Former President Carter’s recent trip to North Korea, and resultant call for a resumption of humanitarian (mainly food) aid to the North, once again brings attention to the controversial issue of sending aid to North Korea. Many people disagree strongly on this one, some blaming aid provision for prolonging the rule of the Kim clan, with resultant additional suffering of the populace, others blame a failure to provide aid for the sickness and death of untold numbers of North Koreans.
Aside from food aid, what about medical aid? Further, what if disease outbreaks in the North sicken people in the South? Should the South provide aid if it protects Southerners? What if those affected include not only South Korean civilians, but also South Korean and U.S. troops stationed near the border? How would that change the debate?
In 2008 and 2009, the South sent aid to the North to help control the North’s mosquito population (the primary malaria vector) and reduce malaria morbidity in the North. While the effect of the aid in the North is unknown, at least outside the North, the provision of aid dropped the number of malaria cases in the South’s Gyeonggi Province (which borders the North) by 50% in 2008 (cases declined from 1,007 in 2007 to 490 in 2008). Aid supplies were hindered in 2009 by the outbreak of swine flu in the South, but what aid was provided still kept Gyeonggi’s number of cases at 611, well below 2007.
In May 2010, however, the South halted provision of all anti-malaria aid after it determined the North was responsible for sinking the Cheonan (a South Korean naval vessel) and killing 46 of the sailors onboard. What happened, absent the aid? The suspension caused malaria case counts in Gyeonggi to jump by 200, to 818. In total, the reduction (2009) and halt (2010) in anti-malaria aid resulted in 300-400 additional Southerners contracting the disease, aside from whatever effect it had on the North. [Information in the preceding two paragraphs available at the Korea Centers for Disease Control and Prevention, and this brief article from MBC News].
Aside from Gyeonggi Province, a broader scope look that includes all of the regions closest to the North (Seoul, Incheon, Gangwon, and Gyeonggi), shows the suspension of aid in 2010 led to a 40% jump in malaria cases, to a total of 1,259 cases. Included in the increased malaria morbidity were not just civilians, but also South Korean soldiers stationed along the border with the North.
While the U.S. is reducing the number of troops it has stationed in areas closest to the border, a 2009 study by the U.S. Army called malaria, “a significant health threat” for those deployed to malaria-endemic regions, like South Korea’s border with the North. The same study found that U.S. forces in Korea accounted for 44% of the total number of malaria cases in the entire U.S. Army from 1997-2002.
While establishing a definitive link between malaria morbidity in the North and increases in the disease among civilians and soldiers in the South awaits further epidemiological research, the numbers above illustrate what that research is likely to find. Taken together, these numbers show that, absent anti-malaria aid to the North, several hundred additional people per year in South Korea will likely contract the disease. Included among those additional cases will likely be members of both the South Korean and U.S. militaries.
The increase in malaria cases in the South has prompted members of the South Korean parliament to call for a decoupling of medical aid from politics and inter-Korean relations. These calls include not just members of the left-wing parties normally associated with aid to the North, but also at least one member of the Grand National Party, the current ruling party and the party that traditionally takes the toughest line with the North. Awareness of the second and third-order effects of medical aid provision appears to be altering the traditional South Korean split between liberals favoring aid to the North and conservatives opposing it. How this will affect international views of medical aid provision to the North waits to be seen.