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Source: UN Office for the Coordination of Humanitarian
Affairs (OCHA)
Date: 28 Feb 2003
DPR Korea OCHA Situation Bulletin Feb 2003
WHO STUDY ON ELECTRICITY SUPPLY IN BLOOD TRANSFUSION CENTRES
AND COUNTY HOSPITALS
WHO, with help of an international industrial engineer,
recently conducted a study on electricity supply in national
and provincial blood centres and some county hospitals during
February 2003. The purpose of the study was to see how new
equipment can be best installed in health institutions,
taking in consideration the existing energy problems.
The study, which was in support of an ECHO funded project to
strengthen blood transfusion services in the DPRK, revealed
that prior to determining the type of medical equipment that
should be provided to health institutions, organisations must
address a number of problems. How appropriate is the
equipment given the energy supply problems in the country?
How do we ensure the equipment is installed and maintained
correctly? How do we ensure adequate electricity for the
equipment once it is installed?
The study revealed that even if the equipment was
appropriate, unless it was installed correctly, it could be
damaged, used improperly or simply left unused by the
hospital for the want of electricity. It was also noted that
problem of electricity supply did only refer to the quantity
of available energy, but also its quality. Both aspects must
be carefully considered in all projects that include electric
powered machines, from the planning stage to the final
installation of the equipment.
From the quantitative point of view, the lack of energy is
the main reason for unused or under-utilised electrical
medical equipment. Even though some aid organisations have
been reluctant to provide generators, it has been identified
that a generator is necessary in many cases to maximise the
effectiveness of the equipment. When providing generators,
organisations should also ensure that the right type of
generator is provided.
The type of generator provided will depend on the quantity
and quality of available electricity, generator fuel and the
type of equipment being supported. During the study, various
county hospitals in different provinces were asked to define
their electricity needs. Large differences were reported in
energy availability, from relatively regular supply to no
electric supply at all. As a general rule, agricultural,
isolated and flat regions have worse electric supply (but
have access to more fuel) than industrial, mountainous and
accessible regions.
The quality of the electric supply, such as unstable
frequency and voltage, impose additional complications on
programme staff when assessing the type of equipment that
should be supplied to hospitals. In the long term, the poor
quality of the electrical supply greatly reduces the life of
the equipment. In the short term, it creates a high
dependency on fuel if the generator is to function correctly.
In the facilities that obtain sufficient electricity from the
electrical grid, it is also essential to install electric
devices that can enhance the voltage, such as transformers or
stabilisers. These hospitals might also need a backup
generator for emergency cases. It should be noted that a high
power generator, with resultant high fuel needs, is not
required. Large kilowatt consumers, such as autoclaves and
water heaters, can be operated during the hours of regular
supply.
As part of the WHO study, recommended specifications have
been produced for electrical equipment based on the differing
conditions of the main electrical supply.
The main conclusion of the study is that medical equipment,
which is provided to DPRK, must be adapted to the existing
energy situation. This may include the provision of an
appropriate generator to ensure effective use of the
equipment. WHO would like to cooperate with other agencies to
find optimal solutions that ensure that the most basic
services can be delivered in hospitals.
For further information on the study please contact: Dr.Eigil
Sorensen, WHO Representative to the DPRK
(Sorensen@whosea.org).
UNICEF AND PARTNERS - ENSURING THE AVAILABILITY OF VERY VITAL
MEDICINES TO TREAT LIFE THREATENING CHILDHOOD ILLNESSES
So far in 2003, "very vital" medicines have been delivered to
eight of the twelve provinces and cities of the DPRK.
Deliveries to the remaining four provinces will be completed
in March. UNICEF now supports the provision of "very vital"
medicines to over 2,000 health facilities countrywide. IFRC
complements UNICEF activities by distributing essential
medicines to over 1,700 health facilities in accessible areas
not covered by UNICEF.
With UNICEF support, the Ministry of Health's logistics
system is improving, and deliveries to health facilities are
now more regular and follow an annual delivery plan.
Deliveries to the most distant provinces in the northeast of
the country are by UNICEF's own transport. Full details of
the 2003 annual delivery plan, the current health facilities
coverage plan and the types of medicines provided are
available from the UNICEF office.
