UNICEF Emergency Programmes: DPR Korea Donor Update 24 Feb. 2000

1. Emergency overview and recent developments
The situation of children and women remains vulnerable. Due to the shortage of coal and electricity, heating is inadequate or non-existent in hospitals and children's institutions. The severe winter coupled with a chronic energy crisis is also diminishing the availability of piped water supply, which reaches over 70% of households nationwide, to only about two hours per day. The erratic power supply is a also major contributor to faecal pollution of water sources as a result of cross contamination between leaking water mains and damaged sewage networks. Food insecurity, especially in the urban areas, is reported to be widespread. No fresh commitments of food and health inputs have yet been confirmed, although it is expected that Japan will resume food aid and humanitarian assistance to the DPRK in the near future. These ongoing difficulties pose immediate threats to the survival and development of children and other vulnerable groups. Prevalence of acute respiratory infections, sepsis, hypothermia and other complications, remains high, particularly in children under five. Timely delivery of life saving supplies to the targeted areas have also been adversely affected due to government transport and logistics constraints and lack of fuel.

In contrast to the prevailing humanitarian crisis, the political environment appears to be taking an upturn. High-level talks are now back on the agenda to further inter-Korean ties as well as with the old adversaries, the US and Japan. Talks continue this month in Seoul on ways of lifting US economic sanctions on DPRK and of offering humanitarian aid under the framework of the "Perry process". The US and DPRK also concluded their talks in Geneva with an agreement to send a senior DPRK official to Washington in March (reciprocating the May 1999 visit by U.S. Presidential Special Envoy William Perry to Pyongyang), although the exact timing and composition of the delegation have yet to be decided. The US is holding out the possibility of removing the DPRK from the State Department’s list of terrorism-supporting nations. Preparations for rapprochement talks between DPRK and Japan in April also coincide with Japan’s resumption of food aid to the DPRK.

2. UNICEF's response: Activities, Achievements and Constraints

To date, UNICEF has supported the delivery of routine immunisation services reaching 430,000 infants, 330,000 women of childbearing age plus 2.1 million children under five against polio. Access to safe water and sanitation was improved in eight provinces, 42 counties and 500 children’s institutions. Achievements in education have been sustained through provision of basic equipment/supplies and teachers’ training, benefiting 350,000 children under 17 years of age. The dilapidated health care delivery system has been upgraded and strengthened in 300 targeted health institutions through the delivery of essential drugs, equipment and training for health providers.

Despite limited funding, UNICEF continues to carry out humanitarian interventions in its designated areas; eight out of the country’s 12 provinces and cities, covering 65% of the country’s population. UNICEF response to the prevailing complex emergency consists in the delivery of medical and nutritional supplies, in addition to support for water and sanitation and education to the most vulnerable and underserved communities.

In the health sector, UNICEF and WHO are continuing collaboration in 2000 to support revival of routine immunisation, which has received wide recognition and commitment from the government. Training modules are being revised to emphasise the new WHO/UNICEF schedule of immunisation from birth to 9 months that was recently adopted by the government. Support is also being provided to revive local production of drugs through provision of raw materials. Inputs for the ORS factory, such as materials for packing, are being procured to sustain production targets of 200,000 sachets per month. Despite poor accessibility to the remote regions of the country during the winter, 300 medical kits are being distributed to the northern province of Ryanggang using UNICEF-assisted transport.

In support of food security and diversification, 2.7 Mts. of vegetable seeds have been provided to 340 children’s institutions for home gardening. Preparations for the Vitamin A campaign in April is currently underway with the Canadian donation of over 2 million low and high dose capsules for 1.9 million children between 6 months to under 5 years and for approximately 260,000 lactating mothers. Local production of corn soya blend (CSB) continues with UNICEF support for vitamin and mineral premix. In collaboration with the World Food Programme (WFP) and Institution of Child Nutrition, over 70,000 recipe booklets for preparing CSB have been distributed to over 25,000 children’s institutions and paediatric hospitals. Life-saving high-energy milk for the management of severely malnourished children is currently being distributed to paediatric hospitals and baby homes. An estimated 20,000 severely malnourished children is expected to benefit from this treatment.

The departure of OXFAM from DPRK in December 1999 has created a vacuum in their designated areas (Pyongyang City, North and South Hwanghae, South Pyongan), thus negatively impacting on treatment of water supply in highly urbanized areas. Consequently, it is feared that assistance with water resources will be spread thinly between the humanitarian partners, especially as local production of water treatment chemicals such as calcium hypochlorite have yet to be restored. As such, the quality of piped water supply may be compromised, leading to a potential increase in the prevalence of water-borne diseases in the population. UNICEF continues to support ground water exploration using the two drilling rigs supplied in 1999 to provide safe water for children’s institutions. To improve and upgrade environmental sanitation, collaboration with WFP has begun in using Food-For-Work schemes to support the construction of 12,000 latrines in children’s institutions and paediatric hospitals.

