PMC:7156578 / 25866-30038 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7156578","sourcedb":"PMC","sourceid":"7156578","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7156578","text":"North Korea\nNorth Korea, the most sealed-off country in the world, has literally shut down all borders and communications on COVID-19, denying, according to their propaganda channels, the existence of any cases or deaths. This is unusual as it sits between China and South Korea, which have recorded the largest numbers of cases. Researchers state it is “unlikely that North Korea is free of COVID-19.” South Korean media reported that Kim Jong Un, the North Korean leader, had an official executed for violating the quarantine after the official returned from a trip to China. This may or may not be true since such reports have proved dubious in the past. North Korea press outlets claim that “not one novel coronavirus has emerged;” yet South Koreaʼs Unification Ministry (Seoul, South Korea), in charge of inter-Korean relations, reported to the WHO that North Korea had tested 141 suspected cases of coronavirus and all came up negative.47 Nevertheless, South Korean media, relying on anonymous sources, report cases of COVID-19 in North Korea, some of them fatal, according to John Linton, head of the International Health Care Center at Severance Hospital in Seoul: “Through private sources, they’re asking for disposable gowns, gloves, and hazmat suits, which are undoubtedly lacking,” he says. “So something is going on, otherwise they wouldn’t be asking for this.”47\nNorth Korea relies on China for more than 90% of its trade. Researchers admit that while health indicators have improved in the two decades since the countryʼs 1990s famine, during which hundreds of thousands of people starved to death,48 but there are still major problems. In the 1990s, Amnesty International (London, UK) detailed a crumbling health care system in North Korea, a nation unable to feed its population, and, in violation of international law. North Korea refused to cooperate with the international community to receive food. Levels of malnutrition, maternal health, and tuberculosis (TB) are chronic problems, but a lack of accurate data on HIV/AIDS and hepatitis B present cause for alarm. Health indicators have improved in the two decades since the countryʼs 1990s famine, but major problems still exist. Whereas communicable diseases account for a large proportion of the disease burden, there are very few opportunities to better understand and control them.49 While health infrastructure has improved, capacity is low and the health system is chronically under-resourced. North Korea has allowed for United Nation (UN) interventions, primarily focused on sustainable development, but this has been on North Koreaʼs terms, a demand not unusual for autocratic regimes.50\nIn 2014, the report of the UN Commission of Inquiry on Human Rights in the Democratic Peopleʼs Republic of Korea (DPRK) concluded that: “20 years after humanitarian agencies began their work in the DPRK, humanitarian workers still face unacceptable constraints impeding their access to populations in dire need.”51 The report found that the DPRK has “imposed movement and contact restrictions on humanitarian actors that unduly impede their access.” The DPRK has “deliberately failed to provide aid organizations with access to reliable data, which, if provided, would have greatly enhanced the effectiveness of the humanitarian response and saved many lives.” The North Korean government “continually obstructed effective monitoring of humanitarian assistance, presumably to hide the diversion of some of the aid to the military, elite, or other favored groups, as well as to markets.” In summary, the report stated:In this tightly controlled political climate, international humanitarian staff often have to make compromises. Some point out privately that it is unrealistic to try to uphold humanitarian standards in an environment as difficult as North Koreaʼs. They try hard to come up with ways to make their aid sustainable for the North Korean people, but their plans are not always accepted.51\nAlthough the knowledge of public health has improved in recent years, 18 million people are dependent on a public distribution system of food rations and more than 10 million are 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