Lee 1

Do Eon Lee
Adriana Petryna
Globalization and Health
9 May 2014

The Political Aid:

The Political Strategies Behind Humanitarian Aid to North Korea

After 35 years of the Japanese colonial era, the Korean Empire1 finally gained
independence in 1935. However, America, England, China, and the Soviet Union, argued that
the Korean Empire needed time and help to fully establish an independent country, and argued
that Korea needed to engage in a trusteeship for a maximum of five years. Despite Koreas
opposition, America and the Soviet Union kept arguing for a trusteeship, which is commonly
received as part of their power struggle during the Cold War. Since the two countries could not
reach a consensus, the US postulated the issue to the UN. The UN concluded that South Korea
should hold a general election under close watch of the US. As a result, Syngman Rhee was
elected as the first president of the Republic of Korea2, and Kim Il Sung was elected as leader of
the Democratic Peoples Republic of Korea3 few months after the UN recognized the Republic
of Korea as a sole legal government of Korea4 (Jang 220-242).

The Republic of Korea became the official name of the country in 1948, the year of the establishment of
the Korean government after the independence (The Republic of Korea). Korean Empire had been the
official name of the nation from 1897 to 1910.
2
May 10, 1948 (Jang 230)
3
September 9, 1948 (Jang 230)
4
December 12, 1948 (Jang 230)

Lee 2
Both governments were highly influenced by the political stances of America and the
Soviet Union beginning from when the nations were first established. Differing greatly in their
political stances, the Republic of Korea and the Democratic Peoples Republic of Korea soon
started to politically attack one another. President Rhee threatened North Korea with a plan for
unification by force, while Kim Il Sung primarily criticized South Korea for being an American
colony. This political tension continued for about a year and half. In June 25, 1950, North Korea
invaded South Korea, and the War that started raged on for three years. The War was not merely
a civil war, but an international war that was a continuation of the Cold War. UN forces
comprised of 16 countries5 stood with South Korea, while the Soviet Union and the Peoples
Republic of China fought on the side of North Korea. After few turnovers during the war, South
and North Korea finally agreed to armistice in July 27, 1953 (The Korean War).
As this recent history suggests, there are many different political interests and agents
other than the two Koreas that are involved in the tension. As a result, great amounts of different
political interests clash surrounding even the issue of sending humanitarian aid to North Korea.
In this paper, I would like to focus on the current nutritional and medical landscape of North
Korea and how different political interests surround the humanitarian aid sent there. As specific
cases, this paper is going to focus on South Korea, America, and China, which are deeply
involved in the relationship between South and North Korea. Due to the lack of sources,
irregularly published official reports, and politically manipulated sources, this paper is going to
mainly focus on the humanitarian aid, limited to food aid and medical aid, sent to North Korea in
the first decade of the 21st century. Most of the resources published by the South Korean
government used in this paper are directly translated from Korean text.

5

England, Australia, New Zealand, France, Canada, South Africa, Turkey, Thailand, Greece, Netherland,
Colombia, Ethiopia, Philippines, Luxembourg, America, and Belgium (The Korean War)

Lee 3
In this paper, I contend that, South Korea, America, and China are providing
humanitarian aid to North Korea with different motives. South Korea uses the aid as a mean to
establish and promote political identities of each party and to satisfy political interests of
Koreans; foreign countries are still using the political situation in Korea to keep or increase their
political power in the international stage.

Part 1: Current Nutritional and Medical Landscape in North Korea

One day, my father hurt his forehead and a finger. We did not have enough
money to buy anesthetics, so a doctor started the surgery without it. I was sitting outside
of the operating room. I had never heard him screaming that painfully. Testimony of
a North Korean defector on a South Korean Television Program (Meet Now 72)
Due to North Koreas isolated political characteristics, it is difficult to get much
information about the medical landscape of North Korea. There is no official record written by
the South Korean government or materials that the North Korean government directly provided,
so the information relies heavily on reports and statistics provided by organizations such as UN,
WHO, and humanitarian organizations6. However, even information from those organizations is
partial. Part 1 is going to focus on the current medical landscape in North Korea based on the
information that is available.
Unlike the present situation, South Korea was much poorer than North Korea right after
the countries reached the Armistice Agreement in 1950. The current territory of South Korea was
the main battlefield for the Korean War. This was because most of the infrastructure was located
in the territory of North Korea7 and what left in the south were demolished, this left the citizens

6

Even official reports written by the South Korean government mostly refer to statistics provided by
international organizations.
7
During the Japanese colonial era, Japan built economic infrastructures in North Korean territory due to
accessibility to natural resources and geographical closeness to China.

