Amputations and other major operations are carried out without anesthesia in North Korea, according to a report published by Amnesty International on Thursday.

Based on interviews with more than 40 North Koreans and health professionals, the report titled “The Crumbling State of Health Care in North Korea” offers the dire portrait of the North’s healthcare system.

Hospitals did not function properly due to a lack of medicines while malnutrition enabled epidemics to develop.

Witnesses in the report described hospitals where hypodermic needles were not sterilized and sheets were not regularly washed.

“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,” said Catherine Baber, Amnesty International’s deputy director for the Asia-Pacific.

Despite the North Korean government’s claim that its health care system is free for all, many interviewees said that they have had to pay for all services since the 1990s, the report found.

“Doctors are usually paid in cigarettes, alcohol or food for the most basic consultations and take cash for tests or surgery,” the report said.

According to the World Health Organization, North Korea spent less on health care than any other country in the world -- less than $1 per person per year. 

The report also found that many North Koreans bypass doctors, going straight to the markets to buy medicine and self-medicate according to their own guesswork or the advice of market vendors.

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

At a news conference in Seoul on Thursday, Norma Kang Muico, Asia-Pacific researcher for Amnesty International, criticized the North Korean government’s reluctance to seek humanitarian aid from the international community.

“Food and security remain a critical concern for millions of people in North Korea,” she said. “This has been compounded by the reluctance of the government to seek assistance.”

The situation worsened after the government’s currency revaluation in December last year, she said.

The price of rice more than doubled and thousands of people started to death between January and February in one province alone, an NGO was quoted as saying by the report.

“As a matter of priority, (the North Korean government must) ensure that food shortages are acknowledged and effective steps taken to address these shortages, including acceptance of needed international humanitarian assistance,” Norma Kang Muico said.

The report begins, introducing a testimony by a 39-year-old woman, surnamed Lee, from Chongjin, North Hamgyeong province.

“We received 15 kilograms of corn and 1 to 2 kilograms of rice per month. To stretch our income, we made alcohol from the corn. We also ate the sediment from the corn alcohol. It was difficult to eat because of the bitter taste, but we were hungry and had to eat it,” she said in the report.

By Lee Ji-yoon (jylee@heraldcorp.com)