The world of foreign aid is a murky one, not least in North Korea, where international organizations and NGOs operate under strict restrictions imposed on them by the state.

Amid tight government regulations and the impact of international sanctions on the ground, many workers from the agencies present in the DPRK could be forgiven for feeling that change is happening at a snail’s pace.

It’s also rare that they talk to press – for good reason. Many are anxious to protect colleagues still working in-country, afraid to impact ongoing programs that have taken years to put together.

Since she left North Korea in March 2014, Fragkiska Megaloudi has been the exception to this rule. Having spent two years in the country working on various projects – particularly on health care issues – she’s seen first hand how North Korea is changing and what needs to improve. Now working as a journalist covering humanitarian issues, she’s been critical of the impact that sanctions have had on the country’s economy and the ability of aid organizations to do their work. She spoke with NK News about her time in the DPRK.

NK News: When exactly did you live in North Korea? What were your first impressions?

Fragkiska Megaloudi: I went there in June 2012 and I left in March 2014. That was the first time I’d visited the country.

Actually it was quite different from what I thought, because people were much more friendly than what I was told they were going to be. We were given by the United Nations a brochure with guideline of what to do, what not to do, and nothing was applicable to what they were saying.

NK News: What did the guide say?

Megaloudi: That we are not allowed to learn Korean, which was completely not true: The government was offering lessons! We were not allowed to move freely, that was not true either, that we couldn’t take the public bus – I took the public bus a few times, that we were not allowed to have our laptops and our cameras – when I arrived I had an iPad, a camera, and a laptop. So all the warnings from the UN were clearly wrong.

NK News: When you arrived in the DPRK what was your job?

Megaloudi: For the first six months I was working for IRIN news (an agency focusing on humanitarian news), but I was covering other areas – I couldn’t cover North Korea, although we did write about their developing disaster management, but it was never published.

After six months I finished my assignment for IRIN, and I started doing consultancy for UN agencies and NGOs, I did an assessment with the WHO which allowed me to go to hospitals, working on consultancy for agencies in the country.

NK News: What did that involve?

It takes too long time for the UN to employ people from abroad, and surprisingly there’s not that many people who want to come

Megaloudi: Once you’re there you take assignments. It takes too long time for the UN to employ people from abroad, and surprisingly there’s not that many people who want to come, and the ones who want to come are not that qualified. So once you have somebody there who can do it, you do short contracts with an NGO, with UN agencies.

NK News: How much freedom did you have to work?

Megaloudi: The more money an NGO has, the more freedom it gets, and the UN has managed to negotiate very good terms for coming into the country. For example the WFP can do visits with 48 hours’ notice, and they can change the program, they don’t need to announce them in advance: UNICEF can do it in four days, or even less than that. For the NGOs it’s more difficult – they’re more controlled.

The UN cannot get in if they are not allowed to operate where they want and are not given access: the UN works on the principle of no access, no aid: if they’re not given access they don’t go in, especially agencies like WFP that give food, and UNICEF that really does critical interventions in the country.

This access is granted because they are needed and they do work. This is one of the reasons I trust what the WFP reports, for example, because they have a good knowledge of what is happening.

NK News: What was it like living day-to-day in the country?

Megaloudi: There are dynamics in the country that you cannot see from outside. I’ll give you an example, it has to do with human rights:  I was there for two years, and I saw a lot of people with disabilities on the streets of Pyongyang. I saw children with down syndrome – they were circulating freely. And I didn’t see this from the very beginning, I didn’t see in 2012, and I started gradually to see this more and more, not just in Pyongyang but in Wonsan.

And I still read reports that people with disabilities aren’t allowed in Pyongyang – I’ve seen them, with my own eyes, and they didn’t seem to have any problems. So this changes a lot.

NK News: What else is changing?

Megaloudi: I’ll give you an example. The foreigners, we lived in the diplomatic compound, which was free, we could walk freely, and it was really in a poor area of Pyongyang. The government assigned a cleaning lady for our apartment, and we paid the government. And they were not really motivated to do the job, because, I mean even if they do or they don’t, they wouldn’t get any money. So in the end nobody really wanted this woman, she didn’t really want to work.

And this is how the whole country works – everybody’s engaging in some kind of private activity

And then suddenly the women set up kind of private service so they make agreements with the foreigners, and we used to pay them 15 pounds to come and clean, so they were very motivated, and they only accepted euros or dollars, no Korean money. They needed it to be very clean, very new, so they could change it in the market. And this is how the whole country works – everybody’s engaging in some kind of private activity.