Lee 4
poor and malnourished. North Korea was at a comparative advantage in their ability to recover
from the scars of war (The Korean War).
North Korea started free health service at 1950. Since the North Korean government put
its political foundation on socialism, it is not difficult to understand why North Korea
implemented the service to all North Koreans regardless of their socioeconomic status8. Its health
care delivery system was well organized from the primary hospital to the quaternary hospital.
Overall, the system focused more on prevention than treatment. Based on the description, it was
exemplary in its blueprints, but it soon started to collapse (Yun).
Since the early 1990s, both the nutritional and medical system started to collapse due to
severe economic crisis. Unlike South Korea, North Korea adhered to a closed economy, which
meant that economic trades, influx of technology, and other exchanges did not occur. Therefore,
as North Korea depleted its stored natural resources and infrastructures, it could not avoid
economic downfall. To make things worse, there were two heavy floods in 1995 and 1996 that
destroyed lands and what was left of the infrastructures. Production of rice and corn was only
around two million tons. According to the National Statistical Office of South Korea, about
610,000 people are estimated to have starved to death. Production of medical supplies decreased
more than 60% (Yun). John Linton, a chief doctor at Severance Hospital, said, Hospitals in
North Korea are in lack of electricity, medicine, and medical supplies. Well, they lack everything
related to modern medical sciences. So doctors climb mountains to find medicinal herbs and
resort folk remedies instead (Lee).

There still exist possibilities that free health service did not provide medical care with complete equal
quality. However, since it is impossible to conclude how much equality existed, this paper is going to
assume that the system provided equal access and quality to everyone.

Lee 5
The current condition of North Koreas nutritional and medical landscape can be
examined from both statistics provided by international organizations and the testimonies of
North Korean defectors. According to the data provided by UNICEF, 37% of children suffer
from chronic nutritional disorder, 23.4% of children from acute malnutrition, and 7% of children
have very low birth weight (Kim). Furthermore, according to UNFPA, neonatal mortality rate is
23.5 out of 1,000, and infant mortality rate is 45 infants out of 1,000 (Moon). And while measles
was once eradicated from North Korea in 1992, it reappeared in 2007, with over 3,000 patients
reported (Ko).
This is the North Korean health system as described by one of the defectors on a South
Korean TV show:
Since the march of hardship9 started, doctors also had difficulties maintaining
their life. They started to sell emergency medicine, such as penicillin and mycillin at a
premium, to buy foods for their families. Ordinary citizens had to buy their own medicine.
We would even have to buy our own anesthetics for our operations. (Meet Now 72)
Not only medicine, but also everything needed for hospitalization was not provided.
Patients had to bring their pillows, blankets, and mattresses along with many other necessities.
According to the defectors, the medical supplies provided by foreign governments and
international organizations as a form of humanitarian aid do not reach the ordinary citizens. The
defectors testified that they had never heard of relief goods when they were in North Korea. One
testified that:
When I went to obstetrics, people from the UN walked in to the room without warning.
Before they came in, six pregnant women in the room were left alone, receiving no care
from medical personnel. However, when they came in and questioned why the doctors
were not treating the women, then North Korean doctors started to check the pregnant
women. Also, medical personnel then started handing out peanuts and snacks that were

9

The march of hardship is a political slogan provided by Jung Il Kim to improve the nations economic
condition (The March of Hardship).

