Amputations Without Anesthesia in NKorea

(July 15) -- North Korea's health system is in dire shambles, with amputations being performed without anesthesia, often under candlelight in impoverished hospitals where doctors are paid in cigarettes.

That's according to a report released today by Amnesty International, outlining disastrous medical conditions in the reclusive communist state and calling on donor countries to send humanitarian aid and stop using North Korea's residents in a game of "political football" with Pyongyang. The report also notes that North Korea has refused to cooperate fully with the international community in order to receive any aid.

North Korea claims that all medical treatment is free for its citizens, but defectors and health workers interviewed by Amnesty International said people have had to pay for treatment since the 1990s. However, because the country is so poor, many doctors are paid in cigarettes, alcohol or food. Only major surgery requires cash, which many North Koreans don't have.

"If you don't have money, you die," the report quotes a 20-year-old refugee as saying.

Amnesty's results were based on interviews with defectors and doctors who've worked in North Korea, but the group's researchers weren't given access to enter the closed communist country themselves. Many of the subjects' names were omitted to shield their identities, or they gave only a single family name. There's been no immediate reaction to the report from North Korea's official media.

The report also describes hospitals that are barely functioning without medicines or even electricity. Epidemics like tuberculosis and anemia have been exacerbated by widespread malnutrition.

"North Korea has failed to provide for the most basic health and survival needs of its people. This is especially true of those who are too poor to pay for medical care," Catherine Baber, Amnesty International's deputy director for the Asia-Pacific, said in a statement on the group's website.

"The North Korean people are in critical need of medical and food aid," Baber said. "It is crucial that aid to North Korea is not used as a political football by donor countries."

North Korean hospitals often have to strap patients to operating tables while amputations and other surgeries are performed without anesthesia, the report said. It quotes a 56-year-old woman from the northeastern city of Musan who underwent surgery in 2001 to remove her appendix -- without anesthesia.

"I was screaming so much from the pain, I thought I was going to die. They had tied my hands and legs to prevent me from moving," she said.

Another 24-year-old defector from North Korea's northeastern Hamkyong province said he had his left leg amputated from the calf down, after he fell from a train and damaged his ankle.

"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," the man was quoted as saying. "I woke up one week later in a hospital bed."

The World Health Organization estimates that North Korea spends less on health care per capita than any other country in the world. The latest WHO figures show Pyongyang spends less than $1 on health care each year per person.

Because of such dire conditions, many North Koreans take matters into their own hands, treating themselves with unregulated medicines sold in markets, often with improper doses and usage, the report said. North Korea recently banned a highly addictive painkiller many people had been using as a cure-all, it said.

In an addendum to the report, Amnesty also describes how thousands of North Koreans face starvation and have been forced to survive on a diet of so-called "wild foods" such as grass and tree bark. The report includes an interview with a 24-year-old North Korean man who said he has survived by foraging for such foods since age 9.

"I ate several different kinds of wild foods, such as neung-jae, which is a wild grass found in the fields. It's poisonous -- your face swells up the next day. Other kinds of grass and some mushrooms are also poisonous, so you could die if you picked the wrong one," Hwang, who goes by a single name, was quoted as saying.

In the mid-1990s, after more than 1 million people died in a North Korean famine, Pyongyang encouraged its citizens to forage for such foods. At that time, the U.N. estimated that wild foods accounted for 30 percent of the North Korean diet, the report notes. Since then North Korea has struggled with chronic food shortages and suffered another crisis in 2006-07 with spikes in world food prices.