Amnesty International botches blame for North Korea’s crumbling healthcare
“Economic sanctions are, at their core, a war against public health.”
–The New England Journal of Medicine 
By Stephen Gowans
Amnesty International has released a report condemning the North Korean government for failing to meet “its obligations to respect, protect and fulfil the right to health of its citizens”, citing “significant deprivation in (North Koreans’) enjoyment of the right to adequate care, in large part due to failed or counterproductive government policies.” The report documents rundown healthcare facilities which “operate with frequent power cuts and no heat” and medical personnel who “often do not receive salaries, and many hospitals (that) function without medicines and essentials.” Horrific stories are recounted of major operations carried out without anaesthesia. Blame for this is attributed solely to the North Korean government.  While unstated, the implication is that DPR Korea is a failed state, whose immediate demise can only be fervently wished for (or worked toward.)
The attack is joined by Barbara Demick, the Beijing bureau chief for the Los Angeles Times and author of Nothing to Envy: Ordinary Lives in North Korea, writing in the British newspaper, The Guardian. She acknowledges the DPR Korea’s considerable social achievements – an acknowledgement that would never have been permitted in the pages of a major Western newspaper in the depths of the Cold War – but does so only in order to show how far the country has regressed.
“The country once had an enviable healthcare system,” Demick writes, “with a network of nearly 45,000 family practioners. Some 800 hospitals and 1,000 clinics were almost free of charge for patients. They still are, but you don’t get much at the hospital these days.” Demick continues: “The school system that once allowed North Korea’s founder Kim Il-Sung (father of the current leader) to boast his country was the first in Asia to eliminate illiteracy has now collapsed. Students have no books, no paper, no pencils.” 
Nowhere is the role of sanctions mentioned in Demick’s account of North Korea’s “giant leap backwards”  or in Amnesty’s condemnation of Pyongyang for failing to safeguard the basic healthcare rights of its citizens. Instead, Demick and Amnesty point to a botched currency reform, as if it alone accounts for the country’s deep descent into poverty. Neither mention that no country has been subjected to as long and determined a campaign of economic warfare as North Korea, or that in recent years, a UN sanctions regime little different from the one that destroyed the healthcare system of Iraq in the 1990s, and led to the deaths of half a million Iraqi children under the age of five from 1991 to 1998 , has been imposed on a country that has struggled with food shortages since the collapse of the Soviet-led socialist trading community and as a result of a series of natural calamities. No mention either is made of Washington’s efforts to “squeeze North Korea with every financial sanction possible” with the aim of bringing about the collapse of the country’s economy,  and with it, its public healthcare and educational systems. What’s more, while Demick acknowledges that South Korea and other countries have sharply reduced food aid to the North, she blames North Korea’s leadership for refusing to dismantle its nuclear program and for “provocations” against the South, for inviting the aid reduction. (The provocations Demick refers to include the sinking of a South Korean corvette in March, attributed, with not a lot of evidence – and over the initial denials of the South Korean military  – to a North Korean submarine.) Demick and Amnesty could have condemned South Korea and the United States for using food as a weapon. Instead, Demick censures North Korea for putting itself in the position of being sanctioned, while Amnesty counsels major donors not to base food aid on political considerations, without acknowledging that this is exactly what major donors have done.
Both Amnesty and Demick operate within the framework of Western propaganda. As the North Korea specialist Tim Beal points out, Western propaganda invokes economic mismanagement as the explanation for North Korea’s collapsing economy, despite an obvious alternative explanation: sanctions. “The results — those malnourished babies,” Beal wrote prophetically three years ago, “can be blamed on the Koreans, which in turn is produced as evidence that the sanctions are desirable and necessary.” 
Sanctions of Mass Destruction
“In contrast to war’s easily observable casualties, the apparently nonviolent consequences of economic intervention seem like an acceptable alternative. However, recent reports suggest that economic sanctions can seriously harm the health of persons who live in targeted nations.”  This has been well established and widely accepted in the cases of Iraq in the 1990s and the ongoing US blockade of Cuba. Political scientists John Mueller and Karl Mueller wrote an important paper in Foreign Affairs, in which they showed that economic sanctions “may have contributed to more deaths during the post-Cold War era than all weapons of mass destruction throughout history.” 