Lee 6
originally given to the hospital as relief goods. They were merely pretending that they
are providing medical assistance to citizens. However, once the people from the UN left,
they took the goods from us. And everything went back to the way it was. (Meet Now
59)
Most of medical deficiency in North Korea comes from scarcity of medical supplies
rather than from the lack of medical knowledge of doctors. According to Stephen Linton, the
president of Eugene Bell Foundation, the modern medical system requires skilled personnel,
machines, supplies, buildings, and energy. Each one of them functions as a building block, and
thus without any of them, the system cannot function properly. Even if an organization provides
expensive medical device or effective medicine, the situation would not improve much without
constant renovation and administration. Therefore, while North Korea still has many doctors,
nurses, and hospitals, their lack of medicine, machines, and supplies10 continue to endanger their
system.

Part 2: Humanitarian Aid from South Korea

Compared to North Korea, South Korea maintains a good quality of life in different
aspects including nutrition and medical care. According to the report of the International Food
Policy Research Institute, there was only 1% of undernourished population in South Korea,
while in North Korea during 2000-2003 there was 36% (Wiesmann 98). According to WHOs
report in 2000, South Korea ranked 59th while North Korea ranked 167th in ranking of health
systems based on an overall level of the distribution of healthcare and responsiveness and
financing of healthcare services. Ironically, South Korea, the country that once fell behind, now
sends humanitarian aid to help North Koreans suffering from hunger and disease. However, the

10

Stephen Linton assumes that there would be more than 300 hospitals all over North Korea (Linton).

Lee 7
aid is not provided only with a humanitarian purpose. It is not difficult to observe how South
Koreas political parties use the North Korean issue as a political tool.
As a divided country sharing a national border, South Koreans are very interested in the
relationship of the two countries. Also, as the two countries are in state of truce rather than the
end of the War, ordinary South Korean citizens have both hope for peaceful unification and fear
of another war breaking out. Since North Korea periodically threatens South Korea with nuclear
weapon and missiles, South Koreans tend to expect a clear line of policy from the government.
Therefore, every party, whether progressive or conservative, takes a stance on the North Korean
issue clearly but differently. Both sides share the ultimate goal as a peaceful unification between
the two countries, but their approaches toward the goal differ greatly. Progressive parties argue
for a conciliatory policy by aiding North Korea, while conservative parties argue for a hardline
policy by isolating North Korea and refusing aid provision. Since the policies regarding the
North Korean government differ greatly between parties, politicians use the attitude toward
North Korea as a means to establish and promote their political identities. This trend can be more
clearly observed from the difference in the policy of humanitarian aid each former president
provided.
This section is going to analyze policies and reactions of the three former presidents since
the late 1990s to the early 2010s: President Kim Dae-Jung, Roh Moo-Hyun, and Lee Myungbak.11 Both the former presidents Kim and Roh were belonged to progressive parties, while the
former president Lee was belonged to a conservative party. For the last decade, there were many
events, great and small, that impacted the relationship between South Korea and North Korea.

11

Park Guen-hye, the current president of South Korea, started her presidential term in 2013, so there is
not much information that can reflect her policy toward North Korea yet. Therefore, this paper will focus
on the three president mentioned above.

Lee 8
Each former president had faced about four major threats12 from North Korea during his term.
However, the amount of humanitarian aid has varied quite drastically between the Kim and
Rohs progressive regimes and the Lees conservative regime.
Before Kim became the 15th president of South Korea, the South Korean government had
been taken a hardline stance towards the North Korean government. To establish the political
foundation of the nation and unite citizens by creating a common enemy, the government had
depicted North Korea as the most dangerous entity that South Korea should fight against. This
hardline policy created a hostile attitude towards North Korea but did not prevent the country
from receiving threats.
As a response, Kim used an opposite political approachthe Sunshine Policy (also
known as the Engagement Policy). The name of the policy derived from Aesops Fables The
Wind and the Sun. Kim thought that cornering North Korea would not reduce the tension but
make the North Korean government take a more hostile attitude towards South Korea. Therefore,
to make North Korea consider the South as its friend that works towards a peaceful unification,
the Kim administration provided support and cooperation to the North Korean government under
the condition of no armed provocation. As a result, in 2000, the first ever North-South Korean
summit was held. Both the former South Korean president Kim and the former North Korean
Supreme leader Kim, met in Pyeongyang and planned out a meeting of separated families, a tour
to the Norths Kumgang Mountains, a participation of North Korean sports team in games held
in South Korea, and other nongovernmental exchanges (The Sunshine Policy).

