Report paints bleak picture of N Korea health care

Norma Kang Muico, who is based in Seoul and is the author of the report, was told by several witnesses about surgeries performed without anaesthesia.

"We had one who had surgery for an appendix to be removed, another an amputation and they were all done without the aid of anaesthesia," she said.

"Some people even told me that when they had surgery with anaesthesia it wasn't enough to actually control the pain, so they were still in a lot of pain.

"[The hospitals] are very rundown, they're dilapidated. There's no electricity - if there is it's very sporadic.

"There's no heat in the winter time, there's no running water. The supplies are in short supply so if you've got say for example syringes, it's being re-used, sometimes with very little regard for hygiene. And sheets are not washed regularly and a lot of the cleaning responsibility falls on the patients' families."

When Australian National University (ANU) researcher Danielle Chubb visited North Korea on a study tour in 2007, government officials were keen to show her group the Pyong Yang maternity hospital.

"It was clearly something that they were very proud of and we were only shown into very certain parts of the hospital, even those parts seemed to a non-specialist in medical care, seemed very basic and there didn't seem to be a lot of medicines or a lot of equipment around," she said.

Malnourishment

In the early 1990s up to a million North Koreans died of famine out of a population of 22 million.

North Korea remains at risk of serious malnourishment and the long-term food insecurity is a major factor in serious chronic health problems for millions of North Koreans.

A UNICEF report between 2003 and 2008 reported that 45 per cent of North Korean children under five were stunted.

Ms Muico says the health situation in the country is directly related to a lack of food.

National uprising

Last year the regime tried to wipe out the black market activities which it saw as a conduit for capitalist ideas by revaluing the currency.

Dr Chubb says it had a dramatic impact on the population.

According to Dr Chubb, with no clear successor there is a power struggle between various factions within the regime to secure power after Kim Jong Il's death.