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Source: UN Children's Fund
Date: 27 May 2004
High rates of malnutrition and diarrhoeal diseases among
children, a high maternal mortality ratio, a shortage of drugs
and deteriorating education in DPR Korea need to be addressed.
UNICEF received only around 50% of the revised CAP
requirements (US$ 14,803,000), including the response to the
Ryongchon tragedy.
Essential drugs for 12 million people, textbooks and basic
school materials for 650,000 girls and boys, as well as
immediate support to 2,000 primary school children in
Ryongchon are UNICEF's current priorities.
1. ISSUES FOR CHILDREN
Malnutrition and micronutrient deficiencies
High rates of child malnutrition and micronutrient
deficiencies continue due to food shortages and the limited
capacity of the country's social services to respond. The 2002
Government-UNICEF-WFP nutrition survey showed that 42% of the
country's children below seven years of age are chronically
malnourished, 9% are acutely malnourished and 70,000 are
severely malnourished, requiring special hospital care for
their survival.
Shortage of essential medicines and equipment
A widespread shortage of essential medicines and basic
equipment due to the continued deterioration of social
services remains a major concern. Local production and
importation of drugs has almost completely ceased. Simple
equipment is either not in place or is over thirty years old.
Knowledge and skills of staff need to be upgraded.
High rates of diarrhoeal diseases and deaths
High incidence of diarrhoeal diseases caused by contaminated
water, use of unsanitary latrines and unhygienic practices
reinforces the cycle of malnutrition and contributes to high
infant and child morbidity and mortality. Piped water
availability has been curtailed and is often contaminated
because of deteriorated infrastructure and distribution
system. The treatment of piped water is no longer a regular
practice due to lack of national budget. Families now
frequently have to seek alternative water sources and the
burden of water collection falls on women and children. The
perception, knowledge and practices of parents concerning home
management of diarrhoeal diseases are also known to be poor.
High maternal mortality ratio
Continued high rates of maternal mortality caused by a
deteriorating health system that is finding it increasingly
difficult to deliver good services and manage emergency
referrals is another major issue in DPRK.
Deteriorating quality of education for children
The improvement in quality of education is an issue in DPRK,
as is the continual shortages of basic school supplies, often
now a charge on parents rather than the local authority,
shortages of textbooks, and further degradation of school
infrastructure. Field observations and verbal reports from the
Ministry of Education indicate that the prolonged hardships,
such as illness and lack of adequate heating in schools during
the long sub-zero winters, are beginning to provoke a pattern
of absenteeism. Humanitarian assistance has made modest
contributions, but without a definite move towards systemic
improvements, this is not a sustainable approach to solve the
problems.
Sudden death, loss and trauma for children: Explosion at
Ryongchon County
On Thursday 22 April 2004, at 1210 hrs local time, two train
wagons exploded at Ryongchon Station, Ryongchon County, North
Pyongan Province. The blast killed more than 160 people,
including 76 children, and injured 1,300 people, 370 of were
hospitalized with serious injuries. The explosion caused major
damage to housing, schools and medical facilities. The only
primary school, one of the two Kindergartens and the only
nursery were totally destroyed causing disruption of
children's education, discontinuation of care-services,
displacement and trauma to nearly 2000 children.
2. ACTION
Addressing malnutrition and micronutrient deficiencies
UNICEF has delivered F100 therapeutic milk to health
facilities in DPRK to treat more than 16% of the country's
severely malnourished children. This was largely due to the
significant ECHO contribution that ensured additional
deliveries to more hospitals at the county level, increasing
the rehabilitation centers to 61 and reaching more children
who would have otherwise died. With more funding from Republic
of Korea and ECHO, it is expected that, by the end of the
year, UNICEF will rehabilitate more than 41% of the country's
severely malnourished children and increase the number of the
rehabilitation centers from 61 to 157.
Targeted care institutions were equipped to carry out regular
growth monitoring in an effort to build capacity of the
Government to prevent malnutrition. A group of master trainers
in all provinces were trained on growth monitoring, early
childhood development and care. The skills and knowledge is
being transferred to the care takers in care institutions
(nurseries and baby homes) through regular refresher training.
With a joint effort of WFP, UNICEF and the Government,
production of vitamin and mineral fortified food has
continued. Vitamin and mineral premix is supported through
ECHO contribution. The food is given to young children,
pregnant (from 4 months) and lactating women, contributing to
the decrease of micronutrient deficiencies and improving the
nutritional status of children in DPRK.
Two protocols on micronutrient supplementation - Protocol on
Iron/Folate Supplementation before Pregnancy and Treatment of
Iron Deficiency / Anaemia, and Protocol on Multi-Micronutrient
Supplementation during 1st Trimester of Pregnancy - were
drafted and shared with the Ministry of Public Health. Supply
of micronutrient supplements for pregnant women is expected in
June/July. UNICEF expects to reach 60% of pregnant women in
DPRK to reduce incidence of micronutrient deficiencies in
pregnant women and protect newborn children from impaired
growth and development.