12

For some threats, it is difficult to conclude as a threat from North Korea. There are several events,
such as Cheonan ship sinking, that are still debated among South Koreans whether they were North
Korean attacks or not. Furthermore, some political science scholars argue that the North Korean
government did not have other choice but to carry out an attack due to pressures from outside. Therefore,
it is impossible to affirm major events that are mentioned in this paper as threats, but for convenience I
am using the word threat to describe the events.

Lee 9
As the data provided by the Ministry of Unification of South Korea suggests, the South
Korean government provided about $270 billion amount of fertilizer to help North Koreas
agriculture, $250 billion amount of food as a form of a loan, and $450 million dollars for
humanitarian aid throughout Kims regime. More specifically, the amount of humanitarian aid
started to increase throughout the regime of Kim. Similar to Kim, Roh also followed the
conciliatory path. In 2006, the South sent humanitarian aid worth $200 billion, which is the
greatest amount that the South sent to the North in a year (Ministry of Unification of Republic of
Korea).
When the policy was first administered, South Koreans started to show a friendlier
attitude towards the North and started to have hopes for peaceful unification. However, in 1999
and 2002, the First and Second Battle of Yeonpyeong took place; in 2003, North Korea withdrew
from the NPT (Nuclear Non-Proliferation Treaty); in 2006, North Korea launched TaepodongTwo ballistic missile and conducted nuclear testing. North Koreas threats were smaller in
number compared to that of the past, but these major political threats were enough to make
people doubt the efficacy of conciliatory policies. Keeping pace with this publics political
interests, the conservative party started emphasizing that they take a hardline stance. As a result,
Lee became the 17th president of South Korea (Ministry of Unification of Republic of Korea).
Starting from the first year of his term, 2008, the amount of humanitarian aid sharply
decreased. Compared to the previous year, the South sent only $430,000 of humanitarian aid,
which is only 20% of what was sent in the previous year. In the following years, the amount of
aid was continuously reduced, and only $23,000 was sent in 2012. However, there were still
threats from North Korea: in 2008, a South Korean tourist was shot to death; in 2009, North
Korea launched another rocket and conducted nuclear testing; in 2010, North Korea bombarded

Lee 10
Yeonpyeong, which is located near the border. Furthermore, the relationship quickly cooled off
(Ministry of Unification of Republic of Korea).

Part 3: Humanitarian Aid from Foreign Countries

Many historians in South Korea argue that Korea would not have been a divided country
if there were no intervention of powerful nations. Due to the different political ideologies that the
powerful nations were holding, South and North Korea is struggling with not only the political
tension between each other, but that of the other countries. Similar to what happened 50 years
ago, foreign countries are still using political situation of Korea to keep or increase their political
power in the international stage. This part is going to focus on America and China as examples
of foreign countries using humanitarian aid as their political tool. America, the worlds most
powerful country, uses humanitarian aid to keep its role as a policeman of the world, while China,
a fast growing country, uses aid as a mean to check America.
America has been a main political opponent of North Korea since the formation of North
Korea. Especially, since America had been a promoter of democracy as the best form of
government, the US government is displeased with North Korea continuing its hereditary
dictatorship and keeping its monarchist government form. Putting the long-standing political
tension aside, the recent relationship between North Korea and America has exacerbated due to
North Koreas tests of nuclear weapons, its development of long-range missiles, and North
Koreas constant threat on the international society with its nuclear weapons. As a response, the
American government does not provide a grant-type aid to North Korea but provides aid under a
specific condition.

