Korea (DPRK) - OCHA: 11-Mar-03
OCHA Situation Report
DPR Korea
February 2003
11 March 2003
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA)
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 | February |
| | 2002 | 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)
The OCHA Office in DPRK produces this Bulletin on the basis of information
supplied by contributing organizations and public sources
Sweden is funding the OCHA Office in 2003
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