporting imports to ensure a feasible food production and supply for North Korea.
Earlier this year, the World Food Programme’s Global Report on Food Crises revealed that close to 193 million people across 53 countries are acutely food insecure and need assistance. This is a staggering 40 million increase compared with 2020. And experts estimate that this number will keep increasing with the recent global upheaval from the war in Ukraine and rising prices of food, energy and fertiliser.
Many nations are now facing a food crisis. Hence, now is the time to monitor the global food market, increase farmers’ productivity, improve access to markets and diversify livelihoods. Global investments and political will are necessary to address the food crisis. Otherwise, we all risk bearing the consequences.
The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.