A nation in transition with lingering constraints
North Korea is undergoing visible economic changes. The country remains deeply challenged by humanitarian and developmental issues. Kim Jong Un’s leadership has openly acknowledged ongoing struggles in several key areas. These include food insecurity and inadequate health care. These problems are worsened by the lack of comprehensive data. The most recent United Nations population census in North Korea is now over a decade old. Without updated information, it is difficult to fully assess the current state of the nation’s population. It is difficult to fully assess the current state of the nation’s needs. Experts and officials continue to note significant gaps in understanding the social and economic conditions inside the country. A situation that makes it difficult to plan or execute effective aid and development programs.
The past decade has introduced a wave of informal marketization and monetization in North Korea, contributing to the emergence of a small but growing middle class. Mobile phone use has also risen, with one subscriber for every three North Koreans. However, these changes have not translated into widespread improvements in the daily lives of most North Koreans. International sanctions, political isolation, and the limited presence of humanitarian groups continue to severely hamper development efforts. The country remains largely cut off from global assistance, and even where progress is seen, it is often uneven and concentrated in specific regions. This is particularly evident in urban centers and areas close to international borders, where market activity is more visible.
Health and food security persist despite new strategies
The North Korean government has launched rural modernization projects. These include investments in livestock farming and dairy production. They are part of an effort to address long-standing food shortages. These initiatives, however, do not eliminate the underlying problem of insufficient food supply. Historically, workplaces and factories gave employees permission to forage in the countryside. They did this to supplement their diets during shortages. A practice that continues to this day. Kim Jong Un himself has acknowledged in public statements that rural agricultural policies have failed. Current government efforts reflect a recognition that food security remains a critical national priority. Despite these efforts, many North Koreans continue to experience regular food shortages. These shortages force them to rely on alternative means to obtain sufficient nutrition.
Health care in North Korea has seen a wave of infrastructure investments. This includes the construction of new hospitals and medical facilities. Nonetheless, these developments do not automatically lead to better health outcomes for the population. A 2026 study conducted by Joon Hee Han and Yo Han Lee, titled 'North Korea’s 2025 Health Revolution,' revealed important findings. While physical buildings are being built, essential components such as trained health workers, reliable medicines, and functioning equipment are still lacking. The study emphasizes that without these foundational elements, improved infrastructure alone cannot resolve public health challenges. During my time in Pyongyang, we observed repeatedly that even the most modern-looking facilities could not deliver quality health services. This is without the necessary support in terms of training, supplies, and ongoing maintenance.
International aid dynamics shift, humanitarian gaps remain
International aid to North Korea has shifted in recent years. Support from Europe and the United States has declined. Russia has become a primary source of funding for certain North Korean initiatives. This shift in aid dynamics became most evident in 2024 and 2025. A Russian court ordered over 30 North Korean nationals to receive tuberculosis treatment in Moscow, according to court records. This case highlights the movement of North Korean labor into Russia. It also points to a growing health crisis among overseas workers from the country. The situation suggests that, despite the regime’s efforts to control the movement of laborers, health challenges persist. These often require treatment abroad.
North Korea continues to grapple with severe public health challenges, including widespread tuberculosis. During the author’s tenure as the United Nations Resident Coordinator in Pyongyang from 2009 to 2013, international collaboration played a key role in managing these health issues. However, since the outbreak of the COVID-19 pandemic in 2020, North Korea has restricted entry for representatives from most EU countries and shut out international NGOs and humanitarian groups. These groups have yet to return, further limiting the global community’s ability to provide support and collect reliable data about the country’s health and humanitarian conditions. The U.N. population census remains the most authoritative source of information about North Korea, but without a recent census, even basic demographic data is out of date, making it difficult to assess the scale of the challenges the country faces.
The continued absence of U.N. agencies and other international humanitarian organizations has left a major void in the country’s support system. While the North Korean regime may have taken steps to improve infrastructure and public services, the lack of international collaboration and support has left many basic needs unmet. The humanitarian situation remains precarious, with food, health care, and basic sanitation all under strain. The situation is further complicated by the regime’s limited transparency and unwillingness to allow independent assessments of the country’s conditions. As a result, many of the problems that existed before 2013 still persist, and the lack of updated data and access only makes them more difficult to address.