Sanctions aimed at punishing the North Korean regime are hampering the ability of aid groups to operate inside the country, triggering warnings that the international campaign is harming ordinary North Koreans.
Difficulties in obtaining supplies, including medical equipment, and in transferring money to fund aid programmes could have a direct impact on health and nutrition levels throughout North Korea, aid groups say. "We need to deal with the nuclear problem, but we need to properly ponder our means for achieving that goal," Tomás Ojea Quintana, the UN's special rapporteur on North Korean human rights, said in Tokyo.
About 70 per cent of the North Korean population is already categorised as "food insecure," meaning constantly struggling against hunger, and growth stunting occurs in one in four children. The sanctions could increase the levels of food insecurity and the incidence of acute malnutrition among children.
"These are not just statistics. This is reality in the DPRK," Quintana said. "It's my responsibility to remind the Security Council that they should develop a comprehensive assessment of the possible impact of their sanctions. What is the concrete impact on humanitarian agencies working inside North Korea?"
The UN's World Food Programme, Unicef, the World Health Organisation and the UN Development Programme all have operations in North Korea. A small number of humanitarian agencies based in the United States and elsewhere provide food, medical and agricultural assistance from bases outside the country.
But the waves of multilateral and direct US sanctions that have been imposed on Kim Jong Un's regime following its missile launches and nuclear tests have now made operations so difficult that some agencies are pulling out. Save the Children has shut down its operations in Pyongyang, billing the move as a "temporary suspension". "US and international humanitarian NGOs working in North Korea are experiencing death by a thousand cuts," said Keith Luse, executive director of the Washington-based National Committee on North Korea, which includes many humanitarian agencies among its members.
"These sanctions were not intended for them, but they have ended up being victims of the international sanctions regime."
At a UN Security Council meeting on Saturday, US Secretary of State Rex Tillerson said that it was the responsibility of the North Korean regime to care for its own people.
"The regime could feed and care for women, children and ordinary people of North Korea if it chose the welfare of its people over weapons development."
The difficulties have mounted as the crackdown has broadened, from "smart sanctions" designed to cut off parts and funding for the nuclear weapons programme to more general measures that are starting to look like a trade embargo.