HEALTH AND NUTRITION
UNICEF
Immunisations continue for children and pregnant women. In
spite of the cold weather, vaccination services continued to
be offered over the winter months in most parts of the
country. Further upgrading of the national system for proper
storage and handling of vaccines (the cold chain) is a
priority for 2003. Although much of the country's cold chain
equipment has been replaced over the past five years, more
needs to be done to ensure that vaccines for the country's
470,000 infants and 480,000 pregnant women, each year, are
potent and safe at the time of vaccination. A UNICEF
technical assistant to the Ministry of Public Health arrived
in country in January and is now providing both formal and on-
the-job training for six months this year.
UNICEF Field visits. UNICEF staff undertake field visits to
health facilities, children's institutions, primary schools,
nurseries and other specific project sites in all of the 12
provinces/cities countrywide. So far in 2003, UNICEF staff
have made monitoring visits to four of the 12 provinces /
cities countrywide. Main findings are:
Acute respiratory infections (pneumonia) and diarrhoea are
still the most common illnesses in children.
Moderate malnutrition is widespread, severe malnutrition is
seen - these field observations are consistent with the
findings of the recent nutrition assessment.
Health clinics have very vital essential medicines for
treatment of children's illnesses until April.
Paediatric hospitals and baby homes have stock of high-energy
therapeutic milk for the treatment of severe malnutrition
until May.
All institutions report fewer hours of electricity compared
to this time last year.
ADRA - NEW SURGERY FOR SARIWON PAEDIATRIC HOSPITAL
ADRA DPRK has recently begun construction of a new Surgical
Building for the Provincial Paediatric Hospital in Sariwon,
North Hwanghae. The new surgical building will be located in
the center of the hospital grounds and will be surrounded by
the wards, and the dentistry. It will contain two operating
rooms to cater for both internal and dirty-wound operations.
The most unique feature of the surgery will be the insulation
method. Due to extremely harsh winter conditions, the
operating theatres can face sub-zero temperatures making it
very difficult for the surgeons to operate safely and
effectively. The building will be constructed with double
layer outer walls and insulated with burnt rice-shell ash.
Burnt rice-shell ash is a traditional insulating material
that is common to the DPRK. The process of burning or
scorching the rice-shell accomplishes two goals; firstly it
prevents the material from absorbing moisture, and secondly
it prevents insects and animals from inhabiting it.
The FDRC is supporting this project by providing the labour
for construction as well as sand, stone, and insulation
material for the building. Currently the foundation is in the
process of being dug. The entire project is expected to be
completed by July 2003.
UNFPA - NEXT COUNTRY PROGRAMME
The UNFPA Country programme outline development mission paid
a visit to DPRK during 8 - 15 February. The next country
programme will be the fourth cycle of assistance for DPRK for
the period of 2004-2006. The outline is based on The Common
Country Assessment and Consolidated Appeal Process 2003, Mid-
Term Review and Annual Review recommendations, consultations
with the government, UNICEF, WHO, UNDP, WHO, OCHA, WFP and
International Federation of Red Cross. This is to ensure
mutual understanding and harmonization of the programme
content.
Furthermore, consultation was also made with Executive Board
members during the programme development process. Partners
have pointed out the leading role that UNFPA could play in
the Reproductive Health area.
The three main aims of the programme will be:
Reduction of maternal mortality through provision of
Reproductive Health services including maternal and newborn
care, Family Planning services, and treatment of RTI/STI.
Improved access for beneficiaries to essential Reproductive
Health commodities through harmonization of donor efforts
both in terms of commodity provision as well as logistics for
their delivery.
Enhanced capacity for collection and analysis of data to
better monitor health delivery, including RH services.
The programme is also complementary with two of the health
sector objectives of the CAP 2003, which are to:
Strengthen the capacity of the health system to deliver
essential services with an emphasis on the treatment of
priority women and child illnesses.
Strengthen the capacity of health services to provide access
to improved basic and emergency obstetric care.
The programme area will be in South Hamgyong and Kangwon in
the east and South Phyongan Province in the west. The Country
Programme Outline 4 will be submitted to The Executive Board
Session in June.