“The dangers posed today by such enfeebled, impoverished, and friendless states as Iraq and North Korea are minor indeed”, they wrote in 1999. It might be added that the dangers posed by North Korea to the physical safety of US citizens are not only minor but infinitesimally small. Notwithstanding the fevered fantasies of rightwing commentators, North Korea has neither the means, nor the required death wish, to strike the United States. However, the danger the country poses to the idea of US domination – and hence, to the banks, corporations, and major investors who dominate US policy-making – are admittedly somewhat greater.
“Severe economic sanctions”, the Muellers contend, ought to be “designated by the older label of ‘economic warfare’”. “In past wars economic embargoes caused huge numbers of deaths. Some 750,000 German civilians may have died because of the Allied naval blockade during World War I.” 
“So long as they can coordinate their efforts,” the two political scientists continue, “the big countries have at their disposal a credible, inexpensive and potent weapon for use against small and medium-sized foes. The dominant powers have shown that they can inflict enormous pain at remarkably little cost to themselves or the global economy. Indeed, in a matter of months or years whole economies can be devastated…”  And with devastated economies, come crumbling healthcare systems and failure to provide for the basic healthcare rights of the population.
Sixty Years of Sanctions
From the moment it imposed a total embargo on exports to North Korea three days after the Korean War began in June 1950, the United States has maintained an uninterrupted regime of economic, financial, and diplomatic sanctions against North Korea.  These include:
o Limits on the export of goods and services.
o Prohibition of most foreign aid and agricultural sales.
o A ban on Export-Import Bank funding.
o Denial of favourable trade terms.
o Prohibition of imports from North Korea.
o Blocking of any loan or funding through international financial institutions.
o Limits on export licensing of food and medicine for export to North Korea.
o A ban on government financing of food and medicine exports to North Korea.
o Prohibition on import and export transactions related to transportation.
o A ban on dual-use exports (i.e., civilian goods that could be adapted to military purposes.)
o Prohibition on certain commercial banking transactions. 
In recent years, US sanctions have been complemented by “efforts to freeze assets and cut off financial flows”  by blocking banks that deal with North Korean companies from access to the US banking system. The intended effect is to make North Korea a banking pariah that no bank in the world will touch. Former US President George W. Bush was “determined to squeeze North Korea with every financial sanction possible” until its economy collapsed.  The Obama administration has not departed from the Bush policies of financial strangulation.
Washington has also acted to broaden the bite of sanctions, pressing other countries to join its campaign of economic warfare against a country it faults for maintaining a Marxist-Leninist system and non-market economy.  This has included the sponsoring of a United Nations Security Council resolution compelling all nations to refrain for exporting dual-use items to North Korea (a repeat of the sanctions regime that led to the crumbling of Iraq’s healthcare system in the 1990s.) Washington has even gone so far as to pressure China (unsuccessfully) to cut off North Korea’s supply of oil. 
Dual-Use Sanctions: 1990s Iraq Redux
The Amnesty report blames Pyongyang for a shortage of syringes at hospitals. Yet in the 1990s Iraq suffered from a similar shortage, not due to failed government policies, but because “the importation of some desperately needed materials [had] been delayed or denied because of concerns that they might contribute to Iraq’s WMD programs. Supplies of syringes were held up for half a year because of fears they might be used in creating anthrax spores.”  Like Iraq in the 1990s, North Korea is under sanctions that ban dual use items – goods that have important civilian uses but might also be used in the production of weapons. “Medical diagnostic techniques that use radioactive particles, once common in Iraq, [were] banned under the sanctions, and plastic bags needed for blood transfusions [were] restricted.”  On October 14, 2006 the United Nations Security Council banned the export to DRP Korea of any goods, including those used for civilian purposes, which could contribute to WMD-related programs – the very same sanctions that led, at minimum, to hundreds of thousands of deaths in 1990s Iraq when the export of potentially weapons-related material, also essential to the maintenance of sanitation, water treatment and healthcare infrastructure, was held up or blocked. Not a word of the escalating sanctions regime against North Korea is mentioned in the Amnesty report, an omission so glaring as to resemble a report on the post-World War II devastation of Europe that says nothing of the string of Nazi aggressions that caused it.
Kaesong, the vast industrial park of South Korean factories employing North Korean workers situated near the South Korea-North Korea border, provides an example of how ridiculously wide the dual-use sanctions net can be cast. “U.S. officials blocked the installation of a South Korean switchboard system at Kaesong on grounds that the equipment contained components that could have been adapted for military use. As a result…the 15 companies operating at Kaesong share a single phone line, and messages must often be hand-delivered across the border.”  While dual-use sanctions may appear to be targeted, just about any item required for the provision of basic healthcare, sanitation, and educational rights – chlorine, syringes, x-ray equipment, medical isotopes, blood transfusion bags, even graphite for pencils – can be construed to have military uses and therefore banned for export.
