North Korea and COVID-19

By John Burton

As South Korea struggles with the coronavirus (COVID-19) outbreak, is North Korea's response to the pneumonia-like illness proving more effective?

In January, the country quickly went into an extensive lockdown, effectively sealing itself off from all outside contact. Travel in and out of North Korea was suspended and foreign visitors were quarantined until last weekend. Travel within the country has also apparently been curbed.

Other steps, including examining rivers and other drinking water sources for the virus, reflect the thorough and comprehensive nature of Pyongyang's response. The local media is giving surprisingly detailed reports about "anti-epidemic" efforts.

As a result, North Korea claims it has not experienced any cases of COVID-19 so far, although that cannot be independently verified given the state's secretive nature. There is plenty of skepticism about the claim amid reports that a few COVID-19 cases have been detected in Pyongyang and Sinuiju.

These tough measures play to the strengths of the country's authoritarian system. But they also reveal the regime's anxiety that the virus has the potential to wreak havoc on its fragile and inadequate health care system. It is for this reason that North Korea imposed similar draconian controls to protect itself from SARS in 2003 and Ebola in 2014.

What is clear is that North Korea is paying a high economic cost for its vigilance. There are numerous reports of sharp price rises for daily necessities due to the shutdown in trade with China, when North Koreans are already suffering as a result of international sanctions.

The main challenge that North Korea faces is what will happen if COVID-19 begins spreading in the country. Will it turn to international humanitarian organizations to help contain the virus and, if so, how will U.N. sanctions and North Korea's restrictions on foreign aid workers, including a likely mandatory quarantine period, affect this effort?

The U.N. sanctions committee on North Korea already appears willing to accelerate exemptions for COVID-19-related activities by international aid groups.

In the last couple of weeks, it has allowed the International Federation of the Red Cross and Red Crescent (IFRC) as well as Medecins Sans Frontieres (MSF) to deliver protective suits, googles, diagnostic test kits and thermometers to North Korea.

This reflects the support of the U.S., which recently said that it was "deeply concerned about the vulnerability of the North Korean people to a coronavirus outbreak" and that it was "ready and prepared to expeditiously facilitate the approval of assistance" from U.S. and international aid and health organizations to contain the illness.

If humanitarian aid groups are granted greater access to North Korea as a result of COVID-19-related activities, it has the potential to lead to an overall improvement in the health of North Koreans by providing an opportunity to re-think the impact of international sanctions on the country's public health and human security.

The U.N.-imposed sanctions and U.S. secondary sanctions have been blamed for weakening North Korea's public health system and making it less prepared to deal with the threat of COVID-19. Although they are not supposed to affect humanitarian aid to North Korea, the sanctions still have a disproportionate effect on these activities.

The international sanctions were never intended to prevent the delivery of non-dual use medical supplies. Nonetheless, such common medical items as syringes and thermometers are subject to sanctions until an exemption from the U.N. is granted, which can take months. The U.S. bans American aid workers from traveling to North Korea unless they receive special permission from the State Department.

These restrictions have made it difficult to deal with persistent health problems in North Korea such as TB. More fundamentally, sanctions have helped affect access to a nutritious diet, clean water and medicines for many North Koreans, increasing their vulnerability to health problems.

North Korea now lacks the tools to prevent a possible COVID-19 outbreak. The country needs everything from an adequate supply of facial masks and other sanitation products to ventilators, intravenous fluids and medicines to stabilize patients with the illness.

Although North Korea must devote more resources to improving its healthcare infrastructure, international aid groups that can help in these efforts have faced additional challenges as a result of sanctions. The easing of restrictions on international relief efforts will help facilitate closer cooperation between Pyongyang and aid agencies and enable North Korea to build up its public health system to deal with COVID-19 and other future health crises.

It is to be hoped that the threat of a COVID-19 outbreak in North Korea might lead to a more streamlined process at the U.N. for future humanitarian aid. In the meantime, it could also serve as an opportunity for the U.S. to offer medical assistance and thus build trust with Pyongyang for future talks on other issues, such as denuclearization.

John Burton (johnburtonft@yahoo.com), a former Korea correspondent for the Financial Times, is a Washington, D.C.-based journalist and consultant.