The Huichon Children’s Hospital is cold and damp. It is the only hospital in this city 200 kilometers north of Pyongyang. It has had no heating since floods in 1995 ruined the boiler. Along with no heat, there is no medicine and no food. Huddled listlessly in the small communal rooms that serve as wards are mothers with their emaciated children in advanced stages of malnutrition, too weak to cry, too strong yet to die.

Nearby on the other side of the river that divides the town — and brought its destruction — is the People’s Distribution Center, responsible for delivering food to the population. There is no food left in the center. The last delivery for the whole population was in late October. Children received an allocation for 33 days, teachers, nurses and doctors 16 days, and the rest of the population 11 days. But the daily allocation was 250 grams, far below the U.N. recommended minimum of 700 grams for long-term survival. There is no indication as yet as to when the next delivery might be expected.

The world knows too well the horrors of famine. Here the sinews of society still hold together as the children, the old and the vulnerable starve in slow motion. In the last five years, 3 million have died — one-eighth of the population. A generation is being slowly crippled. A World Food Program nutritional survey taken two years ago showed that one in six children had suffered brain damage from lack of food and the growth of 50 percent would be permanently stunted.

The key to kick-starting the system again is coal and rice. Productivity in both is set to fall more than 10 percent this year. With no electricity available to bring coal to the surface, mines are operating woefully below capacity. The factory chimneys remain smoke-free. De-industrialization is taking place at a pace that would make the most radical ecologist blush.

A little over a generation ago, North Korea was one of the world’s economic successes. After the Korean civil war had reset the economies of the two portions of this divided nation back to zero, it was the North that led the way. They did have help until 1958 from Chinese “volunteers” who stayed behind after the war to rebuild the shattered infrastructure, but this assistance paled in comparison with the hundreds of millions of dollars the Americans pumped into the South to prop up its corrupt, brutal military regimes.

Despite this handicap, Stalinism came out ahead of capitalism red in tooth and claw for a moment of time. North Korea became one of the most heavily industrialized countries in the world. They sent aid to Africa, pilots to Vietnam and even blankets and rice to South Korean flood victims.

Then the Stalinist motor started to misfire. The industrial shock-troops of the “Chollima” movement and the “Taen” labor system grew tired. The heroes of labor were battle fatigued and shell-shocked, and the forward march of labor halted. The economy stagnated. In the South, Japanese-style corporate capitalism started to pull the economy up by its bootstraps and into the passing lane. Worse was to follow.

The U.S. used its military might to set targets for the Soviet empire in terms of men and machines, goals that could only be met by neglecting the civilian half of the command economy. The entire Soviet bloc’s economic system crumbled and fell. The result was that the parallel system of trade that made up the industrial wing of Pax Sovietica went as well. The economy that had been inside the “cordon sanitaire,” exchanging indigenous raw materials and agricultural products for inferior manufactured goods, went as well. Trade between Russia and North Korea effectively stopped.

North Korean trade fell from $3 billion in 1989 to $40 million in 1999, leaving the country economically marooned. North Korea’s only customers were the world’s rich pariah states of Iran, Iraq and Libya, and the only product it could sell was military hardware. Over the last decade, over a quarter of North Korean exports have been sales of upgraded Scud missiles, with an estimated street value of $3.5 billion.

What finally put the tin lid on it all was a series of natural disasters that seemed to only need plagues of locusts and boils to have the full biblical set. Enormous long-term damage was done. Bridges were swept away, mines were flooded and saltwater ruined tens of thousands of hectares of farming land for the foreseeable future. North Korea now threatens to fade away.

Without assistance on a massive scale, there are only two likely outcomes. First, South Korea’s economic and political infrastructure will be destroyed as millions flee south overwhelming any capacity for action. Second, in a final desperate move, the North Koreans will engage in military adventurism that will have even more devastating results, adding 1 million casualties to the present humanitarian disaster.

The first hints exist that Kim Jong Il, North Korea’s supreme leader, is willing to start to bring the country into the international community of nations and open it up to the realities of the new world. It will be a long, slow and painful path before North Korea can be seen to meet minimum global standards of nutrition, economic openness and human rights. This will require international cooperation on a massive scale. However, all other options are worse.

Participating in such a partnership will be costly both financially and politically. Some countries will have to lay down the burdens of the past in order to move forward. I believe it is a price worth paying, not only for those suffering in the North but for us all. In this age of globalization, no one can escape the consequences of chaos in North Korea.

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