As a doctor, my responsibility is to treat patients regardless of nationality, race, ideology or circumstance. This obligation stems from a belief in the value of human life superior to any other judgment. And as a Korean American, I have felt a particular sense of duty to help people on the Korean Peninsula — specifically in North Korea — where circumstances have created some of the most pressing humanitarian conditions in the world.
As one of the few American physicians who has worked to deliver humanitarian aid and improve health care in North Korea, I have seen how the North Korean doctors have adapted to scarcity. For example, they reuse intravenous catheters, scalpels, gauze and gloves by meticulously cleaning and resterilizing them — until they become unusable. The current sanctions are making matters worse. Critical parts for vital medical equipment are no longer able to be quickly and effectively imported.
During my most recent trip, an intra-operative X-ray machine, a piece of equipment which I depended upon for spine fracture repairs during my more than 20 visits to North Korea, was broken, making the operation much more treacherous. I fear the worsening of access to basic medicines and medical equipment in this isolated country will lead to increased deaths and disabilities.
Health care is humanitarian aid
The United Nations Security Council, the United States and other countries that have imposed sanctions on North Korea bear some of the responsibility for the worsening humanitarian crisis.
Take, for example, UNSC Resolution 2397, adopted in 2017, which prohibits the transfer of all industrial machinery, transportation vehicles and iron, steel and other metals. According to a 2019 letter from the U.N. Panel of Experts, this prohibition “covers several goods which are vital to agriculture or public health programs, including a variety of agricultural machinery and medical equipment.”
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Although in its resolution the UNSC states that sanctions are “not intended to have adverse humanitarian consequences for the civilian population of the" Democratic People's Republic of Korea (DPRK), it is clear that they do. Health facilities in the country — particularly in rural areas — often lack essential medical equipment, as well as access to clean water and reliable electricity. This is why it’s all the more concerning that the list of banned humanitarian-sensitive items includes such basic medical supplies as sterilizers, ultraviolet lamps for disinfection, ambulances, syringes, needles, catheters, X-ray and ultrasound machines, microscopes as well as machinery for filtering or purifying water.
Although the UNSC can make case-by-case exemptions for humanitarian-related items, this mechanism is insufficient to allow humanitarian organizations to deliver necessary equipment in a timely manner. For example, in an analysis of 25 exemption requests, the U.N. Panel of Experts observed months of delays for cases such as water systems, ambulance vehicles and medical equipment for emergencies.
Another major barrier to the delivery of humanitarian aid in North Korea is the long lead time applicants must have in planning humanitarian shipments, because exemptions, the panel notes, become invalid if there are “any changes to planned suppliers, shipping routes, item specifications or quantities.” At the same time, organizations that do get exemptions have to renew their request ever six months. You can see why some nongovernmental organizations might avoid even trying to get an exemption request in the first place.
Closing paths that keep civilians alive
While the U.N. sanctions stress that North Korea is primarily responsible for providing for the needs of its people, there does not appear to be any mechanism to allow the government to apply for any exemption requests — putting the onus completely on international and NGOs to carry out assistance and relief activities in the DPRK for the civilian population.
Although we might not know the full extent of the humanitarian impact of sanctions on the DPRK until it is too late, a new report commissioned by the Korea Peace Now campaign estimates that 3,968 people — the majority of them children under age 5 — may have died last year as a result of sanctions-related delays and funding shortfalls affecting U.N. agencies. The actual number of preventable deaths due to the full impact of the sanctions is likely much higher.
An estimated 11 million people — more than 40% of the population — in North Korea lack sufficient nutritious food, clean drinking water or access to basic services like health and sanitation, and this is directly linked to a high prevalence of diarrhea and other diseases, as well as undernutrition. North Koreans also suffer from one of the highest rates of tuberculosis in the world, causing an estimated 16,000 deaths each year.
The international community is rightly concerned with the humanitarian conditions inside North Korea. But we cannot hold these positions while also supporting policies that exacerbate the problem. The time is now to lift sanctions that harm and hamper the delivery of lifesaving medical and humanitarian aid.
We should never have to ask for permission to save another human being’s life.
Dr. Kee B. Park is a lecturer on Global Health and Social Medicine and the lead for the Korea Policy Project at Harvard Medical School. As the director of the North Korea Program at the Korean American Medical Association, he has worked alongside North Korean doctors in the Democratic People's Republic of Korea since 2007.
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This article originally appeared on USA TODAY: United Nations sanctions on North Korea exacerbate health care crisis