The mission was composed of UNFPA Country Director for DPRK,
Ms. Siri Tellier, based in Beijing, Dr. Katherine Ba Thike
and Dr. Jayanti Tuladhar from UNFPA Country Services Support
Team, Bangkok and Mr. Yu Yu, Programme Officer from UNFPA
Beijing.
IFRC HEALTH CARE
Activities conducted by the IFRC health team in the period
included:
5,824 basic drug kits, which were donated by ECHO for the 1st
quarter 2003, were distributed to the health institutions
responsible for Primary Health Care for inhabitants in 44
cities/counties of South Pyongan, North Pyongan, Jagang
provinces and Kaesong municipality in January-February 2003.
The other seven counties located in remote areas received the
basic kits for the 1st quarter at the end of last year.
1,905 household doctor kits, which were purchased with funds
from the German and Netherlands Red Cross, were distributed
in January-February 2003 to household doctors in 1,759 health
institutions.
1,515 safe delivery kits, 51 county hospital kits, 158 Ri
hospital kits for institutions, and 1306 ri clinic kits,
which were donated by the Canadian and Australian Red Cross,
were supplied to obtain better quality of maternal care at
community levels.
Review and revision of training materials were conducted for
the workshops on the topics of prevention of water-borne
diseases, malaria, Acute Respiratory Infections and
Tuberculosis (ARI/TB), aseptic techniques, rational drug use
and safe delivery planned for 2003.
WATER AND SANITATION
Water and Sanitation -UNICEF Report Good Progress
Good progress is reported by the UNICEF-supported water and
sanitation programme. The programme continues its focus on a
number of selected counties for greater impact.
Rehabilitation of town and rural water supplies is underway
in three focus counties in Kangwon and South Hamgyong
provinces. Piped water systems are being replaced; bore-wells
are being drilled in institutions. Seventy-two small-scale
institution based sanitation projects are nearing completion.
IFRC
Activities conducted by the IFRC water and sanitation team in
the period included:
Monitoring arrival of cement for Ecosan Latrines in 4 Health
Institutes and 1 village.
Collected information on the incidence of water borne
diseases from Ri clinics/hospitals in 30 villages was
collected
A watsan training workshop, which mainly focused on
sanitation, was conducted in N. Pyongan Province. 40 people
from 8 counties participated in the workshop.
UNICEF - CONTRIBUTIONS TO CAPACITY BUILDING
UNICEF Supports Overseas Study Visits and Technical
Assistance
In January a five-member team from the Ministries of Foreign
affairs, Public Health, City Management and Education,
together with UNICEF senior staff, undertook a two-week study
visit to Cuba to look at UNICEF-Government of Cuba
cooperation and Early Childhood Development programming in
particular. As a result, changes are anticipated in child
care policies, emphasizing greater parental responsibility,
involvement and capacity building.
A four-member team from the Ministry of City Management,
together with UNICEF project staff, traveled to China and
Vietnam for two weeks from February 14. In China the team
spent time learning about WES item technical specifications.
In Vietnam the focus was to learn about approaches to
decentralized planning for improving rural water supply and
community participation.
UNICEF is currently providing specific technical assistance
to the Ministry of Health's national immunisation programme
to upgrade the cold chain (Phase 1: January - April).
Technical assistance will be provided in March to the
Ministry of Public Health in Breastfeeding Management as part
of the renewed effort to promote and protect breastfeeding in
the DPRK.
UNICEF's approach to capacity building in the DPRK combines a
number of key components:
agreement on a well-prepared medium term action plan to build
capacity rather than ad-hoc training events,
overseas training or specially prepared study visits for key
officials increasing exposure to international developments
and standards,
in-country technical assistance, and
support for assessments/studies.
PROGRAMME PLANNING
The Government-UNICEF programme plans of action for 2003 were
completed in January, and signed on February 10. Copies are
available upon request from UNICEF. As last year, plans are
output based and developed using a logical framework
approach.
On March 10, the Government and UNICEF will hold a country
programme strategy meeting, to review draft plans for
cooperation over the period 2004-2006. The UNICEF Regional
Director for East Asia and the Pacific will attend the
strategy meeting, as well as UNICEF's main partners in the
DPRK.
