Water and sanitation key to better health in the DPR Korea

By France Hurtubise in East Asia
Like elsewhere in the world, water is a big issue in the Democratic People's Republic of Korea (DPRK) - but particularly so since 1995. There has either been too much or too little due to unpredictable, climatic events that either flooded or dried out the land. A large part of the harvest in a country threatened by famine was lost to floods in 1995. Further floods in 1996 were followed by a drought and a tidal wave in 1997.

These events hit a country already confronted with deep structural problems of water supply, distribution, and treatment. More than the short-term catastrophic events, water supply problems have a greater long-term impact on the country's population. Already there are health effects from lack of access to potable water and proper sanitation.

More than 42 per cent of children in the DPRK suffer from chronic malnutrition or stunting. Although this has dropped by 20 per cent since 1998 due to the huge intervention of aid organizations, the major causes of death among children now, according to UNICEF, are diarrhoea and pneumonia. Diarrhoeal and chronic gastrointestinal diseases due to contaminated water supplies are common in general as the lack of fuel and power shortages also mean that few households can boil their water before drinking it.

It wasn't always like this. Economic progress was considerable during the first 25 years of DPRK's history and the country was capable of providing safe drinking water to its whole population. But the demise of the Soviet Union, the political reforms in Eastern Europe, and the economic and policy changes in China, have all contributed to isolating DPRK. Consequently, its economy and productivity have suffered significantly. Through lack of maintenance and investment, not only have water and sanitation infrastructures failed to keep up with a growing demand, they have deteriorated severely.

The Ministry of City Management (MoCM) faces significant hardship in producing and supplying drinkable water. Breakage of main lines, leakages, and power shortages prevent water-pumping stations from supplying water in adequate quantity. Within cities as elsewhere in the country, most of the water that does get to houses is of inadequate quality for drinking. It is highly contaminated through spillage from sewer systems and leaking supply pipes, which have often been laid down in the same trenches.

In rural areas, most of the population rely on old wells that are often poorly protected and subject to bacteriological and chemical contamination. Throughout the country, more than 80 per cent of toilets are latrines dug into the ground and whose leakage and overflow contaminate groundwater. In villages as well as in urbanized sectors, latrines are often situated near residential areas and set higher than sources of water supply.

It is a problem that the International Federation and the DPRK Red Cross are trying to address. It was evident early on that emergency response to natural disasters through the provision of food, clothing, medical aid, was negated by poor water quality and lack of proper sanitation in hospitals and clinics. So since 1999, the Red Cross has made the rehabilitation of water and sanitation facilities in health institutions a major part of its health programmes in three provinces and one municipality - North Phyongan, Chagang, South Phyongan and Kaesong.

However, "due to improper sanitation and contaminated drinking water in the communities in general, the number of patients entering the health institutions, keeps increasing," says Kim Un Chol, of the DPRK Red Cross. In response, water and sanitation programmes may have to be extended to the community at large, focusing on improving the health of people through the provision of clean water, appropriate sanitation facilities and hygiene education.

Some work had already begun through a pilot programme in 18 communities that ended last summer. Appropriately designed wells and reinforced concrete tanks were installed on higher ground to store water for distribution by gravity to villages. Pipelines were buried up to two metres below the surface of the land to prevent the water from freezing during winter and wells were constructed with concrete rings as deep as possible to isolate the clean groundwater from surface water.

Not only were these measures used to demonstrate how alternative ways could be found to supply high-quality water to every dwelling, but the programme also involved the communities themselves in the construction and maintenance, thus ensuring a more sustainable approach.

The programme has now been extended to another 100 villages with the aim of also having an impact on sanitation, hygiene education and on the prevention of waterborne diseases. To discuss water and sanitation in an open forum has not been easy as subjects such as the adequate construction of latrines are thought to be confidential or unpleasant topics. However, with clear links between clean water and good health, it's never been so important to address the water and sanitation issue in DPRK as now.

However, substantial amounts of work, funding and dedication will be needed to reverse the deterioration in water and sanitation conditions - this at a time when financial support for humanitarian work in the DPRK has seen a decrease. The International Federation has appealed for US$ 9.8 million dollars for programmes in DPRK for 2003, of which the bulk represents programmes investing in the health of the people. It's an investment that has to be long-term and this can only happen if the will is there to support it by the international community.