To contain COVID-19’s spread, North Korea has virtually shut the country’s borders, save for some limited trade. Unlike most other countries, North Korea is able to do so thanks to its normally tight border control and limited interaction with the outside world. The regime does in fact have a number of advantages when it comes to imposing anti-COVID-19 measures, such as the system’s rigid social control and strict suppression of the freedom of movement of the population.

On balance, however, the consequences of the country’s COVID-19 measures pose a major challenge to the regime, and meanwhile, any significant outbreak would be extremely challenging for the government to handle given the poor state of the country’s healthcare system. Throughout his tenure, Kim Jong-un has staked much of his credibility on improving the people’s living standards. Suppose, theoretically, that North Korea does successfully avoid an outbreak of significant proportion. Even so, anti-virus measures, combined with already crippling sanctions, are having a devastating impact on the country’s already dismal economy.

These two factors have, at least for the time being, put Kim Jong-un’s vision for economic growth and improvement of people’s living standards on hold. Only time will tell whether this situation metastasizes into a domestic political challenge.

North Korea’s COVID-19 Situation: What We Know, What We Don’t, and the Government’s Public Response

Images both from official and unofficial sources show citizens wearing masks around North Korea, and a video smuggled out of the country shows that quarantine facilities exist. The video—uploaded by a South Korean church group in early March 2020 and filmed (secretly) in Hyesan, in the northern part of the country—shows a door clearly marked off for “quarantine.” In the background, loudspeakers are broadcasting announcements admonishing citizens to keep their distance and maintain hygiene caution.

At this time of writing, the government continues to claim that no cases of COVID-19 exist in the country. In all likelihood, however, North Korea has had an unknown, but not insignificant, number of cases, but lacks both the capacity to test and diagnose them. According to NK Pro’s COVID-19 tracker, 11,500 tests had been pledged to North Korea by donors as of May 24. Still, no information suggests that any significant number of tests have been conducted in the country. Thus, there technically are zero confirmed cases in the country, making for a good statistical representation in the government’s favor, but likely with little bearing on reality. Grassroots reporting by indispensable outlets such as Daily NK, with sources inside North Korea, have reported several instances of fever-related deaths around the country after symptoms seemingly similar to COVID-19. The outlet reported in April 2020, for example, that a large-scale outbreak of fever had occurred in Ryanggang province bordering China. One North Korean defector in China reportedly tested positive for the disease in late April, suggesting that the same person had likely infected several others before entering China.

Another complicating factor is that several of the areas in China that have seen cases resurfacing over the past few months, such as the Heilongjiang province, border North Korea. Although the government has imposed an almost total border closure, promising to shoot violators whether from the Chinese or North Korean sides, it is unlikely that it has managed to fully keep the border so tightly closed that not a single unauthorized person would get through. In normal times, the border is rife with smuggling operations, which the government often turns a blind eye to, not least thanks to systemic corruption. Most of this activity may have ceased—we simply don’t know for sure—but most likely not all of it.

Without proper testing or professional medical diagnosing, there is no way to confirm whether such reported instances truly constitute cases of COVID-19. All schools in the country are set to re-open on June 1 after a prolonged closure, with some already having opened in late April. In late May, the government eased restrictions on the freedom of movement of foreigners, primarily diplomats, which it previously imposed as a containment measure. According to official sources, close to 25,000 people have been in quarantine so far, with all but a few hundred released.[1]

It is not exactly clear why North Korea has chosen to consistently claim zero cases of COVID-19, an extreme figure by any measure. North Korea is not the only country to claim unrealistically low numbers. Cambodia, another impoverished country run by an autocratic government, also claims zero deaths, a figure called into question by many, but it never claimed, like North Korea does, to have had zero infections. Most general information about conditions inside North Korea not published by the regime is treated as a matter of national security. Market prices, for example, have to be reported clandestinely to contacts in South Korea and elsewhere, usually via Chinese cell phones smuggled into the country. Smuggling out a North Korean phone book is punishable by death, since such information is also considered a matter of the gravest national security. The government does not want signs of domestic weakness visible to the outside world, particularly not at a time of crippling international sanctions.

The country’s propaganda apparatus has seized the moment. To the domestic audience, it claims, for example, that South Korean activists sending balloons to North Korea with rice and propaganda leaflets are using this as a cover to send coronavirus into the country. Its delegation to the World Health Organization (WHO) recently made a statement against other countries—implicitly, the United States—for their “irresponsibility” in criticizing the WHO’s anti-virus work. The Twitter account “@coldnoodlefan,” almost certainly run by someone affiliated with the North Korean regime, has made several posts claiming through video clips and pictures that North Korea remains virus-free with no economic instability whatsoever, in stark contrast to much of the rest of the world.

A Rigid System of Social Control

Because of abysmal socio-economic conditions that prevail in most of the country, many outside observers are under the impression that the North Korean system is generally weak. This is true in many ways, but when it comes to social control and suppression of the freedom of movement—something that most countries combatting COVID-19 use in some fashion—the North Korean system has several advantages.

