North Korea cannot meet the food needs of its people. It desperately needs more aid, and the presence of humanitarian agencies, writes Gerald Bourke.
The boy's mother held him close. His face was pained and exhausted. His mouth hung open, as if he didn't have the strength to close it. Only the whites of his half-open, unblinking eyes were visible.
Staff at the hospital south of Pyongyang said the two-year-old - far too small for his age - had been admitted a month earlier, suffering from acute malnutrition. His mother, also malnourished, didn't have enough breast-milk to feed him.
This is the "inheritance of hunger". With one-third of North Korean mothers malnourished and anaemic, according to the latest World Food Programme/UNICEF nutritional survey, their children become victims as well. North Korea cannot meet the food needs of its 23 million people. Less than 20 per cent of the mountainous country is arable, and soil quality is deteriorating from overuse.
General economic decline means only a small fraction of the requisite farm machinery, fertilisers and other inputs can be domestically produced or commercially imported. Floods and drought frequently decimate harvests. Recent harvests have been relatively good, thanks to favourable weather. But this year's cereals deficit will exceed 1 million tonnes, or 20 per cent of the minimum needed.
As an aggregate, the shortfall may seem modest. Yet 70 per cent of the population depends heavily on a government-run public distribution system typically providing less than half of a survival ration. The diet is narrow, and inadequate. Meat, fish, eggs and fruit are rarely consumed luxuries.
It is now the agricultural "lean" season. Public distribution system stocks of rice and maize harvested last autumn are running low, and this year's crops will not be available for at least two months. Staples sold in inflation-prone private markets are beyond the means of most.
As a result, millions of North Koreans are having to forage for wild foods - grasses, leaves, tree bark and seaweed - that give little nourishment and induce digestive disorders, especially in the weakest.
Without substantial and sustained external assistance, the country's long-running food crisis could degenerate into a repeat of the severe food shortages of 1996-1998, which claimed countless lives. Estimates range from 200,000 to more the 2 million.
Since international relief efforts began in the mid-1990s, donors have supplied 7.2 million tonnes of commodities to the neediest North Koreans. Much of the assistance has been channelled through the World Food Programme (WFP), which targets the most vulnerable of the vulnerable: young children, pregnant and nursing women, and the elderly. That aid has had a major impact. Malnutrition rates, while still high, are dramatically lower than they were in the late 1990s. Yet the gains are precarious, and could be lost.
Previously solid support for the programme's emergency operation waned last year. The agency mobilised 380,000 tonnes of food, just 60 per cent of the volume planned.
Compelling crises elsewhere, disputes between Pyongyang and donor governments, and frustration over restrictions on the WFP's ability to monitor distributions properly and reach areas deemed off-limits by the authorities, were responsible for the downturn. Millions were deprived of the programme's cereal rations.
Food-for-work activities, designed to support hundreds of thousands of underemployed and their families, had to be severely curtailed. Factories producing micronutrient-enriched blended foods for infants, children, pregnant women and mothers suffered disruptive shortages of donor-supplied raw materials.
Supplies from the international community have been sporadic this year too. The programme has faced some difficult choices. It's a tough call having to decide whether to provide for children in kindergartens or for elderly people in derelict cities.
Moreover, there's no such thing as retroactive feeding. A missed opportunity is one that is lost forever. And the longer it lasts, the greater the damage especially for children. Lack of food compounds the hardship caused by a host of other factors, such as poor living conditions and a deficient healthcare system.
Although WFP is denied the kind of access for its monitors that would have allowed a thorough assessment of the impact of this reduced assistance, its inability to help most of its four million "core" beneficiaries for much of the past 12 months surely must have aggravated their suffering.
The vicious cycle of inherited hunger is being reinforced. Moderately malnourished children are becoming severely malnourished, and therefore more susceptible to sickness and disease.
Underfed women are giving birth to smaller babies, and are less able to breast-feed them.
WFP urgently needs more pledges for its North Korea operation. The food pipeline must be sufficiently supplied if the country's young are to avoid lasting mental and physical damage from chronic hunger.
Crucial assistance would flow more substantially, and in a more timely manner, if the Pyongyang authorities were to relax the constraints that cause aid operations to be less than transparent. WFP's working conditions have improved over the years, but more needs to be done in this area.
The presence of WFP and other humanitarian agencies has done much to expose North Koreans to the ways of the world outside. It is a vital part of the engagement process that must continue if the country is to become a full member of the community of nations.
Gerald Bourke is the UN World Food Programme's spokesman on its North Korea operation