EDUCATION - UNICEF PROVIDES BASIC STUDENT MATERIALS FOR 1,500
SCHOOLS
Distribution of basic school materials - including pencils,
rulers, erasers - and textbooks using 2002 contributions is
now being completed in advance of the new school year, which
begins on 1 April.
The project provides support to over 1,500 primary schools-
mainly primary schools in the northeast of the country. For
the first time since 1988, all 14,500 kindergartens
countrywide have recently received reprinted textbooks
through the project.
AGRICULTURE - TRIANGLE G.H. SUPPORT TO ENVIRONMENTAL
PROTECTION
In March 2003, Triangle GH will start a forestry and
environmental protection project in South & North Pyongan and
South & North Hwangae Provinces. This one-year project,
funded by the Swedish International Development Cooperation
Agency (SIDA) is an integrated project for tree nurseries
rehabilitation and environmental protection that will concern
5 tree nurseries at the county level. Attention will be
focused on both the nurseries and the transplanting areas in
order to improve erosion control and production of fuel wood
and fodder. Staff training and capacity building will be
strongly developed with the organisation of a study tour in
China and local workshops for the Heads of the targeted tree
nurseries.
FOOD AID - WORLD FOOD PROGRAMME
Due to the shortfall in donations, in February WFP was not
able to provide food aid for up to 2.9 million vulnerable
people, including children in nurseries and kindergartens,
primary school children, pregnant/nursing women, elderly
people, and caregivers in child institutions. Cereal
distributions to children in nurseries, kindergartens and
pregnant and nursing women, which were suspended in some
regions late last year, will resume only after the middle of
March until the arrival of the 46,000 mt (ECHO contribution)
shipment.
With the arrival of the ECHO contribution, food distribution
needs for all beneficiary categories - pregnant and nursing
women, children in orphanages, nurseries, kindergartens and
primary schools, the elderly and caregivers at children's
institutions - will be met through April.
However, if no new contributions are received by then,
distributions will again need to be cut from May onwards.
Food-for-work project food allocations for the spring season
have been curtailed to about 70% of that planned as resources
dwindle.
In February, cash contributions were received from the
governments of Australia (USD 1.76 million) and Norway (USD
900,000). Both will be used for the purchase of wheat.
However the outlook for the second half of the year remains
grim. WFP's emergency programme remains heavily under-funded
for all commodities in the latter half of the year. It is
imperative that additional donor contributions, including
cereals, pulses, Corn Soya Milk, oil and sugar, are confirmed
as soon as possible to cover the third and fourth quarters.
To avoid worsening the widespread hunger and malnutrition in
the country, donor contributions for about 77,000 mt of food
are urgently required to cover the operation for the first
half of 2003. In addition to 60,000 mt of cereals,
requirements also include powdered milk (2,200 mt), CSM
(8,000 mt), sugar (600 mt), pulses (6,000 mt), and oil (800
mt).
Nutrition Survey Report released
According to the Nutrition Survey results announced on
February 20, 2003, malnutrition among children in the DPRK
has been reduced significantly over the past four years. The
field portion of the survey was carried out in October 2002
after the DPRK government agreed to a follow-up survey, with
the participation of UNICEF and WFP, to that conducted in
1998. WFP staffed the majority of the survey teams with its
international and national Emergency Officers.
The survey covered children under seven years of age and
their mothers, from 6,000 randomly selected households in 10
of the country's 12 provinces and municipalities. The
youngest child from each household was weighed and measured,
and the mother's nutritional condition was assessed. In
addition, questions were asked about factors that could
influence nutrition, such as food availability, child feeding
and care, and health status.
Although the new assessment is not strictly comparable with
the 1998 survey, clear positive trends are discernible:
The proportion of children underweight (weight-forage) has
fallen from 61 percent in 1998 to 21 percent in 2002.
Wasting, or acute malnutrition (weight-for-height), has
fallen from 16 percent to 9 percent.
Stunting, or chronic malnutrition (height-for-age), has
dropped from 62 percent to 42 percent.
