appeal no. 01.33/99
period covered: September- 30 November 1999
Despite some improvement in food production, the situation in the Democratic People's Republic of Korea (DPRK) remains critical in terms of the sustainability of the national economy and the resulting human cost. Assessments conclude that external food and health assistance will need to be continued for an indefinite period.
The lack of pharmaceutical raw materials and antiquated production facilities has brought the production of drugs within the country to a halt, leaving the health sector almost entirely dependent on herbal medicines. In addition, many hospitals are unable to provide a basic and balanced food ration to in-patients, while the increasing number of patients suffering from gastrointestinal ailments as a result of eating "substitute food" is further straining the inadequate health facilities.
It is difficult to predict how the situation in the DPRK will develop. The Government's mid-term strategy will reportedly concentrate on the rehabilitation of the agricultural sector in order to maximise food security. It recognises that international support to the health sector will be needed during the year 2000. The recovery of the pharmaceutical production industry may take some three to four years.
Against this background, the International Federation and the DPRK Red Cross developed the joint 1999 programme, structured as follows:
Operational in 47 counties in North and South Pyongan, Kaesong and Chagang provinces
- quarterly distributions of basic drugs and supplies to 1, 681 health facilities
- health training / health promotion activities
- water and sanitation project
- winterisation - provision of blankets and sheets for medical institutions
Training and provision of equipment to Red Cross first aid posts
Disaster Preparedness, Response and Capacity Building
- Operational throughout the country
- Disaster Preparedness and Response training (DPR) and familiarisation with relief equipment
- Disaster Preparedness operations - Decentralisation of DP relief materiel to regional warehouses and disaster preparedness measures by Red Cross branches jointly with other agencies
- Further development of the vehicle workshop in Pyongyang.
FAO and WFP reports estimate that the cereal deficit and food aid needs for 1999-2000 will be 1.29 million MT. and 993,000 MT. respectively, including 580,000 MT. in emergency assistance to the most vulnerable. The nutritional situation of the population remains fragile, with a vicious cycle of poor nutrition compounding poor health.
The national harvest began in October and was completed in November. According to the United Nations Office for the Co-ordination of Humanitarian Affairs (OCHA), rice production improved in 1999, due to increased fertiliser use, adequate irrigation and the absence of serious pest and disease attacks, although the country still has a food supply deficit because of decreased maize production.
Fertiliser use in 1999 was almost double that of 1998, but remained less than a third of needs. A higher double crop production of potatoes, wheat and barley provides invaluable food supplies during the lean season, but overall production remains severely constrained by shortages of fertiliser and other essential inputs.
Red Cross/Red Crescent action
In September and October Federation Delegates visited and monitored a total of 62 health institutions. Monitoring showed that all institutions had practically exhausted the supplies of medicines distributed by the Federation in late June and July.
The fourth quarter drugs distribution funded by the Norwegian Red Cross and the Australian Red Cross is under way after the arrival of the medical kits in Pyongyang in October-November. The kits were distributed to 47 county warehouses, prior to their final distribution to hospitals and institutions.
Warehouses in Changang, South Pyongan and Kaesong have been monitored by the Federation health team. Monitoring is scheduled to be completed at the beginning of December.
On 27 and 28 September a health workshop, initiated by the Federation and the first of its kind, was held in conjunction with the National Society. It aimed at discussing ongoing programmes, achievements and difficulties encountered.
The issue of restrictions imposed by the Ministry of Public Health and the National Society on the monitoring of drugs by Federation Delegates was extensively discussed with the Society. It has been resolved that Federation delegates will continue drug monitoring at each administrative level according to established procedures. In addition the Federation health team restarted the drug distribution impact study (disease surveillance) in 15 institutions in North Pyongan, as from November.
Reports from the Ministry of Public Health (MoPH) on the incidence of malaria in the country record a total of 100,000 cases in 1999, with 40,000 of these occurring within the Federation operational area. All observed cases are caused by P. Vivax.
The Delegation purchased midwife kits using funds received from a private Chinese donor in April this year. These kits were distributed in September and October to Ri hospitals in the Federation operational area.
Distribution of brochures relating to "Diarrhoea and Mothers' role" and the "Drugs Manual" continued during this period. In October the Federation together with the DPRK Red Cross completed training on diarrhoea prevention and treatment. A total of 73 health staff participated in one day workshops. The last safe motherhood training session also took place: it was organised in Byokdong for midwives from Ri hospitals. Training materials on Acute Respiratory Infections have been prepared by the Federation, translated by the National Society and presented to the Ministry of Health for approval.