Approximately 49,000 pregnant women in vulnerable areas of the
country with high iodine deficiency received iodized oil
capsules. This includes all pregnant women in Chagang and
Ryanggang provinces and all pregnant women in selected
counties in North Hamgyong province. Now approximately 49,000
newborns are less likely to be born with iodine deficiency,
which impairs mental and physical development.
Supply of essential medicines and equipment
UNICEF has ordered sufficient quantities of vaccine to fulfill
the needs of DPRK in 2004. Cold chain equipment needed to
store vaccines as well as spare parts and local means of
transport have also been ordered. Over 350,000 infants will be
fully immunized, protecting them from disease and disability.
However, with GAVI assistance for AD Syringes and safety boxes
drying up at the end of 2004, pre-order of further supplies of
these items for 2005 looks uncertain unless the Government can
ensure alternative funding sources.
UNICEF delivered essential medicines to 2,648 health
facilities, reaching all provinces and cities in the country.
The deliveries were on time thanks to sustained progress of
the Central Medical Warehouse (CMW) / Ministry of Public
Health (MoPH) logistic capacity. The very basic drugs
necessary to treat the main causes of children's illness and
mortality in DPRK are available. Millions of children will be
treated for simple yet life threatening illnesses, including
diarrhoea and pneumonia. However, the number of such drugs has
been limited to 22 out of 60 on the Essential Drugs List
adopted by WHO, UNICEF, IFRC and UNFPA, thus limiting the
treatment of some diseases and conditions while other serious
illnesses remain untreated or not optimally treated.
In addition, local production of oral rehydration salts (ORS)
was maintained at 3 million sachets meeting 30% of the
country's need and contributing to the decrease of child
mortality due to diarrhoeal diseases.
Water supply and sanitation interventions for reducing
diarrhoeal diseases
The construction of gravity flow water supply systems in Kosan
and Kowon counties is one of the most successful achievements
of the WES programme in 2004. 15,000 families (about 75,000
people) now receive uninterrupted supply of clean water, which
is expected to substantially reduce risks of diarrhoea
transmission, thus helping to break the vicious cycle of
reduced resistance/increase vulnerability and malnutrition.
The UNICEF Water and Environmental Sanitation project will
continue to work in these two focus counties, but at the ri
level (rural communities). The predicted outcome of this
project is uninterrupted supply of clean water to individual
households in these cities and ris and reduced risk of
diarrhoeal diseases.
The DPRK Government and UNICEF have also agreed to encourage
and expand this gravity flow piloting scheme to seven
additional cities and counties during 2004-2006. Assessments
of some new water and sanitation project activities have been
completed and others are in progress. No new rehabilitation
has been initiated, but will begin by mid-year.
Due to the arrival of ECHO 2003 funds in 2004, an upward
adjustment of implementation targets for 2004 is possible. In
the face of a large unmet demand in this sector and increased
handling capacity, the planned funding level has just been
revised upwards in the CAP MYR by US $ 1,000,000.
Implementation is on track, and the absorptive capacity of
UNICEF as well as the Government is adequate to take on the
additional implementation load this increasing planning level
will imply. This increased implementation, if achieved, will
ensure clean water supply and sanitation facilities to an
additional 30 children's institutions such as nurseries, and
baby-homes as well as 15 remote schools, serving a total of
approximately 25,000 children.
Addressing maternal mortality through safer delivery
Equipment for emergency obstetric care at county hospitals and
midwifery kits for the ri level have been ordered out of 2003
Swedish SIDA contributions, now completely expended. Pregnant
women now have access to emergency obstetric care, which is
expected to reduce the maternal mortality rate. Basic
Obstetric Care kits will serve an estimated 14,400 normal
deliveries at Ri level and Emergency Obstetric Care kits will
serve an estimated 250 complicated deliveries at the referral
level of County/Provincial hospitals. For the first time,
funding has been received specifically for Safe Motherhood.
New Zealand has recently contributed US$ 199,500 for this
project.
Improving quality of education for children
UNICEF has been able to provide 82MT of printing paper due to
the late arrival of pledged funds in 2003, which resulted in
some spill over to 2004. 60,000 primary and pre-school
children (out of a planned coverage of 650,000) will have new
textbooks. With funding just received UNICEF has ensured basic
school materials (pencils, rulers, erasers and notebooks) for
300,000 children. The effectiveness of the classroom,
including learning retention, is expected to iincrease.
Two regional office advisors visited DPRK to do an assessment
of quality of education in DPRK and run a workshop on the
subject to the Government. Also, plans have been finalized for
two staff from the Ministry of Education to attend a regional
technical workshop on learning assessments in Bangkok later
this year. The process of reviewing ways and means of
improving quality of education, including incorporating life
skills in schools, has been initiated.
