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WASHINGTON North Korea: where children look like old men
DISPATCHES
WASHINGTON
North Korea: where children look like old men
food production even lower than that affecting children. At the end of 1997 he recent resumption of talks in 1997. WFP report that North and earlier this year, the Korean between North and South Korea’s grain stocks will be near Buddhist Sharing Movement, based Korea—suspended since 1994—had depletion by the end of April or in South Korea, surveyed 472 North brought some optimism for improvbeginning of May. And the PVO Korean “food refugees”—people who ing the dire health situation of team estimates that a large-scale migrate to China the North Korean food-aid programme will be needed from a wide range of people—stricken by at least until October, 1998. In many North Korean cities drought and famine counties throughout the country, the in search of food. The for almost 3 years. last food distributions at normal refugees estimated But with the collapse ration rates were in 1995. that 24–32% of their of the talks last week In this context, future food-relief immediate family came reports indicatactivities need to be initially targeted members had died ing that the worst is at the most vulnerable groups: from lack of food. not over for the North children and the elderly. Several A consortium team Koreans. observers have indicated that many of five US private Doug Coutts, head elderly have stopped eating to voluntary organisaof the World Food provide food for children. WFP tions (PVOs) visited Programme (WFP) in intends to direct food aid toward the country at the end North Korea, recently 5 million children, hundreds of of 1997 to monitor indicated that the thousands of hospital patients, food aid provided health of the general Politics betrays the people pregnant women, handicapped by the US Food for population is rapidly people, and agricultural workers. Peace Program. The team found that deteriorating. Among those most It is in the interests of Japan, the national health system can proaffected are children, many of whom, China, the USA, and South Korea to vide only limited services because of according to Milton Amayun, from make sure that the North Korean shortages of medicines, equipment, the Christian charity World Vision, people can overcome this hardship. supplies, and food. Some hospitals are in such an advanced state of Aside from the moral issue, there is a have to send patients home for lack of malnutrition that “they are skin and pragmatic reason food, medicines, bones, with the faces of old men”. as well. The alterand heating. One In 1997, a nutritional survey “refugees estimated that native is a hungry result of the food carried out by World Vision in five 24–32% of their immediate population escapshortages is a popprovincial children’s centres indifamily members had died ing in large numulation weakened cated that 29% of children had severe bers towards China through surviving weight-for-height deficiencies. Out of from lack of food” and South Korea, long term with less 4200 children under 5 years assessed which could lead than the minimum recently in four eastern provinces by to a situation of even greater instabildaily nutritional requirements. The WFP, 50% were malnourished— ity in the region. That an obdurate breakdown of health services and lack 17% with moderate and 33% with and cruel regime allows its people to of water have put a vulnerable popusevere malnutrition. Several nutristarve to death should not deter other lation at serious risk. tionists who have visited the country countries from increasing assistance The future does not look bright. fear that many children have become to a desperately needy population. The depleted water supply in the sys“nutritional dwarfs”, and will be tem of reservoirs could dramatically damaged for life. affect the rice crop and make 1998 The situation, however, is not only César Chelala Panos Pictures
T
DELHI
Unicef puts children’s rights first in India
C
oinciding with a new 5-year plan, Unicef has released its analysis Rights and Opportunities: The Situation of Women and Children in India. This document will form the basis of Unicef’s India Country Programme until 2002 and envisages a substantial shift in policy and perspective. Unicef’s work will inherently change, states the document, “from supporting across the board efforts for all children to a more critical and focussed look at those who are not enjoying the basic rights spelled out in the Convention on the Rights of the Child”. The analysis notes that “three of the most distressing
THE LANCET • Vol 351 • April 25, 1998
forms of violations of the rights of Indian children” are child labour, children living on streets and illegal settlements, and child prostitution. Although India halved its infant mortality rate from 146 deaths per 1000 live births in 1960 to 72 per 1000 in the mid-1990s, 2 million infants still died in 1995. Children born in the most populous state of Uttar Pradesh face risks of death comparable or worse than those in sub-Saharan Africa. Every year, 100 000–125 000 Indian women die from often avoidable pregnancyrelated causes, accounting for some 25% of annual global maternal deaths. In the absence of timely
access to health-care services, major causes of death are haemorrhage (22·6%), severe anaemia (20·3%), toxaemia (12·8%), and abortion-related problems (11·7%). But substantial successes have been achieved, such as with measures to reduce deaths from neonatal tetanus which have fallen from 10–20 deaths per 1000 live births in the early 1980s to the current rate of less than one death per 1000 throughout India. “India itself has remarkably demonstrated that its system can indeed be mobilized to this end”, notes the document. Sanjay Kumar