The assessment also provided the first objective analysis of
differing vulnerability across the country. Stunting among
children in Nampo City was 25 percent, for example, compared
to 48 percent in South Hamgyong Province. The wasting rate in
Pyongyang, the capital, was just under 4 percent, against 12
percent in South Hamgyong. The survey found similar patterns
in food availability and the incidence of childhood
diarrhoea. A further important finding was that about one-
third of mothers are malnourished and anaemic.
Though child malnutrition has fallen considerably, the UN
agencies believe there is still cause for great concern and
that gains could be lost if international support for
humanitarian assistance to the country continues to decrease.
According to World Health Organization criteria, the
underweight rates are still "high", and the stunting rates
are "very high." Moreover, the recent slump in external
donations for food, medical and other assistance could
compromise the gains.
A joint UNICEF/WFP presentation of the results of the
Nutrition Survey was made to the resident humanitarian
community and WFP staff after the release of the report.
WFP Conducts Nutrition Workshop
Two nutrition workshops were conducted in Pyongyang by staff
from the WFP Regional Bureau in Bangkok, Ms. Judit Katona-
Apte and Ms. Anette Haller, during the month. WFP
international and national staff attended the workshops.
Daily food rations provided by the government through Public
Distribution Centers (PDCs) in February remained at 300
grams/person/day, similar to that in the last quarter of
2002. Distributions at this level are expected through March.
WFP - Monitoring and Access
All WFP sub-offices were operational in February, as the
Hyesan office in Ryanggang province re-opened for regular
monitoring activities. Though Food For Work activity was less
in February compared to one year earlier, monitoring visits
have increased by about 15%. Further, Emergency Officers have
increasingly been able to observe food distributions in PDCs.
Monthly Monitoring Visits
February
2002 February
2003
Ports 7 12
LFP Factories 16 18
FDRC/PDS 107 78
Family visits 56 58
Hospitals 7 4
Orphanages 8 0
Kindergartens 37 26
Nurseries 63 35
Schools 33 13
FFW 8 51
Total 342 295
Access as at end February 2003
Access 162
No Access 44
Total Counties 206
Food-For-Work (FFW)
Of the remaining 17 incomplete long-term projects from the
autumn 2002 season, 6 FFW projects were monitored during
February. Due to resource constraints, only 24,000 mt of food
has been allocated for the 2003 spring season, about 70
percent of the planned tonnage.
East coast provinces were allocated 18,000 mt and west coast
provinces 6,000 mt. In total 91 FFW project proposals were
received from the government by the end of February.
Two FFW workshops were conducted from February 4 to 12 for
provincial and local authorities in Kangwon, Ryanggang and
North and South Hamgyong provinces. The FFW Unit introduced
the prospect of implementing new types of FFW projects: water
sanitation, urban activities, community/household food
security, and food-for-training. The findings of these
workshops are also being used to review the project types
proposed for implementation in the coming spring season.
Mr. Rezaul Karim, FFW technical consultant from WFP
Bangladesh, is in-country from February 22 to March 8, to
assist the FFW unit in developing operational guidelines and
revising work norms.
During his review of WFP-assisted FFW activities in the DPRK
and field visits, work-norms were highlighted and the
feasibility of various new activities assessed. Initial
discussions with FDRC on work norms for different project
types were also initiated.
A meeting was held with Mr. Ralph van Gelder of UNOPS on
IFAD's Upland Food Security Project (UFSP) in Ryanggang and
North Hwanghae provinces to discuss WFP's participation
through the FFW programme. Preliminary food requirements for
assisting tree-planting projects in UFSP areas would be about
1,200 mt for 2003.
Local Food Production
The total output for February was 1,328 mt, with an increase
of operational factories from five at the beginning of the
month to fifteen during the last week of February as
factories began to receive wheat and DSM (powdered milk). The
latter was reallocated from the CSM/CMB (corn soya milk/
cereal milk blend) factories after recipes were (temporarily)
changed to exclude DSM. Those factories will now produce CSB
(corn soya blend) and CB (cereal blend). From the beginning
of March, all 18 factories are expected to be operational.
ADRA Switzerland's contribution of 27 mt of skimmed milk
powder to WFP's RMB (rice milk blend) production was received
in the month.
