In chapter 4, we talked about what aid was intended to do and how restrictions on monitoring and diversion to various uses—consumption or sale—might have affected who got assistance. In this chapter, we have talked about the possible consequences of marketization and the reform process and the emer- gence of new vulnerabilities. The data do not permit us to separate the precise weight of these offsetting effects: the positive benefits of aid versus the adverse effects of the reform. Nor can we say how the North Korean population might have fared under various counterfactual scenarios, for example, with less aid or under different reform scenarios. The best we can do is offer a descriptive snapshot of how vulnerable populations are faring as of 2005, after a decade of humanitarian assistance. What we see is a distressing continuity in the welfare of vulnerable groups.
As relief activities got under way in the mid-1990s, a number of NGOs attempted to do assessments that would size up the scope of the hunger prob- lem, identify the populations in greatest need, and benchmark the effectiveness of their activities in providing relief (see KDI 1999). In 1997 a WFP request to implement a conventional randomized survey was rejected by the North Korean government. Médecins sans Frontières had similarly been denied per- mission to conduct its own nutritional survey, despite having been assigned responsibility for conducting emergency feeding activities over an extensive geographic area.
The government did consent to a more narrow evaluation of child anthro- pometric status. In August 1997, the WFP examined 3,965 children under the age of seven from forty government-selected institutions located in nineteen counties in five provinces. The results provided unambiguous evidence of long- term malnutrition. Seventeen percent of the children were wasted (as mea- sured by weight-for-height, signaling short-term malnutrition), and 38 percent were stunted (as measured by height-for-age) and/or underweight (42 percent, measured weight-for-age), measures of longer-term problems (figure 7.4). The age-related figures in particular again suggest that the country’s food problems did not begin with the floods of 1995 but were of much longer standing. This
196 DEALING WITH A NEW NORTH KOREA
FIGURE 7.4. Child Nutritional Status
Sources: 1997: Katona-Apte and Mokdad 1998; 1998: WFP 1998; 2002: Central Bureau of Statistics (North Korea) 2002; 2004: Central Bureau of Statistics , Institute of Child Nutrition, 2005.
evidence is thus consistent with our interpretation of a secular decline in food availability well before the famine.
As two of the survey’s designers observed, the results might not have been representative of the country as a whole or even of the selected institutions. If anything, the sources of bias seemed in the direction of painting a more favor- able picture than actually existed, which make the findings even more horrific.
The institutions selected were in either the capital or “rice bowl” counties in which conditions were generally believed to be superior. On the day that data was collected, attendance rates at the institutions varied from 21 percent to 100 percent, and there was no way to ensure that local authorities were not deliber- ately keeping some children away (Katona-Apte and Mokdad 1998).
Some commentators have claimed that the basic anthropomorphic norms embodied in the standards are inappropriate for the Korean population, specifi- cally, that they overstate the expected size of normal Korean children, recall- ing the debate among nutritionists and anthropologists about the existence of
“small but healthy” populations.20 The implication is that if Korean children are naturally small, the true degree of malnutrition is less than indicated in these figures.
The division of the Korean peninsula and the existence of a large corpus of historical data allow us to do a natural apples-to-apples comparison that
Coping, Marketization, and Reform 197 does not involve anthropomorphic standards of different races or nationali- ties. Eberstadt (2001b) reports that the mean heights and weights of the North Korean seven-year-old males measured in the 1998 survey discussed below were 105 centimeters and 15 kilograms, respectively. According to the South Korean National Statistical Office, the comparable figures for South Korean seven- year-olds in that year were 126 cm and 26 kg. This is to say that, if these figures are to be believed, in 1998 seven-year-old North Korean males were roughly 20 percent shorter and 40 percent lighter than their southern counterparts—a gigantic difference that cannot be ascribed to genetic differences or inappropri- ate norms. Indeed, the North Koreans in 1998 are significantly smaller than the South Koreans in 1965 when the National Statistical Office series begins, and if the Japanese colonial records reported in Yun (1987) are to be believed, smaller than Korean seven-year-olds at any time in the twentieth century.21 And whatever the validity of the “small but healthy” claim with respect to the level of malnutrition, it should not affect the interpretation of changes in the indicators over time.
