One of the most unsettling aspects of humanitarian work in North Korea (or the Democratic People’s Republic of Korea, DPRK) is the disconnect between the country’s proud official face and its desperate reality. A scene I witnessed along a dusty road in North Hwanghae province in 1997, when I directed an NGO aid program, was emblematic of this apparent state of denial. Our team was returning to Pyongyang after visiting a hospital where severely malnourished children were being rehydrated with drips fed from discarded beer bottles. An elderly woman, clearly exhausted, was collapsed at the roadside under a large brown bundle. Above her one of the ubiquitous arches across the road proclaimed in large letters: The Victory of Socialism Is in Sight!

North Korea first appealed for international humanitarian assistance in 1995 after devastating floods pushed its already faltering economy over the brink. Since then a number of multilateral, bilateral, and nongovernmental aid organizations (NGOs) have responded to its call. Providing humanitarian assistance to North Korea has posed unique challenges to aid providers, however. Underlying the problem is the fact that the very act of requesting aid contradicts the bedrock ideology of juche on which the North Korean state is built. Juche, or self-reliance, proclaims that North Korea can build a socialist paradise for its people, relying primarily on its own resources and ingenuity under the “genius leadership” of Kim Il-sung and Kim Jong-il.1 Acknowledging problems and mistakes is the starting point for seeking solutions, but this goes against the national ethos and pricks the personal pride that has been deeply instilled in all DPRK citizens. Indeed, doing so may even border on treason.