(FILE PHOTO) Amoxicillin, a drug provided by international aid agencies, on sale at a market. The drug is used to treat skin infections, but now all stores of the drug sold through illegal channels have dried up. Taken in October 2014 by ASIAPRESS.

Starting in August, the Kim Jong-un regime started an intense crackdown on private medical activities, which have flourished due to the paralyzed state of the country’s medical system. In January of this year, Kim Jong-un ordered the crackdown on illegal medical activities, leading to the crackdown. What is the regime aiming to achieve through the crackdown? (KANG Ji-won)

◆ N. Korea’s “free medical care system” implodes in the 1990s

One of the socialist North Korean regime’s oldest policies is “free medical care.” The regime has long claimed that medical visits related to injuries and disease, treatments, surgeries, hospitalizations, and even medicine prescriptions are all free.

In the 1990s, however, the lack of medicines and equipment, and halt in government rations for doctors and other medical professionals, led to the implosion of the country’s “system of free medical care.” People had to hand over bribes to get treatments and surgeries, and it became commonplace for medicines to be purchased through markets and under-the-table deals.

The medical supplies supplied by the government to medical facilities and the medical supplies received from the United Nations and other aid organizations were frequently siphoned off to the black market. Starting in the 2000s, people found that while they could get checkups at hospitals, they would have to pay their own way to obtain medicines.

A “Top Secret” document acquired by ASIAPRESS in late 2022. The cause of chronic “illegal medical activities” is due to the drastic reduction in Chinese medicine imports stemming from North Korea’s overreaching efforts to prevent the spread of COVID-19.

◆ COVID-19 shows how dilapidated the country’s medical system really is

The start of the COVID-19 pandemic in January 2020, which led North Korea to close its borders and end almost all trade with China, resulted in the country’s medical system completely collapsing. Medicine imports from China dried up, and in the ending months of 2020, many elderly people and children died because they failed to get simple treatments or surgeries.

With the collapse of the medical system, traditional remedies such as moxibustion, acupuncture, cupping, acupressure, and the consumption of medicinal herbs filled in the gap. Despite having just hastily studied traditional remedies, even non-professionals jumped into the industry with dreams of earning money. There are now sometimes reports of incidents occurring due to traditional remedies. Starting in 2022, the North Korean authorities began cracking down on the rapid spread of traditional remedies.

What is particularly noteworthy is that Kim Jong-un handed down an order in January 2023 calling for the “strengthening of crackdowns and control over illegal medical activities.” A “Top Secret” government document obtained by ASIAPRESS says the following:

“(The government) aims to strengthen education and controls with a view to eliminate the phenomenon of people earning money through illegal medical activity in the Workers’ Party, labor organizations, and among ordinary people and employees. The Ministry of Social Security (the police) and other law-and-order agencies will strengthen their crackdowns and controls on preventing illegal medical activities with a view to make it clear to ordinary people and employees that anyone who has caused harm to patients by conducting illegal medical activities will face a public struggle (denunciation rally) and be severely punished under the law.”

However, why did the country’s Supreme Leader personally hand down an order instructing the authorities to crackdown on traditional remedies, which is only one part of the myriad of illegal activities that occur in North Korean society?

(FILE PHOTO) A room inside a hospital in Yanggang Province. A patient can be seen lying on a bed. Taken by ASIAPRESS in April 2015.

◆ A “secret vote” is held that leads to arrests of doctors and nurses

A reporting partner in the northern region of the country told ASIAPRESS in mid-August about the start of the large-scale crackdown on people prescribing traditional remedies:

“Our inminban (neighborhood watch unit) was ordered to eliminate private medical activities through a pan-national reporting system, and on August 4, there was a ‘vote’ held to report those who perpetrate illegal medical activities.”

The authorities also informed the population that there were would severe legal punishments meted out to those involved in abortion-related surgeries. Meanwhile, they demanded that those who practice acupuncture, cupping, create medicinal herbs, acupressure, use IVs, and conduct blood transfusions voluntarily turn themselves in along with the medical devices in their possession.

“Through this ‘vote,’ the names of many doctors and nurses working at hospitals were made known. Even the names of those who practiced Oriental medicine were revealed. Those who were reported were investigated by the police and even faced having their houses searched.”

Many people are expressing discontent about the government’s hardline approach to the issue, particularly because they are unable to get treatments at hospitals and are forced to turn to traditional remedies due to the lack of money. Meanwhile, medical practitioners are avoiding crackdowns by the authorities by halting procedures at homes and are instead making house calls to conduct checkups and various medical procedures.

◆ The state aims to exert a monopoly of sales of medicines, too

In tandem with the crackdown on illegal medical practices, the authorities are intensifying their control over the distribution of medicines. The reporting partner told ASIAPRESS that one government official said the following:

“Sick people don’t go to state-run medical facilities. That’s because the hospitals don’t have medical supplies imported by the government. And that’s why private citizens are increasingly conducting checkups, diagnoses and selling medicines. Going forward, the private sale of medicines will be eliminated…That was what the notice said.”

After the notice was made, hospitals stopped selling medicines and only wrote prescriptions, and patients took these prescriptions to state-run pharmacies to buy medicines at state-set prices.

“I heard that the measure was implemented to ensure the revitalization of the free medical care system in the future,” the reporting partner emphasized.

In short, the reporting partner said that the Kim Jong-un regime is intent to revitalize the “system of free medical care” in the future, regardless of whether this is an achievable goal or not. To achieve this goal, the regime aims to eliminate illegal medical activities conducted by private practitioners, along with the illegal sale of medicines, with a view to ensure the state has overall control over the medical system and the distribution of medicines.

Given that it will be impossible to achieve a sudden revival of the “system of free medical care,” the government’s initial goal appears to be aimed at turning the “privatized” medical system into one controlled by the government.

※ ASIAPRESS communicates with its reporting partners through Chinese cell phones smuggled into North Korea.