On the other hand people are not really starving – it’s that they don’t eat well. So this is a really big difference, there’s the stunted population, of course, which is improving.

NK News: Is this true in more remote parts of the country?

Megaloudi: As far as we know. With North Korea you can never know 100 percent. There are some areas that even the UN, two provinces that no agency can enter. Up in the mountains near China. These are areas where aid is not allowed – nobody can enter. Malnutrition rates are high. The UN doesn’t give aid in these areas, because it’s not allowed to go in: that’s the principle: no access, no aid.

NK News: What would you say, then, have been the direct results of sanctions?

Megaloudi: They’ve failed: sanctions are only political. I think the aim is to provoke unrest and this can lead to the government’s collapse. I think this is the long term objective: that’s why they keep implementing sanctions that they know don’t work, and I think from a humanitarian point of view I think sanctions, especially 2013 and 2014, the consequences were huge.

First of all, the agencies, and the NGOs ran out of money, so they couldn’t continue their programs. This meant that critical programs for the people had to stop. I think the most known example is they couldn’t import Kanamycin A, the anti-Tuberculosis medicine, which is imported to North Korea from Japan. Because it’s imported through a fund, and Japan wouldn’t allow the import any more because of the sanctions, and they had to stop, they had to find a different kind of medicine to replace it! When you do this in an active program against tuberculosis, that leads to what? To disaster.

I was in a hospital, and I saw with my own eyes: they had to use disposable tools for IV intrusions, where it was plastics for a single use, and had to sterilize them and reuse them. And I can say with my personal experience because my son got sick, and he needed an IV infusion, and we couldn’t get the right needles for children, because of sanctions.

NK News: Many would say the sanctions are the government’s fault for its nuclear tests and human rights abuses. Do you not think there’s truth to that?

Megaloudi: When we say this we also have to see why North Korea insists on its nuclear program. I mean if you think about it, after what happened to Gaddafi when he delivered his weapons, what happened to Iraq, and North Korea has also been in the “Axis of evil” for over a decade. I mean the threat is real from both sides.

And in the end what is, when you have the UN resolutions, and you say that we ban luxury products, but there’s no definition of luxury – they just give a list which is not conclusive. So the member states can actually ban whatever they think is luxury, it’s also about technology and spare parts for agriculture and things to computerize the system, and the distribution system for food. It’s many things.

There hasn’t been any study that really has examined the relations between humanitarian crises and sanctions, there hasn’t been any study of that, just some reports here and there and some “experts” talking about it.

NK News: What do you think of (former UN Panel of Experts member) Bill Newcomb’s comments that the sanctions don’t impact on food, agriculture, or trade?

Megaloudi: I definitely don’t agree. They have an impact on aid, we all lived this impact in 2013 and 2014. What happened was that there were sanctions against the Bank of Foreign Commerce of North Korea and they had frozen all financial transactions, so the aid groups couldn’t pay salaries to the staff, they couldn’t rent a place, they couldn’t pay utility bills, and as a result was that they had to abandon programs, or completely pack up and leave because they couldn’t operate anymore.

Even the World Food Program, they suspended production in five of its seven factories that were making nutritional biscuits for children, and all the agencies that needed special permits in order to import even a computer because of the sanctions. How can you work when you have delays to the program for months? You cannot.

NK News: You’d say the effect of the sanctions is that it slows these programs down?

Megaloudi: No, it stops them. When you have to stop the whole treatment and replace the drug, doesn’t it put you back? What happens when you’re treating people against tuberculosis and you stop the treatment? That creates multi-drug resistant tuberculosis, in a country where tuberculosis is a public health issue. You cannot computerize the distributions for example, you cannot have enough fuel, you cannot repair the trucks!

NK News: Do you think, with the escalation of tensions on the peninsula, that changes might slow?

Megaloudi: There are so many changes going on inside the country, because it has to happen, there’s no other way, and people now have an idea of what life is like outside, they’re not ignorant. They know, and they demand things. Kim Jong Un is letting this happen, and he’s indirectly supporting it. He knows that there’s no other way. And we’ve seen what happened in the past when his father tried to devalue the won – it provoked social unrest in Pyongyang.

So I think he can see that he has to offer some kind of life to the people, and the living standards have improved, in a way. So I think that if the international community stopped being so fixated on the political change, because this is all about regime change. If they were less fixated on that, and not supporting the small changes that happen, step by step – very small but they do happen – they could engage in a dialogue.

This interview has been edited and condensed for clarity.

Images courtesy of Fragkiska Megaloudi.