Lee 11
According to Foreign Assistance to North Korea published in 2012, between 1995 and
2008 America provided over $1.3 billion for aid. Since early 2009, however, the United States
has not provided aid anymore (Manyin 2-3). More specifically, America has provided food aid
only when North Korea had desperately asked foreign nations for help. However, there were
some times when America did not aid North Korea even in times of their desperateness: 20062007 and 2010-2012. Provision of medical aid is even more limited in condition. In 2008, the
Bush administration provided $4 million under the clear investigation and control of
international organizations in allocation; in 2010, the Obama administration only provided
$600,000 to help specific flooded areas of North Korea (Manyin 1-3).
In general, America promises aid under clearly stated conditions such as nuclear
disarmament. In other words, the type of Americas humanitarian aid is closer to trades
exchanging aid and global security. If North Korea does not fulfill the promise, the American
government stops providing aid to the country. As North Korea conducted its second nuclear
testing in 2009, the American government stopped sending humanitarian aid completely (Manyin
3). Also, in May 2014, the Obama administration canceled a proposed food aid after North
Koreas attempt to launch a long-range rocket (Welker). America argues that the fact that North
Korea conducts nuclear testing and launches missiles threatens not only Americas national
security but also international peace. Furthermore, the fact that the American government reacts
more directly to the threat from North Korea rather than what North Korea actually needs to
sustain life of its citizens demonstrates that the American government is playing its role as a
policeman of the world rather than a warm-hearted helper.
On the contrary, China is one of few countries that continues a politically favorable
relationship with North Korea. Although there is no official report published on the amount of

Lee 12
humanitarian aid that China provides to North Korea, that China is sending great amount of
humanitarian aid to North Korea has been widely accepted as a fact. The South Korean
government estimates that China provides $300 million to $400 million grant-type aid to the
North Korean government. Based on this estimate, China is the worlds biggest aid provider of
North Korea (The Relationship of North Korea and China). Few months ago, a Chinese
scholar He Fang wrote on Yanhuang Chunqiu magazine that China provided $96 million of
humanitarian aid in a form of grant since the late February of 2012 (Hong). However, since there
is no open explanation of the motive behind the enormous amount of aid, it is difficult to make
an exact assumption based just on the statistics.
Even though there have been some recent tension between the two countries, China has
supported North Korea both politically and economically even before the formation of North
Korea. From the late 1940s to the late 1950s, China had cooperated with Soviet Union for
socialist nation building, and North Korea was a part of a larger socialist community. Based on
the shared political stance, China and North Korea kept their close relationship. China
participated the Korean War as a political ally, and kept the favorable relationship after the War
by forming a trading relationship. From the late 1950s to 1970s, when China and Soviet Union
experienced political conflicts, China tried to win North Korea to its side by concluded multiple
treaties on trade, armed forces assistance, and technology assistance. However, as China started
to open its gate to western countries and international organizations, the relationship between the
two countries turned stale due to the international pressure on the Chinese government. However,
China is still playing a role as a bridge between North Korea and international society and even
supported the stance of North Korea publicly (The Relationship of North Korea and China).

Lee 13
Currently America and China are the two politically powerful countries in the world that
constantly keep checking each others power. As a part of that, China seems to support North
Korea with aid. Since China has been one of few countries that hold the notion of communism
after the Cold War ended, there are not many countries that China built a national alliance for a
long time. After the open-door policy of China in the 1980, China started to form a close
relationship with other nations, but it does not have as many political alliances as America. Many
political science scholars argue that China wants to surpass the political influence of America in
the international settings, and thus maintains close relationship with North Korea. Firstly,
without the presence of North Korea, China would be geographically surrounded by Americas
military bases and pro-American nations, which may pressure China both politically and
militarily. Furthermore, by keeping a close relationship with North Korea, China can be the
greatest power that exerted on North Korea. In other words, North Korea would listen to China
more than other countries, and China can use that political relationship as its power in
international scenes.

Conclusion
According to the Global Humanitarian Assistance, humanitarian assistance is aid and
action designed to save lives, to alleviate suffering and maintain and to protect human dignity
[] that is intended to be governed by the principles of humanity, neutrality, impartiality and
independence. North Koreas current nutritional and medical situations desperately need the
help from outside. Especially, since the nation is sustaining its reclusive characteristic due to its
political structure, it is difficult for outsiders to help them in different ways other than sending
humanitarian aid. To fight against hunger and illnesses, there should be cooperation between