Crisis in Ryongchon
UNICEF delivered a truck carrying emergency essential medical
supplies valued at $17,000 (antibiotics, ORS, Paracetamol, IV
fluid, syringes and water purification tablets) within 48
hours after the explosion to the provincial medical warehouse
of Ryongchon (transported within 12 hours of receiving
official information and appeal). An assessment of damage was
taken and the reconstruction of a primary school, a
kindergarten, and a nursery has been included in the Mid Year
Review of the CAP. UNICEF has provided technical support for
the drilling of bore holes at the affected site to provide an
alternative water sources to those temporarily without water.
50 school-in-a-box kits have been delivered to ensure
continuation of children continue receiving education in
temporary arrangements while the schools are rebuilt.
Emergency preparedness and response to the Ryongchon crisis
has contributed to saving lives of those wounded in the
explosion. In addition, UNICEF has played a part to returning
normalcy to children by having them back to school and
restoring education services and system.
Advocacy dialogue with the Government
UNICEF Executive Director, Carol Bellamy, visited DPRK 13-16
March to look first-hand at the situation of children in the
country, to engage the Government in dialogue regarding the
opportunities and constraints in programming for children, and
to increase awareness amongst the international community that
results for children are being achieved with UNICEF support in
DPRK. The visit resulted in renewed commitment from the
Government on behalf of children, interest from the Republic
of Korea who is now emerging as a more active partner of
UNICEF's programme in DPRK, as well as enhanced awareness of
the international community and donors of the situation and
needs of children in DPRK.
3. APPEAL REQUIREMENTS AND RECEIPTS
As part of the 2004 UN Inter-Agency Consolidated Appeal for
the DPRK, UNICEF appealed for US$ 14,803,960 to support its
Emergency Programme for children and women in the country. The
table and graph below show the current funding status of the
Appeal, by sector.
Sector Target (US$) Funded (US$) % Funded Unfunded (US$)
Emergency Nutrition Rehabilitation, Prevention of Malnutrition
and the Control of Micro-nutrients 2,358,720 1,666,976 71
691,744
Expanded Programme on Immunization 1,299,200 885,254 68
413,946
Essential Medicines 5,118,400 1,873,724 37 3,244,676
Safe Motherhood 343,840 199,500 58 144,340
Water and Environmental Sanitation 3,732,800 2,671,001 72
1,061,799
Education 924,000 636,626 69 287,374
Ryongchon 1,027,000 0 0 1,027,000
Total 14,803,960 7,933,081 54 6,870,879
The following table indicates the contributions received for
the Appeal, by donor. ECHO remains the largest donor for DPRK
with combined contribution of US$ 2,615,666 against CAP 2003
and CAP 2004. An amount of $1,396,771 allocated in 2003 was
utilized for the prevention and treatment of malnutrition.
UNICEF is grateful to the generous donor contributions, which
have greatly assisted in continuing humanitarian interventions
for the most vulnerable children and women in the DPRK.
TABLE 2: FUNDS RECEIVED FOR 2004 APPEAL BY DONOR
AS OF 25 MAY 2004
Donor Income/Pledges (US$) Purpose
Canada 451,128 Essential medicines, water supply and
sanitation
European Community (ECHO) 998,752 Nutrition rehabilitation,
essential medicines
European Community (ECHO) 1,616,914 Water supply and
sanitation
Finland 373,134 Education, nutrition rehabilitation
New Zealand 350,000 Safe motherhood, essential medicines
Norway 426,750 Immunization, water supply and sanitation
OPEC 250,000 Water supply and sanitation
Republic of Korea 1,000,000 Nutrition rehabilitation,
essential medicines, immunization
Sweden 649,350 Education, essential medicines
United Kingdom 1,817,053 Nutrition rehabilitation,
immunization, essential medicines, water supply and sanitation
Total 7,933,081
4. IMPACT OF UNDER-FUNDING AND CURRENT PRIORITIES
Under funding and late funding for UNICEF programmes in the
DPRK has usually forced postponement of activities, slowed
implementation of activities and reduced programme coverage.
Shortfalls in funding prevent UNICEF from providing adequate
support and puts children at greater risk of death and
malnutrition. For example, UNICEF is currently only able to
provide several "very vital" drugs out of the more than 200
items on the WHO essential drugs list.
The table below outlines the most urgent priority
requirements:
Table 3: PRIORITY REQUIREMENTS AS OF 25 MAY 2004
Project Beneficiaries/coverage Amount Required (US$)
1. Essential medicines 12 million people in eight
provinces/cities
Children and pregnant women referred to provincial hospitals
in three provinces and one city 1,000,000 (for vital drugs)
2. Safe-motherhood 480,000 pregnant women 100,000 (for
equipment for safe child deliveries)
3. Education 650,000 girls and boys in the most vulnerable
provinces (north-east) as well as in orphanages in all
provinces countrywide 200,000 (for textbooks and basic school
materials)
4. Ryongchon 2000 children of one primary school, one
kindergarten and one nursery that had been totally destroyed
1,027,000 (more firm estimates subject to further detailed
assessment)
UNICEF is thankful to the above-mentioned donors who have
contributed/expressed indications to support its efforts in
responding to the humanitarian needs of children and women in
DPRK.
Details of the UNICEF DPRK Emergency Programme can be obtained
from:
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