and 1996, and drought in 1997 have brought on a severe food crisis in the reclusive, communist nation that has placed millions of people at risk of starvation. Infusions of international food aid since 1996 are believed to have helped stabilize the situation, at least in certain areas and among targeted populations, but the crisis does not seem to have passed. Efforts to gauge the effects of this crisis, however, have been hampered by the North Korean government's reluctance to permit randomized surveys of morbidity and mortality.
A nutritional assessment mission to the DPRK undertaken by the World Food Program (WFP) in August 1997 found a 16.5 percent prevalence of wasting (<-2 Z-scores weight-for-height) and a 38.2 percent prevalence of stunting (<-2 Z-scores height-for-age) in a nonrandom sample of 3,695 children under 7 years of age in 42 selected nurseries and kindergartens from 19 counties in 5 provinces. The WFP assessment noted that “a prevalence of wasting greater than 15 percent is considered a serious situation and suggests that mortality rates have already increased” (Katona-Apte and Mokdad, 1998). In September 1998, WFP collaborated with the United Nations Children's Fund (UNICEF) and the European Union to conduct a randomized survey of 1,762 children in 3,600 households in 30 North Korean counties. This survey found 15.6 percent of children aged 6 months to 7 years to be wasted, 62.3 percent stunted, and 60.6 percent moderately or severely underweight (European Union et al., 1998). The authors of the 1997 WFP study concluded that
The chronic and cumulative shortage of food, the shortages of basic medicine and fuel, the damage to the infrastructure from floods, and the difficult economic circumstances of the DPRK pose substantial challenges to improving the nutritional status of its children. On the other hand, the presence of the PDS [Public Distribution System], the evident order and discipline in DPRK society, the universal access to health care, the dedication of the care providers and the high literacy rate augur well for the likelihood of successful resolution of the crisis if adequate food, medication and training can be made available (Katona-Apte and Mokdad, 1998).
Other assessments were not so sanguine. Frustrated by the DPRK's unwillingness to permit random sample surveys or independent interviewing of the population, some organizations began to look to the Chinese border where North Koreans had been crossing in search of food. In July 1997, World Vision interviewed 33 individuals at the China/North Korea border (19 of whom were North Korean and 14 of whom were from either China or Russia) and concluded that mortality averaged 15 percent in the northern provinces. “This famine,” said the World Vision report, “may well be much more severe than any news reports have indicated ” (World Vision, 1997).
In June 1998, a private South Korean organization called the Korean