As noted above, a second survey of 1,762 children under the age of seven was conducted in September and October of 1998 (WFP 1998). Although involving fewer children than the first venture, it covered a larger geographic area. Two provinces (Chagang and Kangwo˘n) that were largely off-limits to the WFP were excluded from the survey, however, as were parts of others, reputedly loca- tions of penal colonies and sensitive military sites. Altogether, eighty-two coun- ties containing roughly 30 percent of North Korea’s population were excluded (See figures 4.3—4.5). The sampling procedures appear to have improved mark- edly over the prior survey, though problems remained. The WFP could not cross-reference its data with that collected by UNICEF and MSF and could not ensure that the households visited were actually the households selected by the survey team (Bennett 1999). Nevertheless, the results of the second survey are generally regarded as more reliable than those of the first despite the much smaller sampling of children.
The second survey recorded a wasting rate of 16 percent, comparable to that observed in the first study. But underweight and stunting rates—indicators capturing chronic malnutrition—were roughly 50 percent higher than the rate observed the previous year (61 percent and 64 percent, respectively). To get some comparative sense of these figures, the results of the 1998 survey implied that the incidence of wasting among children in North Korea was more than double that in Angola, a country in the midst of a thirty-year civil war, and more than 50 percent greater than in Sierra Leone, a country that had collapsed into virtual anarchy.
198 DEALING WITH A NEW NORTH KOREA
The North Koreans were reportedly infuriated by the public release of what they regarded as embarrassing information and refused repeated requests by the WFP for a follow-up study (GAO 1999, Snyder 2003b). A subsequent sur- vey was apparently conducted by the North Korean government in 2000 and documented broad improvements in nutritional status, but to our knowledge this study was never publicly released or, as two UN-affiliated analysts put it,
“wasn’t internationally observed” (Shrimpton and Yongyout 2003:3).
In October 2002, a survey of 6,000 children and 2,795 mothers was con- ducted by the North Korean Central Bureau of Statistics in collaboration with the North Korean Institute for Child Nutrition. UNICEF and the WFP provided financial and logistical support. Certain geographic regions accounting for roughly 20 percent of the population were excluded, including Chagang and Kangwo˘n provinces. The survey results implied extraordinary improvements in nutritional status. The percentage of underweight children fell from 61 to 21 percent. Stunting dropped from 62 to 42 percent, and wasting from 16 to 9 percent. The proportion of low birth-weight babies in the North Korean survey (6.7 percent) was actually lower than that for the United States (7.6 percent) or England and Wales (7.7 percent), as was the reported rate of infant mortality. These improvements were so astonishing as to provoke considerable internal debate about their veracity within the col- laborating UN institutions. In the end, the UN agencies decided to accept and disseminate the North Korean report (see Shrimpton and Yongyout 2003, 2004a, 2004b).
The data confirmed the strong regional dimension to the famine that we emphasized in our discussion in chapter 3 (table 7.6). Variation in child and mother nutritional status varied sharply across regions of the country. Stunting and underweight rates reported for the capital of Pyongyang and the port city of Namp’o, for example, were consistently about half that recorded for the province of Yanggang in the northeast. The wasting rate of Pyongyang (4 percent) was a third of that of the worst province, South Hamgyo˘ng (12 percent).
In October 2004, North Korean authorities with the support of the UN agencies conducted a survey of 4,800 children and 2,109 mothers. Again the survey excluded certain geographical areas and cannot be regarded as neces- sarily representative of the country as a whole. Indeed, even some areas being served by the WFP were omitted, and the results cannot therefore even be interpreted as representative of areas in which the WFP has operations. Foreign participants in the study registered a variety of complaints with respect to basic lack of quality control over the implementation of the survey, such as the North Korean authorities impeding standard randomization procedures.