3. Summary of 2000 Appeal Requirements

UNICEF requires US$ 17.6 million for the implementation of the following seven projects:

Planned UNICEF Activities
1. Nutrition rehabilitation, growth monitoring and micronutrient control
2. Expanded Programme of Immunisation (EPI) and polio eradication
3. Essential drugs
4. Safe motherhood
5. Water supply, environmental sanitation and hygiene (WES)
6. Food security
7. Education

4. Impact of Under-funding

Social service budget reductions, aggravated by the economic crisis, have negatively impacted on the government’s ability to deliver quality basic services through its extensive infrastructure networks. Without timely intervention by humanitarian and development partners, it is expected that malnutrition rates, child and maternal morbidity and mortality will continue to rise. Critical support for basic social services will be required in order to improve the standard of health care, education and other underlying determinants affecting the wellbeing of children and women.

Specifically, the cessation of local production of essential drugs, including vaccines, and lack of equipment/supplies for essential obstetric care underlines the need to sustain basic health interventions in the DPRK. Major challenges remain in the reduction and eradication of diseases preventable through immunisation and emerging infectious diseases. Without the timely delivery of vaccines and improved capacity for surveillance, the goal of Universal Child Immunisation by 2000 will not be attainable, and DPRK may remain an enclave for polio. Similarly, treatment of common childhood diseases will not be possible without the supply of essential drugs such as antibiotics and antipyretics, and thus leading to complications and deaths.

Inadequate access to clean water and proper sanitation contributes to a large proportion of childhood illnesses and in particular diarrhoea, which along with respiratory tract infections, accounts for 80% of deaths in children under five in DPRK. The linkage between poor sanitation, personal hygiene practices and malnutrition is becoming evident. As a result, shortfalls in WES interventions can potentially result in increased diarrhoeal deaths as well as a rise in the prevalence of malnutrition. Notwithstanding the enormity of the problems and heavy investments required in this sector, complementary interventions to rehabilitate water networks and sanitation facilities in the targeted health facilities, children’s institutions and under-served communities must be supported and prioritised.

Support for local production of micronutrient-dense complementary foods will also be difficult to guarantee without supply of vitamin and mineral premix. Over 190 Mts. of premix with an estimated cost of US$ 1.37 million is required to meet production targets this year. The provision of complementary foods to children’s institutions and paediatric hospitals continues to be an important intervention in 2000 for the prevention of malnutrition as well as to support nutrition rehabilitation. Inadequate prevention and control of micronutrient deficiency (vitamin A, iron, iodine) could substantially affect child survival, learning potential, productivity, self-reliance and quality of life. Poor maternal nutrition, which affects birth outcomes such as low birth weight, is likely to remain high without adequate micronutrient intake through supplementation or food fortification.

In summary, poor government capacity to ensure qualitative and quantitative health care and other social services is causing adverse effects on basic living conditions. Child survival rights are threatened, as are their development and protection rights, as a result of declining quality of basic education and inadequate healthcare. Unless donor commitment and broad partnerships are reaffirmed, the health and wellbeing of the Korean child will remain precarious. Significant progress in achieving World Summit and national goals for children and women can not be realised if these basic services are not protected.

5. Funding status as of 4 February 2000

Of the US$17.6 million required for its emergency programmes in 2000, UNICEF has received US$ 605,392 i.e. 3% of the total budget requirement. Since January, contributions were received from the following donors: US Committee (US$ 301,994); Australia (US$ 163,398), Japan NatCom (US$ 100,000) and UK Committee (US$ 40,000). As in 1999, contributions from CDC Atlanta and UN Foundation are anticipated to support polio eradication. The graph below indicates the status of contributions received as of 4 February 2000:

Details of the DPRK Emergency Programme can be obtained from:

Dilawar Ali Khan
UNICEF Representative
Tel: 8502 381 7150
Fax: 8502 381 7676
E-mail: dakhan@unicef.org

Robin Medforth-Mills
Tel: + 41 22 909 5554
Fax: + 41 22 909 5902
E-mail: rmmills@unicef.org

Dan Rohrmann
New York
Tel: + 1 212 326 7009
Fax: + 1 212 326 7165
E-mail: drohrmann@unicef.org

For more information on UNICEF, visit its web site at http://www.unicef.org