Lee 14
governments. However, the statistics regarding humanitarian aid sent to North Korea from South
Korea, America, and China show that North Korea is not receiving help that is free from political
ideologies and interests.
South Korea sends aid as a country that was once together, but the aid itself is used as a
mean to show political identity of a politician or a political party and to satisfy peoples
expectations on national security. America uses aid as a mean to threat North Korea. By defining
North Korea as a threat to peace and controlling the amount of aid based on North Koreas
actions, America attempts its position as a policeman of the world. In contrast, China provides a
significant amount of aid to North Korea continuously. By doing so, China keeps its influence on
North Korea, and thus attempts to mitigate American political power.
It might be difficult, or too nave, to expect nations to send humanitarian aid based solely
on a humanitarian purpose, since aid has to do a lot with money, resources, and even political
relationship. I do not want to defend nuclear testing, missile launches, and other military actions
taken by the North Korean government. However, it seems like those excessive military actions
and threats seem like a last resort that North Korea is implementing in order to sustain its nation.
The current circumstance of North Korea is vulnerable in political, economic, medical, and other
ways. Of course, there must be constant pressure on the North Korean government to make sure
North Korea is not taking an extreme way to keep its status. However, I believe there must be
nonpolitical humanitarian aid to North Korea to open the gate of that country. Showing warm
hearts of different countries would make them less intimated by the foreign countries and might
lead to a peaceful unification of the two Koreas one day.

Lee 15
Works Cited
Defining Humanitarian Assistance. Global Humanitarian Assistance. <
http://www.globalhumanitarianassistance.org/data-guides/defining-humanitarian-aid>.
Episode 59. Meet Now. Channel A. Republic of Korea. 27 Jan. 2013.
Episode 72. Meet Now. Channel A. Republic of Korea. 28 Apr. 2013.
Hong, Seung Jun. China provided 600 Million Yuan Since the New Kim Regime. SBS News.
11 Feb. 2014. < http://w3.sbs.co.kr/news/newsEndPage.do?news_id=N1002232077>.
Jang, Yong Jun. Korean History Caf with Teacher Jang. Seoul: Bookmentor, 2008.
Kim, Hye Ryun. Overview of the Nutritional Status and Policy Directions of Supporting
Childrens Nutrition in North Korea. Health and Welfare Forum Oct. 2007: 24-34.
Ko, Il Uk. The International Red Cross Declares 3,000 Measles Patients in North Korea. MBC
News. < http://imnews.imbc.com/replay/2007/nw1200/article/1501725_13324.html>.
Lee, Dong Hun. Supplies and Equipment Aid is More Urgent. Unified Korea July 2008: 94-96.
Lee, Ilhak. The North Korean Health and Healthcare: Issues and Strategies. Korean Medical
Association 56. 5 (2013): 356-357.
Linton, Stephen. Medical Aid to North Korea and Unification of Korea. Eugene Bell
Foundation. Anyang, Republic of Korea. 19 Mar. 2004.
Manyin, Mark E., and Mary B. Nikitin. "US Assistance to North Korea." Library of Congress of
Washington DC Congressional Research Service, 2008.
Moon, Ok Ryun. Current Status and Needs of Health and Medical Care Services in North
Korea. Health and Welfare Forum June 2005: 17-27.
Statistical Data. Ministry of Unification of Republic of Korea.
The Korean War. Doosan Encyclopedia. 2010.
The March of Hardship. Doosan Encyclopedia. 2010.
The Relationship of North Korea and China. Doosan Encyclopedia. 2010.
The Republic of Korea. Doosan Encyclopedia. 2010.
The Sunshine Policy Doosan Encyclopedia. 2010.
United Nations Development Programme. Human Development Report 1998. New York:
Oxford University Press, 1998.
Welker, Kristen. US Cancels Food Aid to North Korea After Missile Launch, Warns of More
Sanctions. NBC News. 13 Apr. 2012. <
http://worldnews.nbcnews.com/_news/2012/04/13/11177478-us-cancels-food-aid-tonorth-korea-after-missile-launch-warns-of-more-sanctions?lite>.
World Health Organization. The world health report 2000: health systems: improving
performance. World Health Organization, 2000.
Wiesmann, Doris. FCND Discussion Paper 212: A Global Hunger Index: Measurement
Concept, Ranking of Countries, and Trends. International Food Policy Research Institute,
2006.
Yun, Young Kwan. Current North Koreas Medical Landscape and the Direction of Support.
KPI Report 4.1 (2010): 1-4.