FALU
Caritas Hong Kong is looking at possibilities to provide 100
mt of DSM and 600 mt of sugar for WFP's LFP facilities. 100
mt of canned meat for pregnant and nursing women and children
in orphanages in the north east of the country may also be
included.
The Caritas donation of 2,200 mt of rice arrived at Hungnam
port in February, for distribution to kindergarten children
in the east coast provinces. The ration, 300 grams/day/child
will last for about 38 days.
Commodity Arrivals
A total of 6,091 mt of food arrived in February (excluding
FALU):
2,886 mt of pulses (USA) arrived on the MV Hua Sha at Nampo
port.
2,000 mt of wheat (Luxembourg) arrived at Sinuiju by rail
from Dalian, China.
151 mt of sugar (Australia) arrived at Sinuiju by rail from
Dalian, China.
WFP WELCOMES NEW AID FOR NORTH KOREA BUT WARNS OF CONTINUING
SHORTAGES
(Press release 4 March 2003)
PYONGYANG - The World Food Programme today welcomed recent
pledges of assistance for its 2003 emergency operation in the
Democratic People's Republic of Korea, but urged donors to
help plug a continuing shortfall in resources that has left
millions of the most vulnerable without vital rations.
"The commitments to date are very important, because they
will ensure that many of the children, women and elderly
people currently deprived of outside support are fed again",
said Rick Corsino, WFP Country Director for the DPRK. "It is
also crucial that more contributors come forward quickly,
because there is nothing in the pipeline beyond June."
On 25 February, US Secretary of State Colin Powell announced
an initial US contribution for 2003 of 40,000 tonnes of
commodities, and said a further 60,000 tonnes would be made
available if improvements in WFP's ability to access the
needy and monitor distributions are allowed. A contribution
of 46,000 tonnes of wheat purchased with funds provided by
the European Commission's Humanitarian Aid Office is due to
begin arriving in the DPRK next week. The targeted
beneficiaries are children in nurseries, kindergartens and
primary schools, and pregnant and nursing women.
WFP, by far the largest aid agency in the DPRK, hoped to
mobilise 512,000 tonnes of food for 6.4 million people during
2003, but deliveries have fallen well short of needs.
Additional pledges of more than 325,000 tonnes are required
for the remainder of the year. A sharp slide in donations,
which began last year, left the UN agency unable to feed 2.9
million of its 4.2 million "core" beneficiaries by end-
February, up from 2.2 million in January. "There's no such
thing as retroactive feeding", Corsino noted.
WFP primarily targets urban residents who cannot easily
obtain food outside the government-run Public Distribution
System, which serves some 70 per cent of the 23 million
population. This year, the PDS expects to provide an average
of no more than 270 grams of food per person per day - less
than half a survival ration.
"This is clearly not enough for the average human being",
Corsino said. "The situation has been made worse as the cut-
off in WFP aid has occurred during the country's harsh winter
months when caloric needs increase."
Aid arrivals over the coming weeks will allow a temporary
resumption of some distributions, and a re-opening of a
number of WFP-supported food factories shut down for lack of
donor-supplied ingredients. The recent pledges underscore the
distinction donors make between humanitarian imperatives and
political considerations, Corsino said, but added that
contributors have a right to know their food is reaching the
vulnerable.
"While our operating conditions have improved over the years,
they are still more restrictive than in other recipient
countries. Above all, we are not allowed to carry out truly
random spot checks at distribution sites. We raise these
issues with the DPRK authorities at every opportunity, and
will continue to do so. "
The results of a major survey conducted in October by the
DPRK government, UNICEF and WFP, released last month, showed
a considerable improvement in child malnutrition rates since
the last such assessment in 1998. The proportion of
underweight children under seven years fell to 21 per cent,
from 61 per cent; wasting, or acute malnutrition, fell to 9
per cent, from 16 per cent; and stunting, or chronic
malnutrition, fell to 42 per cent, from 62 per cent.
Food aid targeted to young children and child-bearing women
clearly has been critical in achieving these important
gains. "It would be a tragedy if they were to be reversed. We
sincerely hope donors can keep the pipeline flowing, so that
WFP can fully implement its operation for the remainder of
the year", Corsino said.
(WFP Press Release - Pyongyang 4 March 2003)
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