DPR Korea: UNICEF Humanitarian Appeal for Children and Women: Jan-Dec 2000

COUNTRY SITUATION

• Three of every 10 children under two suffer severe malnutrition
• Six of every 10 children under seven suffer from stunted growth
• Approximately 10,000 children in need of special protection
• Educational gains threatened
• Health care system in crisis
• Re-emerging threats of polio, tuberculosis and neonatal tetanus
• Low immunization coverage (DPT: 37 per cent; measles: 34 per cent)
• Epidemic levels of tuberculosis - 40,000 new cases per year
• Severe and moderate malnutrition affect 16 per cent of children aged seven and under
• 95 per cent of wells pose risk of faecal contamination
• 80 per cent of all dug latrines in the country are unsanitary
• Crude death rate as reported by the Government increased to 9.3 per 1,000 in 1998, up from 6.8 per 1,000 in the early 1990s

UNICEF COUNTRY FOCUS

• Sustain achievements in education through providing basic equipment/supplies and teacher training, reaching 350,000 children under 17 years of age.
• Increase access to safe water and sanitation in eight provincial towns and 42 counties through 150 water stations and in 500 children's institutions.
• Support delivery of routine immunization services to reach 430,000 infants, 330,000 women of childbearing age and 2.1 million children under five against polio.
• Rehabilitate health care delivery system through provision of essential drugs, equipment, upgrading maternal health services and training for health providers.
• Improve food security and nutrition of mothers and under-fives through supporting small-scale supplementary food production and nutritional rehabilitation services for severely malnourished children.

UNICEF, in partnership with the World Food Programme (WFP), the World Health Organization (WHO), the United Nations Development Programme (UNDP), the International Federation of Red Cross and Red Crescent Societies (IFRC), the Oxford Committee for Famine Relief (OXFAM) and others, responded to the critical food shortage and resultant humanitarian crisis in health and other basic social services, with emergency relief and supplies. Along with rehabilitation, a recovery programme is being implemented to ensure a safety net for vulnerable populations. This includes building capacity for local production of essential drugs, promoting preventive health care practices, bolstering the health and nutritional status of women and children and ensuring proper access to safe water and sanitation to control the spread of water-borne diseases.

TOTAL FUNDING REQUEST: $17,656,000

EMERGENCY CONTEXT

Food shortages and deteriorating health services brought widespread child malnutrition to the Democratic People's Republic of Korea (DPRK) in the mid-1990s. Although food availability remains scarce, improvement in the food situation since the peak of the crisis in 1996/97 is attributable to large inputs of food aid, better harvests as a result of double-cropping, increased use of fertilizers and pesticides and potato production. The health condition of children in nurseries and kindergartens, who were the prime beneficiaries of food aid and other targeted basic services, improved in 1999. Nevertheless, agencies continued to report the presence of large numbers of malnourished children, particularly in hospitals and in baby homes. The joint Nutrition Survey of children under seven years of age confirms very high rates of wasting (16 per cent) and stunting (62 per cent), reflecting both a current food shortage problem as well as long-term deprivation.

In contrast to the improved food situation, the health situation remains critical, as evidenced by the re-emergence of previously controlled diseases and high morbidity among children under five years of age. The decline in the DPRK economy, attributed to the loss of traditional markets with the former trading partners in the socialist bloc and limited international cooperation, has had an adverse impact on the capacity of the country to maintain quality health care and other basic social services. Specifically, the near-cessation of local drug production and other commodities has resulted in a shortage of essential drugs and basic equipment. Health providers' limited access to contemporary developments in health care has also created a knowledge gap in standard treatment practices and global trends in medical science.

The economic crisis has further crippled the public water system, in terms of water quantity and quality. In highly populated areas, this breakdown could lead to a large-scale outbreak of water-borne diseases, if the situation continues to deteriorate. The continuing fluctuation in water pressure, due to interruption in the electricity supply, allows for contaminated water to flow back into the pipes, polluting the water supply to households. Furthermore, the lack of chemicals for disinfection, such as calcium hypochlorite, resulted in many treatment stations pumping water directly to consumers without chlorination, exposing many people to great risk. People are encouraged to boil their water; however, fuel is a scarce resource. In children's institutions, the potential risk of infection due to an unreliable water supply and improper sanitation facilities is considerable. Water-related infections are major contributors to high morbidity amongst children, especially diarrhoeal diseases and skin infections.

The DPRK has made remarkable achievements in the field of education, attaining Education for All (EFA) goals long ago. The nation has a reported near-universal adult literacy. However, the economic crisis has had a severe impact on the pre- and primary school sectors. There are inadequate financial resources for the purchase of teaching equipment, including textbooks, basic teaching materials such as paper and writing tools, and play equipment. School infrastructures are in disrepair. Field reports indicate that school attendance has dropped as a result of the general priority to meet food and nutrition needs by students and teachers. Educational goals will inevitably be retarded unless large-scale interventions are made in support of the creation of a safe, warm and educationally stimulating environment for all children.

The humanitarian strategy in DPRK focuses on the improvement of health services, water purification and sanitation programmes and food aid in the targeted areas. A second major component is recovery and development with stronger linkages between relief programmes. Partners in these efforts include 11 non-governmental organizations (NGOs), ICRC, WFP, UNDP and WHO. It is believed that international aid has helped to stabilize the current food crisis and stemmed the further decline in the quality of basic social services in the targeted communities and institutions. The gains made thus far, however, could undergo rapid reversals if external assistance is not sustained.

UNICEF PROGRAMMATIC INTERVENTIONS IN 1999

Progress has been made in responding to the crisis affecting children and women since relief agencies began operations in 1995. Government understanding of the requirements of agencies in terms of access, knowledge, information and accountability has increased. CAP interventions have reinforced activities, which are being implemented under the regular Country Programme of cooperation (1999-2000). Major achievements included:

• Reviewed EPI policy, strengthened EPI staff capacity through training, met the entire vaccination requirements and provided equipment and logistical support to refurbish the cold chain;
• Successfully observed National Immunization Days (NIDs) in October and November to eradicate polio by year 2000 and supported prevention of vitamin A deficiency through high dose of vitamin A supplementation;
• Supported nutritional rehabilitation in paediatric and county hospitals and children's institutions nationwide, in partnership with WFP and NGOs;
• Provided winter clothing and created an enabling environment for children in need of special protection;
• Rehabilitated local salt pan in collaboration with UNDP and WFP, including the iodization of salt for human consumption;
• Initiated domestic production of pharmaceuticals in an effort to revive local capacity and increase self-sufficiency, in partnership with WHO and ACT/Diakonische Werk/DIFAM;
• Supported monitoring and testing of water quality in partnership with OXFAM in an effort to control the spread of water-borne diseases;
• Upgraded nine provincial maternal and 40 country hospitals with basic equipment to provide women with emergency obstetric care; trained midwives and doctors;
• Provided essential drugs to more than 2,500 health institutions covering a total population of 12.8 million in six provinces and two cities;
• Implemented a nationwide training programme to familiarize doctors with standard treatment guidelines and the rational use of essential drugs. In total, 350 trainees participated in the workshops;
• Distributed drug and treatment manuals, which were developed in collaboration with WHO and IFRC to improve case management, and introduced treatment schedules according to internationally recognized standards.

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