1261
WASHINGTON
North Korea: where children look like old men
food production even lower than that affecting children. At the end of 1997 he recent resumption of talks in 1997. WFP report that North and earlier this year, the Korean between North and South Korea’s grain stocks will be near Buddhist Sharing Movement, based Korea—suspended since 1994—had depletion by the end of April or in South Korea, surveyed 472 North brought some optimism for improvbeginning of May. And the PVO Korean “food refugees”—people who ing the dire health situation of team estimates that a large-scale migrate to China the North Korean food-aid programme will be needed from a wide range of people—stricken by at least until October, 1998. In many North Korean cities drought and famine counties throughout the country, the in search of food. The for almost 3 years. last food distributions at normal refugees estimated But with the collapse ration rates were in 1995. that 24–32% of their of the talks last week In this context, future food-relief immediate family came reports indicatactivities need to be initially targeted members had died ing that the worst is at the most vulnerable groups: from lack of food. not over for the North children and the elderly. Several A consortium team Koreans. observers have indicated that many of five US private Doug Coutts, head elderly have stopped eating to voluntary organisaof the World Food provide food for children. WFP tions (PVOs) visited Programme (WFP) in intends to direct food aid toward the country at the end North Korea, recently 5 million children, hundreds of of 1997 to monitor indicated that the thousands of hospital patients, food aid provided health of the general Politics betrays the people pregnant women, handicapped by the US Food for population is rapidly people, and agricultural workers. Peace Program. The team found that deteriorating. Among those most It is in the interests of Japan, the national health system can proaffected are children, many of whom, China, the USA, and South Korea to vide only limited services because of according to Milton Amayun, from make sure that the North Korean shortages of medicines, equipment, the Christian charity World Vision, people can overcome this hardship. supplies, and food. Some hospitals are in such an advanced state of Aside from the moral issue, there is a have to send patients home for lack of malnutrition that “they are skin and pragmatic reason food, medicines, bones, with the faces of old men”. as well. The alterand heating. One In 1997, a nutritional survey “refugees estimated that native is a hungry result of the food carried out by World Vision in five 24–32% of their immediate population escapshortages is a popprovincial children’s centres indifamily members had died ing in large numulation weakened cated that 29% of children had severe bers towards China through surviving weight-for-height deficiencies. Out of from lack of food” and South Korea, long term with less 4200 children under 5 years assessed which could lead than the minimum recently in four eastern provinces by to a situation of even greater instabildaily nutritional requirements. The WFP, 50% were malnourished— ity in the region. That an obdurate breakdown of health services and lack 17% with moderate and 33% with and cruel regime allows its people to of water have put a vulnerable popusevere malnutrition. Several nutristarve to death should not deter other lation at serious risk. tionists who have visited the country countries from increasing assistance The future does not look bright. fear that many children have become to a desperately needy population. The depleted water supply in the sys“nutritional dwarfs”, and will be tem of reservoirs could dramatically damaged for life. affect the rice crop and make 1998 The situation, however, is not only César Chelala Panos Pictures
T
DELHI
Unicef puts children’s rights first in India
C
oinciding with a new 5-year plan, Unicef has released its analysis Rights and Opportunities: The Situation of Women and Children in India. This document will form the basis of Unicef’s India Country Programme until 2002 and envisages a substantial shift in policy and perspective. Unicef’s work will inherently change, states the document, “from supporting across the board efforts for all children to a more critical and focussed look at those who are not enjoying the basic rights spelled out in the Convention on the Rights of the Child”. The analysis notes that “three of the most distressing
THE LANCET • Vol 351 • April 25, 1998
forms of violations of the rights of Indian children” are child labour, children living on streets and illegal settlements, and child prostitution. Although India halved its infant mortality rate from 146 deaths per 1000 live births in 1960 to 72 per 1000 in the mid-1990s, 2 million infants still died in 1995. Children born in the most populous state of Uttar Pradesh face risks of death comparable or worse than those in sub-Saharan Africa. Every year, 100 000–125 000 Indian women die from often avoidable pregnancyrelated causes, accounting for some 25% of annual global maternal deaths. In the absence of timely
access to health-care services, major causes of death are haemorrhage (22·6%), severe anaemia (20·3%), toxaemia (12·8%), and abortion-related problems (11·7%). But substantial successes have been achieved, such as with measures to reduce deaths from neonatal tetanus which have fallen from 10–20 deaths per 1000 live births in the early 1980s to the current rate of less than one death per 1000 throughout India. “India itself has remarkably demonstrated that its system can indeed be mobilized to this end”, notes the document. Sanjay Kumar
1261