The World Health Organization found itself on Friday in the strange position of defending the quality of healthcare in North Korea from an Amnesty International report.
Amnesty’s report on Thursday described North Korea’s health care system as a shambles, with doctors sometimes forced to perform amputations without anesthesia and working by candlelight in hospitals lacking essential medicine, heat and power. It also raised questions about whether coverage is universal as the WHO claimed, noting that most interviewees said they or a family member had bribed doctors to receive medical care. Those without the means to do so reported that they could get no health assistance at all.
WHO spokesman Paul Garwood said that Thursday’s report by Amnesty was not up to the UN agency’s scientific approach to evaluating health care.
“All the facts are from people who aren’t in the country,” Garwood told reporters in Geneva. “There’s no science in the research.”
The issue is sensitive for the WHO because its director-general, Margaret Chan (陳馮富珍), praised the communist country after a visit in April and described its health care as the “envy” of most developing nations.
Major global relief agencies have been quietly fighting for years to save the lives of impoverished and malnourished North Koreans, even as the government wasted millions on confrontational military programs.
Some groups may fear being expelled from the country if they are openly critical of Pyongyang, which is highly sensitive to outside criticism. Despite such considerations, Chan’s comments were considered uncommonly upbeat.
Garwood and WHO spokeswoman Fadela Chaib insisted that Amnesty’s report complemented the observations of their boss. The focused on the challenges she outlined for the country, from poor infrastructure and equipment to malnutrition and an inadequate supply of medicines.
But whereas Chan noted that North Korea “has no lack of doctors and nurses,” Amnesty said some people had to walk two hours to get to a hospital for surgery. Chan cited the government’s “notable public health achievements,” while Amnesty said health care remained at a low level or was “progressively getting worse.”
Chaib highlighted the importance of maintaining the WHO’s presence in the country, where its officials do their best to save lives despite “persisting challenges.”
“We are an organization dealing with member states, and we respect the sovereignty of all countries,” Chaib said. “We need to work there to improve the lives of people.”
Sam Zarifi, head of Amnesty’s Asia-Pacific program, said the human rights group stood by its findings.
“We certainly have a lot of restrictions in terms of working in North Korea, but we did our best in terms of capturing the information we could verify,” Zarifi said.
He said Amnesty had spoken to North Koreans as well as to foreign health care and aid workers, and relied heavily on the WHO for information — including the assessment that North Korea spends US$1 per person per year on health care, the lowest level in the world.
The UN estimates that 8.7 million people need food aid in North Korea. The country has relied on foreign assistance to feed much of its population since the mid-1990s when the economy was hit by natural disasters and the regime lost its long-time Soviet benefactor.
Garwood said Amnesty’s research added a needed element to understanding health conditions in North Korea, but added that it didn’t even mention recent improvements in the country as the result of a program funded by South Korea and aided by the WHO.
The UN body claims that maternal mortality has declined by over 20 percent since 2005, and diarrhea cases and deaths in operations have also dropped. It says more than 6,000 doctors and nurses have been trained in emergency obstetric care, newborn care and child illnesses, while clinics have received better material for operations, blood transplants and other medical interventions.
Zarifi, of Amnesty, said the whole debate would be ended if North Korea’s government provided access to monitors so that everyone had a better understanding of the country’s health care system.
“Every indication we have indicates the state of health care in North Korea is dire,” he said.
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