Trauma experience of North Korean refugees in China

Abstract

Objectives: We examined trauma experience and mental health conditions among North Korean migrants in China.

Methods: Personal interviews of 170 North Korean “food refugees” in China were conducted in 1999. Structured questionnaires were used to identify specific trauma experience and symptoms of post-traumatic stress, anxiety, and depression.

Results: All participants surveyed reported trauma exposure, with food and water shortage (93%) and illness without access to medical care (89%) being the most frequently cited events. Post-traumatic stress disorder was suspected in 56% of the respondents. Above-threshold scores on anxiety and depression were found in 90% and 81% of the cases, respectively.

Conclusions: The burden on the part of North Korean migrants in China who experience trauma appears to be very high. An international call for action is warranted to monitor and safeguard the mental health status of this vulnerable segment of people and respond to their urgent psychiatric and medical care needs.

Introduction

I n North Korea, officially known as the Democratic People’s Republic of Korea (DPRK), years of economic downturn accompanied by natural disasters since 1995 have taken a heavy toll on the country as a whole. The public health infrastructure has been seriously compromised, with poor hygiene and inadequate provision of health care services adversely affecting the health of its people.1 Accounts of cumulative effects of malnutrition, with stunted growth of young children, have been reported on a nationwide scale.2, 3, 4

With escalating levels of food shortages and poor living conditions in North Korea, a large segment of the population has been displaced from their homes, and even forced to flee to neighboring China. Because the refugees are constantly on the run for fear of being captured, it is difficult to make an estimate of the total number of the North Korean refugee population. The number of refugees is estimated at around 10,000 by unofficial government estimates, whereas, nongovernmental organizations working near the border area have suggested a much higher number of 100,000 to 200,000.5, 6, 7 On the run, the refugees risk expulsion and face severe punishment when confronted by government authorities. A few studies have focused on the poor health status of this vulnerable segment of the population. A high prevalence of infectious diseases and an increase in mortality with dwindled family size have been reported.8, 9 Starvation has been reported for about 40% of causes of death.10

North Korean refugees crossing the border to China, already beset by traumatic experiences in their homeland, encounter tremendous numbers of stressful events. During their flight and even after their entry into China, North Korean migrants are in constant fear of being captured, extradited, tortured, or even killed. Recently, China has begun to actively track down these people due to pressures from North Korea.11 Since the migrants repeatedly cross the border to bring food and medical supplies to their families at home, their chances of being exposed to traumatic events are likely to be very high. Studies on refugees’ mental health indicate a high prevalence of trauma and related mental disorders.12 In addition, mental distress has been known to persist among natural disaster victims already living in destitute conditions.13

The aim of this study was to assess trauma experiences and levels of psychological distress among North Korean migrants in China. The scope of trauma and symptoms of post-traumatic stress, anxiety, and depression were evaluated using standardized questionnaires. To our knowledge this is the first report to document trauma-related psychiatric conditions suffered by North Korean migrants in China.