COVID-19 in North Korea: what do we know about the health system?

North Korea confirmed its first death from COVID-19 on Friday, saying the "fever" was spreading "explosively" across the country.

COVID-19 in North Korea: what do we know about the health system?

North Korea confirmed its first death from COVID-19 on Friday, saying the "fever" was spreading "explosively" across the country. But with one of the worst health systems in the world and an unvaccinated population, Pyongyang could be in trouble from the outbreak, experts say.

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What healthcare system? The healthcare system is officially one of the worst in the world, ranked 193rd out of 195 countries, according to a 2021 Johns Hopkins University survey.

Authorities say health care is free for all, but NGOs say people have long had to pay for essential medical services, usually in cigarettes or alcohol.

Patients' families have to buy drugs on the black market, and doctors are forced to practice clandestine care to earn a living, notes Sokeel Park of Liberty in North Korea.

"Doctors' incomes are certainly not low by North Korean standards, but even then it's hard to buy a kilo of rice," researcher Choi Jung-hun told AFP.

There are no hospitals with intensive care units in rural areas or small towns, where the majority of the country's 25 million people live, adds this defector who worked as a doctor in the North.

Is the population healthy? Very little is known about the health of the population, but the World Health Organization said in 2018 that non-communicable diseases like diabetes are responsible for 84% of deaths in North Korea.

Ahn Chan-il, a defector turned researcher, said poor health, particularly widespread malnutrition, made North Korea particularly vulnerable to COVID-19.

State media said last year that the country was facing a "food crisis", with a United Nations expert warning that vulnerable populations were at risk of starvation.

"Most North Koreans are chronically malnourished," said Lina Yoon, researcher for Human Rights Watch.

After two years of blockade at the borders, "there are almost no more medicines", she added.

Are they prepared? North Korea closed its borders two years ago, halting trade, suspending inbound flights and issuing orders to shoot anyone illegally crossing the border from China.

Pyongyang says these draconian measures helped keep the virus at bay, but did not take the opportunity to vaccinate its population.

Last year, the country rejected an offer of three million Chinese vaccine doses, suggesting they be given to “countries most in need”.

He also refused the AstraZeneca vaccine offered under the WHO's Covax programme. According to the WHO, North Korea and Eritrea are the only countries that have not launched a vaccination campaign.

What equipment? State media said this week that North Korea had used "gene analysis" to diagnose Covid patients, but experts say the country's testing capabilities are extremely limited.

According to the researchers, the country also lacks quarantine centers equipped with negative air pressure systems or refrigerated storage systems necessary for the distribution of mRNA vaccines.

North Korea's failing health system would likely struggle to help people suffering from vaccine side effects, which could explain the rejection of vaccine donations, experts say.

Malnutrition is thought to affect the quality of an individual's immune response to vaccination - meaning the country could also need significant food aid to be successful in its inoculation campaign.

Can the world help? China, South Korea and the WHO immediately offered support, with the new government in Seoul saying it was ready to send vaccines.

But Kim Jong Un's regime, which test-fired three banned ballistic missiles hours after the first Covid cases were announced, does not appear to want international help.

Yet experts believe they may soon have no choice.

By publicly announcing facing a massive outbreak in English-language media, the regime sends an “indirect message that the North may seek vaccine assistance from the United States or international organizations in the future,” it said. Yang Moo-jin, professor at the University of North Korean Studies.