Most of North Korea’s trade after the fall of the Soviet Union was with China, Japan and South Korea. In 2002, Japan banned the export of rice to North Korea and effectively prohibited North Korean ships from using Japanese ports.  In 2009, Tokyo went further, imposing a total ban on exports to the beleaguered country.  No wonder former US President George W. Bush called North Korea “the most sanctioned nation in the world”. 
Food as a Weapon
The Amnesty report recommends that “major donors and neighbouring countries…ensure that the provision of humanitarian assistance in North Korea is based on need and is not subject to political conditions”. In making this recommendation, the rights organization tacitly acknowledges that humanitarian assistance has indeed been subject to political conditions. (If this practice was unheard of, why make the recommendation?) In fact, the United States, Japan and South Korea have used food aid as a weapon. “After Pyongyang test-fired missiles in July (2006), South Korea announced plans to eliminate the 500,000 tons in annual food aid it provides directly to North Korea.” At the same time, food aid from China dropped one-third.  And in 2005, the Bush administration cut off all food aid to North Korea.  In all instances, humanitarian assistance was withheld to exact concessions from Pyongyang.
Amnesty International and Imperialism
The United Nations Committee on Economic, Social and Cultural Rights recognized in 1997 that sanctions “often cause significant disruptions in the distribution of food, pharmaceuticals and sanitation supplies, jeopardize the quality of food and the availability of clean drinking water, severely interfere with the functioning of basic health and educational systems, and undermine the right to work.”  These disruptions were evident in Iraq in the 1990s, and led to the crumbling of the country’s healthcare system, contributing to what the UN Humanitarian Coordinator in Iraq, Denis Halliday, called “a de facto genocide.”  Additionally, the deleterious effects of US economic warfare on the Cuban healthcare system are uncontested except by anti-Castro émigrés and the US government.  If we recognize that “economic sanctions are, at their core, a war against public health” and acknowledge, as a former US president has, that North Korea is “the most sanctioned nation in the world,” it is difficult not to draw the obvious conclusion: that North Korea’s crumbling healthcare system and “great leap backwards” are not due in large measure to Pyongyang’s “failed or counterproductive” policies, but to the inhumane policies of the United States, Japan and South Korea.
Amnesty’s failure to point to the role played by the United States and its allies in undermining the conditions that would allow Pyongyang to fulfill the healthcare and other rights of North Koreans, and its willingness to play a part in legitimizing Washington’s foreign policy agenda, is not without precedent. While Amnesty was critical of the human rights record of apartheid South Africa, it alone among human rights organizations refused to denounce apartheid itself.  The organization also refused to condemn the 1999 NATO bombing of Yugoslavia , even though it was an exercise in imperial predation that denied the rights of many innocent Yugoslavs to life, security of the person and employment. Amnesty excused its inaction on grounds that it is not an antiwar organization, as if war and human rights are not often inextricably bound. The war on Yugoslavia certainly was, at least rhetorically, since NATO invoked the language of human rights to justify its attack. But Amnesty’s most egregious service to the propaganda requirements of US foreign policy came in 1991, when the rights group released a report in the run-up to the Gulf War claiming that Iraqi soldiers had thrown Kuwaiti babies from incubators. This was a hoax, perpetrated by the daughter of the Kuwaiti ambassador to the United States, orchestrated by the public relations firm Hill & Knowlton, which had been hired to launch a propaganda campaign to galvanize public support for a US war on Iraq. When US President George H.W. Bush appeared on television to announce that he was readying for war on Iraq, he had a copy of the Amnesty report in his hands. 
A Western-based organization, Amnesty has proven itself time and again to be incapable of operating outside the propaganda system of Western governments, and at times has acted to justify the imperialism of dominant powers or turned a blind eye to it. In its latest North Korea report it has made an invaluable contribution to the campaign of the United States and its East Asian allies to bring down one of the world’s few remaining top-to-bottom alternatives to capitalism and Third World dependency on the United States and former colonial powers. It has done so by fulfilling the two requirements needed for an anti-North Korea propaganda campaign to work: First, to cover up the role played by the United States, Japan and South Korea in starving the country’s healthcare and educational systems of necessary inputs, and second, to blame the ensuing chaos on the North Korean government. The action of Amnesty in misdirecting responsibility for this tragedy is no less shameful than that of the governments that have perpetrated it.