Community Based First Aid (CBFA)
The Federation health team continued data collection on CBFA, visiting seven first aid centres during the reporting period. The visits showed that regular training of trainers and of Red Cross volunteers takes place and that Red Cross volunteers conduct training in the communities on a regular basis. An assessment of the current First Aid activities of the National Society is still continuing.
Disaster Preparedness and Response (DPR)
In September, 95 MT. of rice were distributed
to flood victims in Keasong. This was in addition to the 100 MT. distributed
in August to 39,000 moderately affected people and 3,000 seriously affected
people. Although the emergency phase is over, the 581 families who were
worst affected have not been fully rehabilitated as the local authorities
do not have the resources to cover their food and rehabilitation needs.
A joint National Society and Federation team carried out a reassessment
of the situation on 22-23 November, which revealed an acute need for food
and clothing. The Federation is planning to provide
food for three months, blankets and winter jackets.
Because of the food shortages, the Government has stopped distributing food, including substitute food, in some areas of the country. A halt in the inflow of rice in the WFP pipeline over the August/September period compelled the Flood Damage Rehabilitation Committee to ask that the rice stocks held by the Red Cross in all its regional warehouses be distributed, which was done.
The Federation is purchasing 60,000 blankets for immediate distribution to hospitals and clinics. The first formal Federation-supported Red Cross branch training in the country was held at Kaesong, 22-26 November, with 40 participants from the four counties. Local authorities and other agencies were invited to participate in this training and they responded well.
Water and Sanitation
A review team from the Secretariat in Geneva and the Swedish Red Cross visited DPRK in October. They accompanied the water and sanitation delegate on field trips to Unsan and Kujang county hospitals and Sunchon city hospital and also held meetings with the Federation delegation and National Society headquarters officials.
In September and October the Federation delegate visited five hospitals in North Pyongan province to asses the water facilities and, together with the review team, visited the water pump factory in Anju. It had previously been difficult to gain access to this factory and obtain information about water pumps and their capacity. This, coupled with logistical delays in obtaining materials and equipment from China has considerably delayed the implementation of the water and sanitation project.
Deliveries of tools for the workshop have been delayed. In the meantime, the National Society has done a lot of work on the workshop building, to make it fit for use.
There has been a lot of activity in this area during the reporting period and this will continue for the remainder of the year and into January 2000, since many procurement projects are still being processed for disaster preparedness, health and water and sanitation activities.
The Federation is now mobilising funds for the procurement of drugs for the first quarter of 2000.
Disaster Preparedness and Response:
Continued support of the Kaesong disaster victims is being planned
External relations - Government/UN/NGOs/Media
A National Immunisation day organised by MoPH, WHO and UNICEF was held on 20 October. Two Federation health delegates participated in this event, during which 2.3 million under-five children were immunised against polio. A total of 12,000 immunisation posts in Ri level clinics were deployed and 45,000 health workers were involved.
Reports from WHO indicate that tuberculosis (TB) cases in the country have reached epidemic levels. Two WHO experts carried out a two week training programme in October on DOTS (Directly Observed Treatment Short-course). A comprehensive manual on DOTS has been prepared in Korean. The Federation has held several meetings with WHO dedicated to the revision of the drug manual printed in March 1999. In the revised version, three new chapters will be included -- on malaria, DOTS and vaccination schemes.
UNICEF jointly conducted an evaluation of its Essential Drugs Project with the Ministry of Public Health from 26 October to 8 November. The evaluation showed that medical practitioners are sparing in their use of modern drugs. This is explained mainly by the concurrent prescribing of traditional medicines.
The United Nations Inter-Agency Consolidated Appeal for the DPR Korea was launched on 23 November in Geneva. The Federation health team was actively involved in the Consolidated Appeal process and attended a workshop held by the United Nations Office for the Co-ordination of Humanitarian Affairs on 15-16 September in Pyongyang.
The National Society is kept informed about the humanitarian programmes of other UN Agencies and NGOs, to avoid duplication of efforts in meeting the needs of the vulnerable, both in the operational areas and other provinces.
See Annex 1 for details.
The continued lack of resources in the country still affects the rationalisation and prioritisation of programmes by the National Society, which recognises that capacity building and response to material needs must be given equal importance.
Asia and Pacific Department
Operations Funding and Reporting Department