Health, Migration and the Future of North Korea

1. Health, Migration and the Future of North Korea Courtland Robinson, Ph.D. Johns Hopkins Bloomberg School of Public Health Center for Refugee and Disaster Response USIP October 19, 2010

2. Outline of Talk • Future scenarios for North Korea • History and patterns of migration from North Korea • How might migration shape/be shaped by evolving scenarios?

3. Future Scenarios for North Korea • Three themes (many variations): • Collapse (hard or soft, near-term or longer-term) • Gradual reform (evolving toward Chinese models, SK models, other) • Status quo (or “muddling through”)

4. Brief History of Migration from North Korea • Migration between North Korea and China relatively limited in the 1950s – 1980s • Famine in North Korea (peaking in 1996-97) followed by continued “March through Hardship” spurred migration across the border • Seeking food, shelter, relief aid • Seeking employment, income • Some seeking migration to South Korea • Some seeking to stay in China • Peak of the arrivals from North Korea in 1998 (migration is a lagging indicator for famine and food insecurity); declining overall numbers but dynamic patterns since

5. Northeast China (including Yanbian Korean Autonomous Prefecture)

6. North Koreans Hiding in China

7. The Problem (and Politics) of Numbers As noted by a 2007 report from the Congressional Research Service: “There is little reliable information on the size and composition of the North Korean population located in China. Estimates range from as low as 10,000 (the official Chinese estimate) to 300,000 or more. Press reports commonly cite a figure of 100,000 to 300,000. In 2006, the State Department estimated the numbers to be between 30,000 and 50,000, down from the 75,000 to 125,000 range it projected in 2000. UNHCR also uses the 2006 range (30,000 to 50,000) as a working figure. UNHCR has not been given access to conduct a systematic survey. Estimating the numbers is made more difficult because most North Koreans are in hiding, some move back and forth across the border—either voluntarily to bring food and/or hard currency from China or North Korea—or because they are forcibly repatriated…Clearly, the refugees’ need to avoid detection, coupled with a lack of access by international organizations, make it difficult to assess the full scope of the refugee problem.”

8. NK Population in China: Study Design • To obtain information about the population of not only North Koreans but children born to North Korean women in China, we conducted semi-structured interviews with 3 key informants from each of 36 geographically randomized sites selected in each of the three study provinces (108 sites in all). Each of these sites was visited by a trained team of two local interviewers to identify key informants who were willing to provide information about North Korean populations living in the site.

9. Population Component • Population Component. Participants included a total of 324 adults who were believed to know about the presence or absence of North Koreans in their communities. These included local church members, community leaders, business contacts, resident North Koreans, and trusted local officials. Questions from the population component of the semi-structured interview included the following: • Total population of North Koreans in 1998, 2002 and 2009 • Estimated proportion male and female of NK adults in 1998, 2002 and 2009 • Estimated number of children born to North Korean mothers in China in 1998, 2002, and 2009 • Estimated proportion of NK women married to Chinese men • Estimated proportion male and female children born to NK women in China

10. Estimated North Korean Population in NE China (Chart not to be reproduced without permission)

11. Estimated Children Born to NK Women in NE China (Chart not to be reproduced without permission)

12. Key Findings • NK Population Decline: Decline from 1998 (peak) to 2009 is 7-fold to 10-fold • Tighter border security • Onward movement to South Korea and other countries (those who cross with intent to migrate internationally do not stay in China long) • Greater awareness of what is, and is not, available in China

13. Key Findings • Population Shift: Main population numbers may have shifted from Yanbian (where more than 50% of population lived in 1998) to other parts of NE China, particularly Heilongjiang • More than 400,000 Korean-Chinese in Heilongjiang (largest number outside of Yanbian) • Directly north of Yanbian, with major rail and road links • Rich in natural resources but remote and sparsely populated; considerable independence from central administration

14. Key Findings • Increase in Proportion Female: In NE China, % of NK adult females rose from 50% in 1998, to 54% in 2002, to more than 77% in 2009 (closely tracks our 2007 study of Yanbian)

15. Key Findings • Increase in China-born Children: The number of children born to NK women in China rose from approximately 8,000 in 1998, to 9,000 in 2002, to 10,500 in 2009 • There are now more children born to NK women than total NK population in China. Given the migration patterns of women, this suggests that many children are living w/o their mothers (of 20 children we interviewed, only five were living with their mothers • Respondents also noted a high sex ratio of 133.6 males per 100 females (China total is around 109, already high)

17. Implications for the Future • The problem of absence does not mean the absence of problem

18. Implications for the Future • Programs (and research) must have broader geographic, conceptual reach • This is not simply a refugee problem; it has evolved to include trafficked women, stateless children, and different dimensions of vulnerability, including people migrating in poorer states of health (TB, MDRTB, etc)

19. Implications for the Future • Time to begin constructing and enhancing safe (or safer) alternatives to current, mainly high-risk, modes of migration. • Need to broaden the framework to encourage all stakeholder countries to consider a more complex range of migration options:

20. Implications for the Future • Range of migration options: • China: naturalize the more than 10,000 children born to North Korean mothers in China • North Korea: permit households with motives for family reunification, labor, or simply survival to leave without penalty in a safe and orderly manner • South Korea: continue to resettle NK “talpukja/saetomin” and broader migration opportunities for Chinese family members of mixed-nationality children • US: broaden scope of support for NK refugees and migrants to include support for other vulnerable populations—victims of trafficking, stateless children, other at-risk groups

21. Implications for the Future “There is a need to enhance our picture of the migration from North Korea, beginning with the war and coming up to the present day, encompassing the full range of migration patterns: internal mobility, the evolving migration into and within China, regional migration dynamics, and the settlement and integration of North Koreans in South Korea. Enhancing bilateral and multilateral dialogue on these issues, as well supporting the full engagement of civil society, may be a confidence-building measure in itself and promote the idea that migration need not be an issue that divides countries but one that may, quite literally, bring them together.” (Robinson, “North Korea Migration Patterns and Prospects,” CSIS/The Korea Project, 2010)