1. Eisenberg L, “The sleep of reason produces monsters—human costs of economic sanctions,” New England Journal of Medicine, 1997; 336:1248-50. http://content.nejm.org/cgi/content/short/336/17/1247
2. Amnesty International, “The crumbling state of health care in North Korea”, July 2010. http://www.amnesty.org/en/library/asset/ASA24/001/2010/en/13a097fc-4bda-4119-aae5-73e0dd446193/asa240012010en.pdf
3. Barbara Demick, “North Korea’s giant leap backwards”, The Guardian (UK), July 17, 2010. http://www.guardian.co.uk/world/2010/jul/17/north-korea-famine-fears
5. “Iraq surveys show ‘humanitarian emergency’”, UNICEF.org, August 12, 1999. http://www.unicef.org/newsline/99pr29.htm
6. The New York Times, September 13, 2006.
7. Stephen Gowans, “The sinking of the Cheonan”, PSLweb.org, May 27, 2010. http://www.pslweb.org/site/News2?page=NewsArticle&id=14044&news_iv_ctrl=2801
8. Tim Beal, “Invisible WMD- the effect of sanctions”, Pyongyang Report, Volume 9, Number 4, October 2007. http://www.vuw.ac.nz/~caplabtb/dprk/pyr9_4.mht
9. Karine Morin and Steven H. Miles, “Position paper: The health effects of economic sanctions and embargoes: The role of health professionals”, Annals of Internal Medicine, Volume 132, Number 2, 18 January 2000. http://www.annals.org/content/132/2/158.abstract
10. John Mueller and Karl Mueller, “Sanctions of mass destruction”, Foreign Affairs, Volume 78, Number 3, May/June 1999.
13. Dianne E. Rennack, “North Korea: Economic sanctions”, Congressional Research Service, October 17, 2006. http://www.au.af.mil/au/awc/awcgate/crs/rl31696.pdf
15. Mark Landler, “Envoy to coordinate North Korea sanctions”, The New York Times, June 27, 2009. http://www.nytimes.com/2009/06/27/world/americas/27diplo.html?partner=rss&emc=rss
16. The New York Times, September 13, 2006.
17. According to Rennack, the following US sanctions have been imposed on North Korea for reasons listed as either “communism”, “non-market economy” or “communism and market disruption”: prohibition on foreign aid; prohibition on Export-Import Bank funding; limits on the exports or goods and services; denial of favorable trade terms.
18. The Washington Post, June 24, 2005.
19. Mueller and Mueller.
21. The Washington Post, November 16, 2005.
23. “KCNA dismisses Japan’s frantic anti-DPRK racket”, KCNA, June 23, 2009.
24. U.S. News & World Report, June 26, 2008; The New York Times, July 6, 2008.
25. The Los Angeles Times, October 25, 2006.
26. The Washington Post, May 16, 2008.
27. United Nations Economic and Social Council, “The relationship between economic sanctions and respect for economic, social and cultural rights”, December 12, 1997. http://www.unhchr.ch/tbs/doc.nsf/0/974080d2db3ec66d802565c5003b2f57?Opendocument
28. Denis J. Halliday, “The Deadly and Illegal Consequences of Economic Sanctions on the People of Iraq”, Brown Journal of World Affairs, Winter/Spring 2000 – Volume VII, Issue 1. http://www.watsoninstitute.org/bjwa/archive/7.1/Essays/Halliday.pdf
29. Richard Garfield and Sarah Santana, “The Impact of the Economic Crisis and US Embargo on Health in Cuba”, American Journal of Public Health, January 19997, Volume 87, Number 1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380757/
30. Francis A. Boyle and Dennis Bernstein, “Interview with Francis Boyle. Amnesty on Jenin”, Covert Action Quarterly, Summer, 2002. http://cosmos.ucc.ie/cs1064/jabowen/IPSC/php/art.php?aid=4573
31. Alexander Cockburn, “How the US State Dept. Recruited Human Rights Groups to Cheer On the Bombing Raids: Those Incubator Babies, Once More?” Counterpunch, April 1-15, 1999. http://cosmos.ucc.ie/cs1064/jabowen/IPSC/articles/article0005098.html
32. Boyle and Bernstein.