The devastating reality of North Korea's late-1990s famine is receiving a fresh, firsthand perspective through a newly published memoir. Co-authored by Swiss humanitarian Kathi Zellweger and journalist Mike Chinoy, "Miss Kathi: Saving Lives in North Korea" chronicles Zellweger's nearly three decades of unprecedented humanitarian work and access within the highly isolated state. As one of the first book-length English accounts written by an aid worker on the ground, the memoir sheds light on the quiet suffering of citizens during the country's darkest years.
An excerpt from the book details a pivotal trip in September 1998 to Sinuiju, one of North Korea's five largest cities. Situated along the Yalu River directly across from the bustling Chinese border town of Dandong, Sinuiju was once a thriving industrial and transit hub. However, following the collapse of the North Korean economy, the city had become dilapidated and shabby, offering a stark contrast to the bright lights of the Chinese side of the river.
Sinuiju was severely impacted by the famine. Earlier that year, North Korean authorities and the World Food Program had requested 1,500 metric tons of barley from Caritas, the international charity where Zellweger worked. Delivering this critical aid granted Zellweger and Mary Healy—a nurse and midwife representing the Irish NGO Trócaire (Caritas Ireland)—unprecedented permission to visit the restricted city. While local officials credited the shipment with helping to alleviate hunger, the conditions on the ground remained extraordinarily grim.
During their visit, Zellweger and Healy met 69-year-old Mrs. Kim, who lived in a tiny, spotless apartment in a gray Stalinist-style building with her son, her daughter-in-law, and her six-month-old grandson. Though the family owned a guitar, a cassette recorder, and a sewing machine—items that normally indicated a comfortable standard of living in North Korea—their situation was desperate. The son and daughter-in-law worked at a nearby textile factory, but they had not received rations through the state-run Public Distribution System in six months.
With her infant child falling ill, the daughter-in-law asked Zellweger, "Is this the end of the Great Leader taking care of us?" She explained that she was breastfeeding because she had absolutely nothing else to feed her baby. Aside from a single delivery of 14 kilograms of rice and some bean curd provided to mark North Korea's National Day, the family survived by consuming alternative foods and bartering textiles with rural relatives who were able to grow their own crops.
Later that day, the aid workers visited Mr. Lee, a 71-year-old carpenter who lived with his wife and youngest son. Like the Kim family, Mr. Lee had not received state rations since February. He managed to survive by designing and building furniture, which he traveled to the countryside to barter with farmers in exchange for food.
These personal encounters highlighted a defining characteristic of the North Korean famine: its epicenter was primarily urban. More than two-thirds of the North Korean population lived in cities and towns. While rural farmers could cultivate small, private garden plots to survive—a practice grudgingly tolerated by local authorities—urban residents living in large apartment blocks had no such option. When the state-run Public Distribution System collapsed, these city dwellers were left with no source of food, causing many to starve quietly and out of sight inside their homes. This phenomenon led Zellweger to describe the crisis as a "hidden famine," distinct from the highly visible rural famines of nations like Somalia or Ethiopia.
To survive, urban residents increasingly relied on bartering, which laid the groundwork for the gradual emergence of informal markets. Zellweger observed people along the roadsides selling buns, cigarettes, vegetables, and live fish. Small service operations also began to appear, including shoe menders, tailors, bicycle mechanics, and wood transporters. The vast majority of these vendors were women, as men were typically tied to fixed state jobs or military service.
The rise of these markets presented a significant ideological and practical challenge to the regime's centralized control, representing a de facto privatization of the economy. Initially, roadside vendors would panic, covering their buckets and fleeing whenever a foreigner approached, while accompanying government minders looked away in discomfort. Over time, however, these markets expanded to replace the nonfunctional Public Distribution System. Despite their growth, prices remained high, with some residents reporting they spent up to 80 percent of their salaries just to purchase vegetables. Cereals like rice and maize remained heavily guarded state monopolies, though they were occasionally sold surreptitiously in the markets.
By 2002, as part of a broader diplomatic outreach to Washington, Tokyo, and Europe, North Korean leader Kim Jong Il formally sanctioned the existence of certain municipal markets. Prior to this reform, the markets existed in a political gray zone, and foreign visitors were strictly forbidden from visiting them. Nevertheless, during their travels, Zellweger and her colleagues occasionally found their vehicles driving directly through crowded market areas, highlighting the complex paradoxes of life inside North Korea.
For the families we visited in Sinuiju, and many others, bartering was a crucial survival mechanism. What had begun with urban residents trading items of value, either from their homes or what could be stripped from their places of work, for food grown by farmers in private family garden plots became the foundation for the broader development of markets. As I traveled around the country, I would see people by the side of the road selling everything from buns to cigarettes to vegetables to live fish. As time passed, I also started to see little businesses appearing – people mending shoes, sewing, fixing bicycle tires, transporting wood in simple carts. Almost all of those involved appeared to be women, presumably because men were more likely to have fixed jobs or be serving in the military.
But the trend only accelerated with the creation of larger markets, especially in or near urban areas, which took over the role of the largely nonfunctional Public Distribution System. Before long, they became not only a source of food but of many other goods, although as they expanded, prices rose as well, and many people remained too poor or too far away to benefit. Indeed, some people told us they were spending up to 80 percent of their salary just to purchase vegetables.
