Body
In March, we reported on the adverse effects South Korean sanctions had on the Eugene Bell Foundation's outstanding work on TB in North Korea; NKNews provided detailed coverage of the case. Sandra Fahy recently alerted us to a collection of essays at the new on-line Health and Human Rights Journal on the broader issues surrounding TB and human rights. The special issue not only makes the generic point that treatment should be universally available, but underlines the more subtle point that “key affected populations—the poor, people living with HIV/AIDS, mobile populations, prisoners, miners, people who use drugs, and children—face entrenched stigma and discrimination, further restricting access to services, discouraging health-seeking behavior, and making it difficult for them to mobilize and demand realization of their rights.” The collection has papers on a number of countries in additions to Fahy’s on North Korea (Kenya, India and Peru) but also on the obligations of the WHO on the issue.
As is so often the case with North Korea, Fahy simply has to be right on these issues even though data is scarce; nonetheless, she pulls together the little we know. Two populations are of particular interest. First TB is almost certainly an issue in North Korean prisons; she draws highly plausible parallels to the late days of the Soviet Union where prison populations were particularly adversely affected. Drawing on human rights reports from South Korea, Fahy notes the near-total disregard for the treatment of prisoners with TB in North Korea, with practices ranging from spraying sterilizing cleaning solutions directly on prisoners with TB to the near absence of testing and treatment services in prison health facilities. The second group is the mobile refugee population. As Marcus Noland and I noted in our very first work on refugees over a decade ago, there is plausible empirical evidence that the fear under which refugees live in China discourages them from seeking needed social services, including health and education for their children. Fahy draws on several South Korean sources that show how the North Korean refugees in South Korea have a higher incidence of the disease.
What is to be done? Given the need for monitoring of TB treatment, this is a prime example of a form of engagement that should not simply be tolerated but actively encouraged. Fahy notes how poor understanding of the disease and its treatment lead to misuse of drugs procured on the black market; New Focus International ran a short piece based on diversion of such drugs to the market based on a defector interview. Organizations like Eugene Bell are crucial to transfer not only medicines but technology and skills. But Fahy makes another point: that information on TB should be circulated in the Sino-Korean border areas where it might filter both into the refugee community and back into the country. This is but one of the many disabilities that arise as a result of China’s approach to the refugee issue.
