Lost generation: the health and human rights of North Korean children, 1990–2018

Lost Generation: The Health and Human Rights of North Korean Children, 1990–2018 is a nearly thirty-year study monitoring the health and human rights conditions of North Korean children. “Health” is defined by the World Health Organization as a “state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity.” Lost Generation applies three core international human rights instruments—primarily the Universal Declaration of Human Rights (UDHR), the Convention on the Rights of the Child (CRC), and the Convention Relating to the Status of Refugees (Refugee Convention)—from a public health perspective.

W. Courtland Robinson, Ph.D., with contributions from Jiho Cha, MD, Ph.D., Soim Park, MA, Casey Branchini, Ph.D., Daeseong Kim, MPH, Seung Yun Kim, MD, and Taeyoung Kim, provide a comprehensive assessment of the health of North Koreans within and outside the country’s borders, focusing on health, nutrition, education, and especially vulnerable children, including children in detention, child laborers, unaccompanied and separated children, and refugee and migrant children (including children born in China to North Korean mothers and Chinese fathers).

Lost Generation reviews more than 200 English and Korean articles and reports, analyzes qualitative data from 61 interviews conducted in China and South Korea in 2016 for HRNK, and reviews and summarizes seven previous studies carried out on the China-North Korea border beginning in 1998 for the Center for Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health. The report applies a public health perspective that treats health as a human right that must be guaranteed to every individual without discrimination.

Chapter 1 provides an overview of the population and demography of North Korea since 1990, factoring in the “Arduous March,” North Korea’s great famine and its effects on children. 2,692 households were surveyed from 1995 to 1998, resulting in reports on 10,640 individuals. In addition, the chapter examines the question: How has the population of North Korea changed over the period from 1990 to 2018 that has encompassed two hereditary transfers of power, a major famine and ongoing food insecurity, natural disasters, economic hardship and restructuring, an exodus of several hundred thousand refugees and migrants into China and beyond, and halting social change even in the face of political stasis? Mortality and causes of death among North Korean children are highlighted.

Chapter 2 examines the food situation in North Korea during the past three decades, focusing on food aid, food accessibility, and the nutritional status of children between 1990 and 2017. The authors include results from a study conducted by the Johns Hopkins Bloomberg School of Public Health in 2007 of household food security in North Korea by interviewing North Korean migrants, both documented and undocumented, in China. While recognizing the limitations of interviewing North Korean migrants, there are “clear indications of a continuing problem,” in which “undernourishment is a common denominator for many of the health problems afflicting North Koreans.” Data from four studies of North Korean refugee and migrant children in South Korea is also reviewed and analyzed. All four studies found that North Korean children were shorter than their South Korean counterparts, with the magnitude of these differences depending on age and gender.

Chapter 3 begins with an overview of the North Korean healthcare system prior to the 1990s, its collapse in the 1990s, and partial recovery in the last ten years. While modernization in secondary and tertiary hospitals has been a priority under Kim Jong-un as well as new telemedicine initiatives and the construction of a large new medical center in Pyongyang, there is continued evidence of under-resourcing of the health sector. The authors also focus on three areas of specific importance to children’s health—maternal and child health, immunizations, and infectious disease. Finally, the authors review available data and studies about the physical and mental health of North Koreans in China and South Korea.

Chapter 4 provides an overview of North Korea’s education system beginning in 1956, changes in the education system post-famine, including compulsory labor as “an extension of learning,” “mini assignments,” where students have to submit supplies, such as rabbit skins, to the school for the state, and school attendance. The authors complete the chapter on education by reviewing the available education for North Korean refugees in China as well as educational challenges in South Korea, including the highly competitive nature of South Korea's education system. For North Korean students who struggled and were unable to handle the academic pressure, they were often considered to be poor students and were discriminated against. However, the authors note a recurring theme of self-worth among North Korean children in South Korea, based on the unique strengths of children who have escaped and arrived in South Korea with hopes for their future.

Chapter 5 focuses on the most vulnerable sub-groups of North Korean children from the 1990s to 2018. In particular, “children outside of family care” and “children on the move,” both umbrella terms, are examined. Children in these sub-groups include children who have been trafficked, children who migrate, children displaced by conflicts or natural disasters, and children who live and work on the streets or kotjebi. This chapter specifically highlights children who are orphans and institutionalized children, including children in orphanages and children in detention, child laborers, and unaccompanied and separated children, including kotjebi. The authors’ interviews confirm concerns raised by the Committee on the Rights of the Child in 2017, including that children in orphanages were subject to sub-standard conditions, including a lack of food (one meal a day), clothing, and/or shelter. Children were often subjected to forced labor instead of attending school. As a result, many were malnourished and in poor physical condition.

Chapter 6 summarizes the situation of North Korean refugees and migrants in China beginning in 1996. It outlines the impact the "Arduous March" had on displacement and migration, and focuses on six studies that the Johns Hopkins Bloomberg School of Public Health, Center for Humanitarian Health (formerly the Center for Refugee and Disaster Response) conducted in northeast China, particularly Yanbian Korean Autonomous Prefecture in Jilin Province, but also in neighboring Liaoning and Heilongjiang Provinces from 1998 to 2014. These studies explored famine migration, trafficking of North Korean women into forced marriage, durable solutions for North Korean children, monitoring of migration patterns and vulnerability, and population estimates of North Koreans in China, North Korean women, and children born to North Korean women and Chinese men.

Chapter 7 examines the migration of North Korean refugees and migrants to South Korea and the United States. The focus is on migration routes, demographic characteristics of the population, and issues in asylum-seeking and resettlement, particularly differences in protection and settlement support to children born in China to North Korean women over time. The authors provide an overview of the situation of North Koreans in the United States and the North Korean Human Rights Act of 2004.

Chapter 8 provides conclusions and recommendations. Specific conclusions focus on the status of North Korean children during the period from 1990 to 2018, expressed in terms of rights: the right to food; the right to health; the right to education; the right to freedom from child labor; the right to freedom from arbitrary detention; the right to freedom of movement; and the rights of migrants, refugees and asylum-seekers to leave from and return to their own country, to seek and enjoy asylum, and not to be returned to a country where their life would be in jeopardy