Has Life in North Korea Changed Since 2013? 

Last month, as I launched my new book “Witness to North Korea,” conversations with Wall Street Beijing Bureau Chief Jonathan Cheng and NK News’ Alannah Hill brought up one important question: is this memoir of my three years living and working as the United Nations Resident Coordinator in the Democratic People’s Republic of Korea (DPRK) still relevant to the North Korea of today? 

I wrote this book for anyone wishing to understand, as Stimson Center Fellow Frank Aum wrote, “what it actually means to engage with the DPRK – not in the abstract language of policy briefs, but through the granular, often maddening, reality of day-to-day diplomacy and humanitarian work.”

This question of continued relevance between what I observed then and the country today is a valid one. After all, I left Pyongyang in 2013 – and yes, things in the country have changed since my departure. Some North Korea experts talk of a rising middle class with cash to spare, of one mobile phone subscriber for every three North Koreans, of ski resorts – all thanks to the phenomena of marketization and monetization changing the up-to-now closed economy and forcing the hand of the North Korean regime to open to international trade. 

Another thing has changed: data has become even harder to obtain. In 2020, North Korea used the COVID-19 pandemic to deny entry to several EU-member countries that had kept an embassy in Pyongyang and to most of the international community’s assistance programs. These embassies and resident U.N. agencies, as well as most international NGOs, have not yet returned. The U.N. population census remains, to this day, an essential source of quality data about North Korean society. Sadly, there has not been such an exercise since I left 13 years ago.

My discussions with U.N. officials and humanitarian organizations point, today, to a continuation of the underlying problems that I describe in my book, which continue to shape the lives of ordinary North Koreans. Kim Jong Un’s regime continues to experience a gap between intention and reality in four major areas: food and nutrition; public health and infectious disease; availability of medicines and medical equipment; and, finally, technical cooperation and capacity building. These problems concern both domestic limitations and international constraints.

During my years in Pyongyang, the United Nations and many NGOs worked with North Korean institutions to improve agricultural production, strengthen health services, support maternal and child nutrition, conduct the national population census, and assist vulnerable communities facing chronic shortages. These efforts were based on a simple reality: despite its political isolation, the North Korean population faced genuine needs that could not be solved through sanctions or diplomacy alone.

Kim Jong Un’s unusually candid admission last February that agricultural production remains inadequate and that decades of rural policy have failed echoes many of the concerns that humanitarian agencies encountered during my posting. While today the emphasis has shifted toward livestock production, dairy farming, and regional development, the objective remains the same: providing sufficient and nutritious food to a population that continues to experience chronic shortages. 

During my time in North Korea, workplaces and factories would allow their people to leave during the day to forage in the hills, as the government acknowledged the persistence of a “food problem.” Today, the North Korean government’s ambitious rural modernization program reflects an acknowledgement that food security is still a national challenge rather than a problem of the past.

The health sector presents an equally familiar picture. Authors Joon Hee Han and Yo Han Lee, in a deeply researched January 2026 article titled “North Korea’s 2025 Health Revolution,” found that while North Korea is investing heavily in new hospitals and health infrastructure, questions remain about foundational input such as medicines, trained personnel, reliable electricity, and sustainable financing. 

Similarly, during my time in Pyongyang, we repeatedly found that physical infrastructure alone could not guarantee improved health outcomes without parallel investments in equipment, pharmaceuticals, professional training, and institutional capacity. All indications suggest that, aside from the usual showy investment centered on Pyongyang, this lesson remains as relevant as it was when I visited health centers around the country from 2009 to 2013.

Many reports point to a shift in international aid from Russia, and away from Europe and the United States. And yet, the issues the country faces remain unchanged. A Russian court ordered more than 30 North Korean nationals to undergo tuberculosis treatment in Moscow in 2024 and 2025, according to court documents, belatedly confirming both North Korean labor flows into Russia and a suspected infection outbreak among overseas workers.

During my assignment to Pyongyang, tuberculosis was already recognized as one of North Korea’s most serious public health challenges, and international cooperation played an essential role in diagnosis, treatment, and prevention. The prevalence of the disease over a decade later highlights the well-known problem of continuing weaknesses in disease detection, treatment and public health capacity in North Korea – and the continuing importance of international health cooperation.

Finally, aside from North Korea’s unwillingness to receive technical assistance from the United Nations, NGOs, and a few bilateral donors, current international restrictions continue to make international engagement difficult. Engagement is neither a concession to the regime nor an endorsement of its policies. It is a practical means of empowering individuals while creating channels of communication in an otherwise isolated country. 

The recent debate over sanctions exemptions, NGO licensing, and restrictions on humanitarian operations demonstrates that this question remains unresolved. If anything, international assistance organizations today face even greater operational obstacles than during my tenure.

Yet international technical cooperation continues to matter. International agencies connect North Korea to the world through a variety of interventions such as civil aviation coordination, vaccination programs, or drug control – albeit within limits and constraints due to their reduced ability to implement and monitor their programs on the ground. 

These developments reinforce one of the principal conclusions from my time in the country: technical assistance to North Korea should not be viewed as a political reward but as a means to support the North Korean people. Isolation has not eliminated North Korea’s needs. Instead, it has often made it more difficult for international organizations to respond effectively to them.

The regime is not a static monolith. Parts of the leadership, aware of structural weaknesses, attempt significant reforms in agriculture, health care, and regional development. International assistance should support them, not by replacing domestic responsibility but by providing expertise, resources, and technical cooperation where they are most needed.

The dilemmas I described in “Witness to North Korea” – how to balance sanctions with humanitarian principles, how to engage without legitimizing the regime, and how to reach vulnerable populations while respecting international law – will shape the work in Pyongyang and the international community’s posture toward North Korea. The details have evolved, but the fundamental questions remain consistent.

For readers seeking to understand whether international engagement with North Korea still matters, the answer emerging from both my experience and these recent developments is clear. The country’s population continues to face serious challenges, and sustained, principled, smart engagement remains one of the few practical means of improving the lives of ordinary North Koreans while preserving channels for dialogue in one of the world’s most isolated states.

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