Vincent Soh is a 4th year medical student at University of British Columbia.
I was born into the war— a war which has carried on for over fifty years.
But “war” for me was nothing more than a word thrown around by newscasters. Growing up in a small South Korean town only 50 kilometers south of the demilitarized zone, I have never felt unsafe or experienced the anguish of true desperate hunger. Instead, over the years, I have witnessed one of the most rapid economic booms in the century, a remarkable global expansion of both culture and technology, and the evolution of a world-renowned health care system. I could never believe that my country was at war…
In stark contrast are the experiences of my cousins north of the 38th parallel. To them, the effects of the war are devastatingly real and tangible.
It is estimated that about 40 percent of North Korean citizens do not have access to adequate nutrition, clean water or basic medical supplies. Due to the lack of medications, diagnostic equipment and health care facilities, many North Koreans still suffer from preventable diseases such as tuberculosis and malaria. Despite efforts from humanitarian organizations, North Korea continues to experience a significant burden of child malnutrition, which causes severe long-term health consequences. Separated by a mere seventy years of diplomatic conflict, the Koreas have become two completely incomparable countries.
Why is this? The two nations enjoy the same culture, share similar climate and geography, and are rooted in thousands of years of rich unified history. But while one is regarded as a global economic leader, the other is considered one of the poorest countries in the world. Is this the immediate consequence of corrupt leadership? Or the inevitable result of communist ideology? To answer this question, I delved into the last seventy years which separated the two nations.
In 1948, following the end of World War II and the independence of the Korean peninsula from Japanese colonialism, the Koreas were split along the 38th parallel with the Soviet Union occupying the north and the United States occupying the south. Eventually, a full-scale war broke out between the two Koreas and their supporting countries. After three years of catastrophic casualties, the fighting ended with an armistice; but not a peace treaty. Even today, North Korea continues to press for a treaty of mutual non-aggression with the US.
In the meanwhile, since the start of the war, North Korea has been subjected to various economic sanctions, spearheaded by the United States. In 2006, following a nuclear test, the United Nations Security Council (UNSC) imposed large-scale, but targeted, sanctions on North Korea, which targeted the elite as well as prohibited the provision of weapons of mass destruction. In 2016, in response to persistent and escalating nuclear threats, the sanctions broadened to transfers of non-military goods such as coal, iron, transportation vehicles, seafood, etc.
To briefly summarize the concept of economic sanctions, it is useful to compare it to a blockade or a siege. While blockades are intended as an act of war—to use belligerent means to cut off the transfer of goods in order to damage the enemy’s economy and force them into capitulation—economic sanctions are supposedly a “peaceful” method of coercing nations towards diplomatic compromise. But when looking at the health consequences of these sanctions on the innocent lives of North Koreans, I can’t help but wonder if it is in fact a peaceful alternative.
It’s easy to imagine how a method intended to disrupt a country’s economy would affect the health of its citizens. However, economic sanctions do more than simply stunt the growth of an economy. In the case of North Korea, people are struggling to meet their health-care needs due to a lack of necessary medical items which are banned by the sanctions such as sterilizers, syringes, needles, ambulances, and medical imaging machines. Humanitarian organizations are facing unprecedented challenges in providing medical aid to North Koreans due to sanction-related red tapes and reluctance by external investors to engage in partnership for fear of political consequences.
I had the opportunity to speak with Dr. Kee Park, , a neurosurgeon and global health activist from Harvard University, who has visited North Korea over 20 times since 2007. He performs spinal surgeries alongside North Korean physicians and acts as an advocate for vulnerable civilians who are impacted by the economic sanctions. During his numerous visits, he has experienced a persistent and progressive scarcity of resources which leaves him to work in conditions that are unimaginable in the developed world. For instance, he often does not have access to X-ray machines because the hospitals do not have the means to maintain them due to the inability to legally import parts. He has seen surgical equipment such as scalpels being “reused until they are absolutely unreusable.” How much longer can people adapt to survive these unforgiving conditions?
One may argue that such circumstances are universal among developing countries. However, the difference is that North Korea is essentially barred from receiving humanitarian aid. Since the implementation of more stringent sanctions, humanitarian activists like Dr. Park have encountered exponential difficulties in providing aid to North Koreans. In recent years, Dr. Park’s organization has found it impossible to send necessary equipment into the country due to the strict regulation of sanctions. Even NGOs, especially smaller organizations, are having to abandon their posts because they are unable to logistically fund their missions. As a result, North Koreans are left to fend for themselves in a world that has completely turned its back on them.
I won’t pretend to know enough about politics to discredit the merit of economic sanctions as a diplomatic tool. But international laws clearly state that sanctions must not compromise the humanitarian needs of its civilians. But what are we doing to mitigate these unintended side effects? Is it ethical to discount the basic human rights of millions of innocent people for the sake of diplomatic compromise? As Dr. Park ardently states, “We cannot block aid out of fear.”
Thank you Vincent for elaboration on this global health issue! Economic sanctions are economic war and it is know that peace and health are inextricably linked! Historic evidence from around the world, such as Iraq and North Korea strongly support that economic sanctions have devastating health consequences.
I would highlight that economic sanctions have indirect negative health effects, which is always hidden. Indeed, economic sanctions compromise a nation’s job market and income. They also increase inflation rate and cause various types of insecurities, including food insecurity. This means, social determinants of health (SDH) will be negatively affected. As a result people especially vulnerable populations will loses access to basic living needs. Interestingly, evidence shows that the effect of SDH on health is much higher than the effect of healthcare on health! For instance, healthcare defines only 25% of Canadian health while SDH defines 50% of Canadian health. (ref. Canadian Medical Association. Infographic: What makes Canadians sick? Health Care Transformation, June 25, 2013)
The negative effects of economic sanctions on a nation’s health is massive!