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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 to be a non-issue in North Korea because it went undocumented, but experts now estimate that drug-resistant TB may already be a serious and growing problem.5 In developed countries, treatment of TB and MDR-TB is approached through public health or strict biomedical solutions. However, underlying social and economic determinants of the disease in North Korea means focusing on the rights of people who live with or who are vulnerable to TB.6 This rights-based approach necessitates identifying the value imparted in protecting the rights of people vulnerable to TB, and those with TB, particularly in terms of providing information, preventing the spread of disease, ensuring quality testing, and guaranteeing that treatment is available and accessible to all.

Marching Through Suffering is a deeply personal portrait of the ravages of famine and totalitarian politics in modern North Korea since the 1990s. Featuring interviews with more than thirty North Koreans who defected to Seoul and Tokyo, the book explores the subjective experience of the nation's famine and its citizens' social and psychological strategies for coping with the regime. These oral testimonies show how ordinary North Koreans, from farmers and soldiers to students and diplomats, framed the mounting struggles and deaths surrounding them as the famine progressed. Following the development of the disaster, North Koreans deployed complex discursive strategies to rationalize the horror and hardship in their lives, practices that maintained citizens' loyalty to the regime during the famine and continue to sustain its rule today. Casting North Koreans as a diverse people with a vast capacity for adaptation rather than as a monolithic entity passively enduring oppression,Marching Through Sufferingpositions personal history as key to the interpretation of political violence.

This article proposes that preparation for internal migration in North Korea, in the case of governmental disruption, will ameliorate humanitarian concerns inside the country while also providing disincentives for outward migration into neighboring countries.

North Korea is renowned for its inaccessibility, with anthropologists and others compelled to work beyond its borders. Presented in this article are select findings from ethnographic research carried out in 2006 among refugee survivors of the North Korean famine living in South Korea. The ethnographic material shows how refugees’ accounts of their plight are shaped by the political conditions of North Korea.