North Korea's health care system is in shambles with doctors sometimes performing amputations without anesthesia and working by candlelight in hospitals lacking essential medicine, heat and power, a rights watchdog said Thursday.
North Korea's state health care system has been deteriorating for years as the country's economic difficulties worsen. Many of the country's 24 million people also reportedly face health problems related to chronic malnutrition, such as tuberculosis and anemia, Amnesty International said.
"The people of North Korea suffer significant deprivation in their enjoyment of the right to adequate health care, in large part due to failed or counterproductive government policies," Amnesty said in a research report on the state of North Korea's health care system.
The report was based on interviews with more than 40 North Koreans who have defected, mostly to South Korea, as well as organizations and health care professionals who work with North Koreans. However, Amnesty researchers did not have direct access to North Korea, one of the world's most closed countries.
There was no immediate reaction from North Korea, which is sensitive to outside criticism of its political and human rights conditions and usually responds through its state-controlled media, though sometimes days or even weeks later.
The Amnesty report said health facilities in North Korea are run down, with frequent outages of power and heat because of energy shortages, forcing doctors to perform duties with only daylight or by candlelight.
"During operations, patients, if lucky, are given anesthesia but sometimes not enough to completely control the pain," it said. "Without essential medicines, health facilities in North Korea clearly cannot provide services such as surgery without endangering the lives of their patients."
A 24-year-old defector from northeastern Hamkyong province told Amnesty that a doctor amputated his left leg from the calf down without administering anesthesia after his left ankle was crushed by a moving train when he fell from one of the carriages.
"Five medical assistants held my arms and legs down to keep me from moving. I was in so much pain that I screamed and eventually fainted from pain," said the man, identified only by his family name, Hwang. "I woke up one week later in a hospital bed."
Doctors also often work without pay and have little or no medicine to dispense, and must reuse the scant medical supplies at their disposal, the report said.
North Korea says it provides free medical care to all its citizens. But Amnesty said most interviewees said they or a family member had "paid" doctors cigarettes, alcohol or money to receive medical care.
"People in North Korea don't bother going to the hospital if they don't have money because everyone knows that you have to pay for service and treatment," a 20-year-old North Korean defector from North Hamkyong province, surnamed Rhee, was quoted as saying. "If you don't have money, you die."
Many interviewees also said they had to walk as long as two hours to get to a hospital for crucial surgeries, said Norma Kang Muico, an Amnesty researcher and author of the report.
"(The lack of) physical access to health care was also quite striking to me," Muico told reporters in Seoul on Thursday.
She said North Koreans are "numbed" to what was wrong with their country's health system because "things keep progressively getting worse, or even staying the same but at that low level."
"So when something else happens they're not quick to react and think, 'Oh, this is my entitlement,"' she said.
Amnesty said North Korea must cooperate with aid donors and ensure transparency in the distribution of food assistance, and guarantee that medical personnel are paid adequately and regularly so they may carry out their duties properly.
Amnesty also recommended that countries such as South Korea, the U.S., China, Japan and Russia ensure that humanitarian assistance in North Korea is based on need and is not subject to political conditions.