The most comprehensive study to date on health in North Korea has accused the regime in Pyongyang of being indifferent to the fate its children in its haste to develop nuclear missiles and other weapons.
The result of nearly 30 years of research, the report details the fine line that children in the North walk between life and death, as well as the
human rights violations they face due to the state's prioritisation policies.
The report, "Lost Generation: The Health and Human Rights of North Korean Children 1990-2018", was released in Washington on Friday and focuses on those who survived - albeit traumatised - what is euphemistically known in the North as the "Arduous March".
Between 1994 and 1998, some estimates suggest that 3.5 million people in a nation of 22.5 million starved to death due to a combination of chronic economic mismanagement, natural disasters and a sharp reduction in financial and food assistance caused by the collapse of allied countries in the Soviet bloc.
Authored by W. Courtland Robinson, an associate professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, and published by the Committee for Human Rights in North Korea (HRNK), the release of the report was timed to coincide with the 15th anniversary of the signing into US law of the North Korean Human Rights Act.
"This is an extremely important report because it demonstrates that the modus operandi of the North Korean regime is regime survival at any cost", said Greg Scarlatoiu, executive director of HRNK.
"The allocation of resources is focused solely on regime survival, with a lot of money being spent on ballistic missiles, nuclear weapons and the military at the expense of the food security of the people and their human rights", he told The Telegraph.
"A lot has been said since the Pyeongchang Winter Olympics in 2018 about assistance for the economic development of the North while permitting the regime to keep its nuclear weapons, but we believe that there can be no development without dramatic improvements in the human rights situation in the North", Scarlatoiu said.
"And that is especially important for the most vulnerable in the North, the children".
The study focuses primarily on the impact that the famine had on children, identifying patterns of mortality, causes of death,
nutrition levels and food security, as well as physical and mental health. One finding of the report is that rations provided by the state to each household per month fell from 12.7 kg in 1995 to just 5 kg in 1998.
Inquiring with refugees and defectors, more than 44 per cent of child deaths in their families between 1995 and 1998 were due to
starvation or malnutrition, with a further 20 per cent attributed to infectious diseases.
It points out that the situation was dramatically worsened by the collapse of the nation's health care system in the 1990s, meaning the re-emergence of vector-borne diseases that had previously been virtually eradicated. Malaria, for example, has returned as a serious threat to public health. Similarly,
tuberculosis and other communicable diseases pose a new threat to the public in general.
The study also examines the particular plight of children in detention, usually through no fault of their own but because
an entire family has been incarcerated due to the policy of shared punishment for one person's transgression. Sections of the "Lost Generation" report are dedicated to the "kotjebi" street children, many of whom lost their parents in the famine, as well as those in orphanages and those living rough in China after crossing the border.
Even now, long after the famine has passed, research shows "clear indications of a continuing problem" in which "undernourishment is a common denominator for many of the health problems afflicting North Koreans".
Data from four studies of refugee and migrant children from the North shows that youngsters from the North are all
shorter than their counterparts in South Korea, with the magnitude of those differences depending on age and gender.
In his forward to the report, Scarlatoiu says
North Korea should improve its dire record on human rights as part of any discussion on the political and security issues that are currently on-going, adding, "For North Korea, the first step towards rebuilding the international credibility it has been squandering for decades is to seriously acknowledge and address its human rights situation.
"To move forward, North Korea will have to cease directing precious resources away from the humanitarian needs of its population, in particular the most vulnerable, toward the development of its nuclear weapons, missiles and other tools of death".
Among its extensive list of recommendations to North Korea, the report calls for access to food and nutrition, especially for the disadvantaged, the monitoring of humanitarian food aid, the reconstruction of health care infrastructure, increased investment in agriculture and immediate access for the Office of the UN High Commissioner for Human Rights and the UN Special Rapporteur on the issue in North Korea.
The study also calls on Pyongyang to adhere to the Universal Declaration of Human Rights and the 1989 Convention on the Rights of the Child.
The 132-page report is dedicated to the memory of the "countless numbers of North Koreans - men, women and children - who have suffered and died from famine, exposure, overwork, imprisonment and torture, or malign neglect by their government".
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