For many other countries, simply closing the border like North Korea did in late January this year would be almost impossible. North Korea, however, has practiced isolation for so long that the anti-COVID-19 measures essentially entail strengthening already existing frameworks and rules rather than, as in other countries, creating new ones. In a normal week, only a handful of flights leave or arrive in North Korea, and almost exclusively to and from China and, on the rarer occasion, Russia. The aforementioned promise to shoot any border crossers to and from China is a good example: even in normal times, unauthorized exits and entries into North Korean territory is strictly forbidden and would in many cases anyway result in the violator, often a North Korea refugee attempting to make it to China, getting shot.

Much illegal border crossing, whether for smuggling or other purposes, is possible for anyone who can pay border guards to look the other way. A significant proportion of the economy is even sustained by illegal and semi-legal cross-border trade. The current regulations, however, have likely made the danger and cost of violating them prohibitively high for most. We don’t know precisely how much smuggling has gone down (or, for that matter, how large the flows are in normal times), but reports suggest it has dwindled significantly.

North Korea also limits and controls domestic freedom of movement for its citizens, perhaps more than any other country in the world today. In theory, every citizen[2] belongs to an administrative People’s Unit (inminban) made up of a number of households, usually between ten and twenty, monitored by one person in charge (inminbanjang), who stays in regular contact with state and public security agencies. Should a person want to travel overnight to another city, they need to ask their People’s Unit head and apply for permission from the local authorities to travel. If they get such permission, they need to report to the People’s Unit head at their destination. People’s Unit heads are regularly tasked with inspecting the homes of their People’s Unit members to make sure that no unauthorized visitors are sleeping over. All of this is ostensibly done for the purpose of national security, although an equally important purpose is to control the population enough to contain any signs of domestic dissent or political disobedience.

Since the North Korean economy broke down in the early 1990s, corruption has become so pervasive and institutionalized that most who can pay their way can now travel around the country as they wish. Many do so for business and trading on the country’s markets, and a whole sector of private transportation has arisen in the country over the past few decades to meet such needs. Nevertheless, domestic travel remains much less common in North Korea than in most other countries, and at times when the state needs to do so, it can clamp down and tighten restrictions relatively easily. Some information suggests that the state has already done so to contain COVID-19.

In other words, the North Korean state has a fairly robust system already set up to limit the freedom of movement of the population. In normal times, it fills the function of monitoring the citizens to keep any socially or politically threatening tendencies at bay, but in times like these, it may come to prove very useful should the government need to contain a major outbreak.

A Crumbled Medical System

While the country’s medical system has some advantages that may make it well-equipped to handle a COVID-19 outbreak, its overall quality and level of resources are extremely low. For example, North Korea has a high proportion of educated medical doctors, albeit not with the same general level of education as those in middle- or high-income countries, but still with enough skills to treat the most common diseases and health problems. Tracking patients, moreover, could be done relatively easily given the rigid system for social control.

Nonetheless, for actual cases of COVID-19, the prognosis looks grim. No information is publicly available, but the country most likely has extremely few or no ventilators available for the general public. North Korea has dedicated significant attention to medical equipment manufacturing over the past few years, but little that would be meaningful during a COVID-19 crisis. In mid-April, the Party’s main newspaper, Rodong Sinmun, reported that a medical oxygen factory had been inaugurated in North Hamgyong province, and in context, this may be a measure to prepare for a growing need for the use of ventilators. Still, even if the measure is related to COVID-19 containment, the country still lacks the necessary treatment equipment.

While there are signs that healthcare is a somewhat growing priority for the regime, the system still remains woefully inadequate, and there are no tangible signs that access to healthcare will improve for the general public in the near future. Most healthcare facilities only have the most basic equipment. According to UNICEF, for example, an estimated half of all healthcare facilities lack even basic water and sanitation facilities. In reality, the figure may well be significantly higher. Theoretically, all North Koreans have a right to free basic healthcare. In practice, members of the general public have to privately pay doctors hefty fees for appointments, and then purchase their medication themselves either from the country’s markets or China. The Pyongyang General Hospital currently under rapid construction most likely will not be open for patients from any geographical location or socio-economic class, but mainly will be reserved for the elites. China has offered support to North Korea to help fight COVID-19, but so far, nothing is publicly known about precisely what support has been given.

Economic Impacts: From Bad to Worse

North Korea’s foreign trade flows are very small even in normal years, almost all of it with China. Its exports totaled only around $2.7 billion in 2016, the year before the U.S. policy of “maximum pressure” through sanctions was imposed. Nonetheless, what little trade it has is crucial, imports perhaps more so than exports, since it needs to import items, such as spare parts, for its industries. North Korea’s trade with China was already heavily decimated from sanctions. Due to the anti-COVID-19-measures, things have gone from bad to worse. Officially, reported trade dropped from already abysmal levels by another 24 percent in January and February, compared to the year before. Moreover, in mid-April, the government issued a general ban against all non-essential imports, as a further anti-COVID-19 preventative measure. Trade is already very difficult because of the extra scrutiny and disinfection measures imposed, leading to a backlog of reportedly thousands of containers by the border and in ports.

