In late January, as global fears around a “mystery virus” with origins in a central Chinese city began to mount, North Korea cut off one of the few non-sanctioned sources of cash still available to it and announced a full ban on foreign tourists entering the country.

That was just the beginning. In the days and weeks that have followed, Pyongyang has cut off all inbound and outbound flights and trains, imposed a quarantine on all visitors coming from abroad, and placed foreign diplomats under virtual house arrest, in a desperate bid to prevent an outbreak of the novel coronavirus in its territory. 

Set to be hit hard is North Korea’s trade with China, which constitutes some 90% of its estimated foreign trade — and on which the country is reliant for many essential goods. 

The move is already wreaking havoc on those that require regular access to North Korea for business, diplomatic, and humanitarian purposes. Germany’s foreign ministry has expressed concern about the status of its quarantined officials in Pyongyang, planned conferences have been called off, and aid organizations have increasingly warned of growing pressure on operations.

“Uncertainties around travel restrictions and port closures have meant delaying planned shipments and travel plans,” a source with extensive experience working in humanitarian aid in North Korea told NK News. 

But despite the potential impact of these steps, multiple observers and experts on North Korean humanitarian issues agreed that Pyongyang’s decision to effectively shut itself off from the outside world was, by and large, a sensible one — and that, under the circumstances, playing tough was the country’s least bad option. 

“North Korea’s response to the Coronavirus threat reflects its realistic assessment of its health system’s limited ability to handle an epidemic,” Kee Park, a lecturer on Global Health and Social Medicine at Harvard Medical School who has worked extensively with healthcare professionals in the DPRK, said. 

“The rational choice, albeit at a steep economic cost, is to prevent the entry of the virus into the country.”

ILL-PREPARED AND UNDER-FUNDED

The shortcomings in North Korea’s healthcare system are well-documented, of course, with leader Kim Jong Un having late last year even admitted that high-quality medical equipment was “badly needed” in the country. 

And given the severity of the novel coronavirus, as well as uncertainty over how best to treat it, the DPRK is in a particularly precarious position. 

“Hospitals and health centers are under-equipped, and as much remains unknown about coronavirus globally, an already weak health system like the DPRK’s could possibly lose a lot,” Nazanin Zadeh-Cummings, a Lecturer in Humanitarian Studies at Deakin University and a columnist for NK News, said. 

“Rather than cope with the virus potentially entering the country and spreading, the DPRK government has chosen to take extreme restriction measures as a form of prevention.” 

Also critical would be North Korea’s ability to accurately diagnose the coronavirus should a citizens exhibit symptoms: diagnostic equipment does not come cheap, and would likely need to be shipped in from abroad. 

“The rational choice, albeit at a steep economic cost, is to prevent the entry of the virus into the country.”

“The potential of an outbreak would be severe as North Korea wouldn’t be able to control it, they simply don’t have the medical facilities/equipment (and know-how),” Thomas Fisler, former head of the Swiss Agency for Development and Cooperation (SDC) in the DPRK, told NK News.

“They are not prepared at all, not because they don’t want to, simply because they don’t have the means. They lack medical facilities and equipment everywhere, but certainly in rural areas.”

Pyongyang has admitted to some of these shortages of basic medical equipment, with state media reporting last week that several prominent clothing factories were taking “emergency methods” to ensure a steady supply of medical face masks.

One factor making North Korea even more vulnerable to an outbreak of the coronavirus is the country’s pre-existing health issues — an under-fed population is much more likely to pick up such an infectious disease.

“Chronic food insecurity and malnutrition are widespread in the DPRK,” Ulick Burke, board member of the Korean Red Cross Foundation, told NK News. “This means a significant proportion of the population is immunodeficient and thereby has a greater susceptibility to infectious agents such as this novel coronavirus.”

And despite assurances this week from the UN Security Council that it is ready to help North Korea weather the coronavirus storm, Burke argued that sanctions have placed major bureaucratic and political hurdles to humanitarian work in the country.

“Sanctions limiting access to medical supplies have contributed to the vulnerability of the North Korean health system and restricted the responses available to them,” he said.

“The global health community must realize that the sanctions on the DPRK (that restrict access to medical goods) undermine any global effort to reduce suffering, death, and to stop this novel coronavirus from becoming endemic,” he added.

“Humanitarian exemptions to the sanctions should be passed and assistance (supplies and expertise) must be offered to North Korea.”

Zadeh-Cummings agreed, telling NK News that the international campaign to isolate and pressure North Korea has contributed to creating a health sector ill-equipped to deal with a major epidemic.

“Between the DPRK’s own restrictions for humanitarians, multilateral and unilateral sanctions, low donor funding, and travel permissions for U.S. citizens, many humanitarian agencies already face multiple obstacles in their quest to respond to humanitarian need inside the country,” she said. 

“Sanctions impact humanitarian agility, causing delays and adding sometimes overwhelming bureaucratic processes to an already challenging undertaking.” 

Beyond that, however, much of the responsibility lies with the North Korean state, with decades of under-funding and mismanagement leaving the country uniquely vulnerable.

“The root causes of this are the political and economic decisions of the North Korean regime,” Zadeh-Cummings said. “Humanitarian organizations do excellent work in the realm of health, but are still trying operating within a flawed system.”

STATE MEDIA RESPONSE

In light of these challenges, North Korea’s state media has sought to hammer the message home, with bombastic state media dispatches reporting the issue as a matter of “national survival” and urging “revolutionary” measures in response.

