Rights-Based TB Programs for Migrants and Prisoners Needed in North Korea

In early 2014, the United Nations Commission of Inquiry published a report identifying widespread rights violations amounting to crimes against humanity in the Democratic People’s Republic of Korea (DPRK).1 While the report identified the system of prison camps and cross-border migration as critical to generating horrendous atrocities, it only briefly linked imprisonment and migration as contributing to poor health. Yet the system of prison camps throughout North Korea and migration across the 1,420 kilometer Sino-Korean border create double trouble for health and human rights, particularly with tuberculosis and multidrug-resistant TB (MDR-TB). TB is one of the most serious public health problems in North Korea.2 Those who are detained and those who migrate are at differential risk for contracting TB, and if they do so, they are more likely than the average North Korean resident to receive little or poor treatment. The value imparted by protecting the rights of those vulnerable to TB and those with TB is instrumental for North Korea to improve the basic quality of life for all within the country. A rights-based approach to TB in North Korea would mean that the North Korean government and its Ministry of Public Health would work toward making the highest standard of health care available, accessible, acceptable, and of good quality (AAAQ) for all members of society, without discrimination, including those most vulnerable to TB, such as prisoners and migrants. The benefits of such an approach would have positive impact on the entire population. Prisoners’ and migrants’ differential risk to TB increases the likelihood of contagion in the wider population. Clearly, this approach to TB in North Korea would meet with great resistance from the state. Prisoners and migrants are deemed treasonous, and are seen to have self-selected out of rights that the state would otherwise grant. Of concern is that North Korea might adopt practices aimed at reducing the burden of TB by limiting the rights of these individuals through enforced medical treatment and further deprivation of freedom.3 The implication of a rights-based approach to TB in North Korea means that information about TB—how it is contracted and how it should be treated— must be accessible to all. Such an approach would mean the implementation of low-cost, targeted TB programs at re-education camps, detention centers, and prisons, which could prevent the cycle of contagion in a timely and expeditious manner. Health care facilities would be physically accessible to all, within safe reach, and medical staff should be skilled. Unexpired drugs would be administered appropriately. The estimated rate of TB instances is 442/100,000 population.4 Treatment would be hard enough in a poor country, but political antagonism, sanctions, limited international medical exchange, and systemic rights violations combine to make testing and treatment extremely difficult. MDR-TB was assumed