As logic would dictate, prices have risen, and at least in Pyongyang, citizens have reportedly been hoarding imported products. The import stop and added difficulties in conducting trade will likely leave North Korea at an even greater shortage of fertilizers and other essential agricultural products than usual during the upcoming planting season, which could possibly lead to a food shortage come the fall harvest. There are strong signs that the regime faces an increasingly serious shortage of foreign currency. The shortage may lead to more severe oppressive economic policies, as the regime pressures the population for cash through measures, such as forcing “loyalty contributions” or mandating entrepreneurs to purchase the recently issued government bonds.

What makes the COVID-19 situation different from sanctions is that had sanctions been all North Korea had to grapple with, then countries that oppose sanctions may have eased up in their implementation, particularly as they perceive the U.S. as the inflexible party. One can easily imagine a scenario in which China would, first under the radar but increasingly more openly, increase trade in sanctioned goods. It would do so not least to benefit its own provinces that border North Korea, which have suffered from the drastic fall in trade with the country. Over the past few months, several firms involved in import-export with North Korea have received employment subsidies to cope. Under the current anti-virus measures, both China and North Korea themselves are the parties taking the measures to seal the border, unlike before, when the main party pushing for it through the United Nations was the United States.

Whither Kim Jong-un’s Ambitions?  

The impact of North Korea’s anti-COVID-19 measures, coupled with continued sanctions, is potentially greater than short-term economic devastation. When Kim Jong-un came to power, he vowed that the people would “never have to tighten their belt again.” He followed up this promise through most of his tenure by building massive white elephants, such as the Masikryong Ski Resort and refurbished and renovated entire neighborhoods in Pyongyang and Samjiyon, in the northernmost part of the country. Such construction sent a message that the country, overall, was reaching toward a higher socio-economic level and that even those far from the capital city, in North Korea’s more remote provinces, would also see their living standards rise with time. Much of the country already did, not thanks to state investments in grand-scale infrastructure projects, but because Kim Jong-un allowed for market mechanisms to play an increasingly greater role in economic management. Unlike his father Kim Jong-il, Kim Jong-un never really clamped down on the country’s market system as a whole, and many of the economic improvements under the younger Kim can be explained by the state simply staying away (although this may be changing).

Over the past few months, however, the tone of state rhetoric has changed. While before it breathed optimism, North Korean state propaganda now speaks much more—and more realistically—about problems and obstacles to economic development and about the old themes of autarky and economic self-reliance. For the time being, any plans to lift North Korea to a higher plane of economic development have largely been put on hold.

What does this mean politically for Kim Jong-un, who staked much of his credibility on delivering economic progress? The truth is that no one really knows. On the one hand, North Korea is perhaps the harshest dictatorship in the world, and the regime crushes even the slightest hint of dissent with an uncompromising iron fist. Over 100,000 people are estimated to be imprisoned in labor camps, many for crimes of political nature (or “speaking mistakes” as the Korean term goes), some for life. Kim Jong-un was in fact absent not just for one period of several weeks—the initial one that drew so much international attention—but for two different periods, and only appeared in North Korean media four times in all of April and May. Kim may be recovering from a medical procedure, but his absence may also be caused by caution against COVID-19. He may simply not want to conduct public visits or meeting sessions due to the risk of infection. In a system where so much power is centered around one single leader, his health is a top priority for national security in the eyes of the state, and will always be strongly guarded.

On the other hand, no dictatorship can truly function sustainably without any sense of at least tacit support from part of the population, such as the privileged, political core class. Kim has catered to this class in North Korea by overseeing their access to an essentially Western upper-middle class lifestyle in many respects, such as luxury department stores and a water park. The provinces have seen little of this development, and the massive and growing cleavage between the capital city and everywhere else is another long-term problem for the regime. Even so, life in the countryside has improved overall, albeit more marginally, thanks to the growth of the market system.

What happens when, over the course of a longer period of time, things not only cease to improve, but become markedly more difficult? The general public may heed the state’s call to get ready for some difficult times ahead for a while, but in the longer run, it may lead to widespread discontent. What that will mean for the North Korean regime, which has already survived challenges that seemed impossible, only time will tell.

The views expressed in this article are those of the author alone and do not necessarily reflect the position of the Foreign Policy Research Institute, a non-partisan organization that seeks to publish well-argued, policy-oriented articles on American foreign policy and national security priorities.

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[1] As compiled by the NK Pro Covid-19 Tracker.

[2] It is not entirely clear whether the system also exists in the countryside and on collective farms, or if inminban only exist in the cities. Some sources claim that a different institution exists outside of urban environments, but nevertheless, its functions are the same.