And while leader Kim Jong Un is yet to appear in a face mask, he has sent Premier Kim Jae Ryong to the frontlines, with the Korean Central News Agency (KCNA) reporting Wednesday on his visit to “emergency anti-epidemic headquarters” in Pyongyang, South Phyongan Province, North Hwanghae Province and Nampho.

“All officials should bear in mind that it is an important work concerning on the state’s security and people’s lives to check the novel coronavirus infection and make full preparations for rapidly coping with it,” state media reported the Premier — the highest-level official to have appeared at quarantine facilities since the outbreak began — as having said.

State television, too, has featured daily broadcasts on the efforts to prevent an outbreak of the virus — as well as bulletins keeping viewers informed on the number of infected overseas.

“North Korea’s handling of the coronavirus is unusually high-profile compared to past epidemics and reflects regime concern about the issue,” Minyoung Lee, a senior analyst with NK News’s sister site NK Pro, said.

“The party daily’s unusual editorial dedicated to the virus not only reflects regime concern but also seems aimed at emphasizing to the public that the country gives priority to the people and that it is doing all it can to prevent an outbreak.”

Reporting from state media has also focused heavily on how citizens can protect themselves from the virus: washing their hands, keeping air circulating, and cleaning food well are all offered up as ways to stay healthy.

Traditional folk remedies — including “burning mugworts” — have also been recommended, as have some of North Korea’s domestically-produced medical products, reportedly able to help citizens strengthen their immune system and prevent coronavirus infection

But despite these steps, many North Koreans appear to not be taking the kinds of precautions needed to stay safe. State television, for example, continues to report on large-scale public gatherings where medical masks — now ubiquitous across East Asia — are nowhere to be seen.

SELF-RELIANCE IN ACTION?

North Korea is certainly spooked by the threat of the coronavirus and the major implications that it could have for political stability — fears likely prompting leader Kim Jong Un’s decision not to make any public appearances for over two weeks.

Reports have even suggested that the country has already seen its first cases. Unnamed sources last week told both the South Korean Joongang Ilbo newspaper and the defector-run Daily NK that the virus had now been detected in-country — claims picked up by some western media but as yet unconfirmed by DPRK authorities or the World Health Organization (WHO).

But with so much state media focus on efforts to prevent the spread of the coronavirus in the country, would North Korean authorities even choose to make news of a confirmed infection public?

“North Korea in the past has acknowledged epidemic outbreaks, so if/when there is an outbreak, we may see a similar state media behavior,” NK Pro’s Minyoung Lee said. 

That last epidemic outbreak in North Korea, of course, was that of swine flu last summer, which saw Pyongyang take “emergency” measures and cull thousands of pigs on farms in the northern Jagang province, and remains a concern.

But readers might be more familiar with the last international epidemic to prompt North Korea to close its borders: that of the West African ebola scare back in 2014/15.

If any country is prepared to weather long-term isolation from the outside world, it’s North Korea

That panic also saw foreigners, if suspected of infection, subject to very strict quarantine measures.

One of those foreigners was the SDC’s Thomas Fisler, who was kept under quarantine for 21 days on two separate occasions during the height of the Ebola scare in North Korea.

“Under Ebola we were not allowed to leave the apartment and a doctor came daily to check the temperature,” he told NK News. “At the time — I was under quarantine twice — it was really quite a frustrating experience. Apart from the restriction physically, it was also having a mental impact as we were treated as we had Ebola.” 

Those measures were ultimately in place for four months, having major impacts on the North Korea tour industry and its ability to engage with the outside world.

And should this year’s coronavirus scare continue, Fisler said, the current measures could be in place for the next few weeks at the very least.

“I believe that they will keep the measures in place longer than anyone else,” he said. “I assume that it may last well into March.”

What, then, might be the impact of weeks, or even months, of border closures on North Korea’s economy?

“This is going to be nothing short of fascinating, to see what the impact of this quarantine on the North Korean economy will be,” Théo Clément, a lecturer at Paris’s Sciences Po university and an expert on DPRK-China economic relations, said.

“If the quarantine is properly implemented and if Pyongyang sticks to its guns for several weeks or month, this will be an interesting experiment to measure how reliant on China the North Korean economy actually is.”

What’s also unclear is the potential impact of the border closures on North Korea’s informal economy: the largely-illegal but often tacitly-approved networks of smugglers and traders that work along the Sino-DPRK border and keep much of that part of the country ticking. 

“Smuggling has become the lifeline of the economy, and both regional governments and border guards need it to continue, making it very difficult to stop,” Peter Ward, a writer and researcher focusing on the North Korean economy, told NK News. “From what I have heard, the border has not been closed and smuggling continues.”

The blockade may already be having an impact, if unofficial data is anything to go by: diesel and petrol prices in three cities were last Friday reported to have sharply risen in the wake of Pyongyang’s new restrictions on cross-border travel. 

But if any country is prepared to weather long-term isolation from the outside world, it’s North Korea — a country for which self-reliance and the ability to fend off foreign threats are embedded in the national psyche, said the SDC’s Thomas Fisler.

“They have undergone several ‘blockades,’ be it externally or self-imposed, and they therefore may be the country that can most easily deal with such a temporary shutdown of external contacts.” 

Jake Kim contributed research assistance

Edited by James Fretwell