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President Donald Trump's historic summit with North Korean leader Kim Jong Un produced a thaw in relations between the two countries but the communist regime continues to face international sanctions and food shortage problems.
However, one U.S.-based non-profit organization that has been partnering for 20 years with North Korean farmers to help them increase food production is starting to see results.
The Food and Agriculture Organization of the United Nations earlier this month identified North Korea as one of 39 countries currently still "in need of external food assistance." Nearly 40 percent of the country's population are undernourished and more than one-quarter of the children stunted due to a poor diet, according to UN.
The heavy hand of the central government in Pyongyang has contributed to physical shortages of food along with erosion of land and frequent droughts. Poor soil quality also is a problem because of ceaseless cultivation of crops. Also, less than 20 percent of North Korea is suitable for agriculture since most of the country is mountainous terrain.
Still, the situation is better than the 1990s when a severe famine claimed as many as 2.4 million lives. Domestic production of staple crops such as rice and corn has grown although the country of just over 25 million people still remains dependent on food aid primarily from China.
"Production has been increasing over the last five years because of changes in agriculture," said Linda Lewis, country director for DPRK at American Friends Service Committee, a Philadelphia-based Quaker organization that has worked with and in North Korea on agricultural and economic issues for several decades. DPRK is short for North Korea's formal name, the Democratic People's Republic of Korea.
North Korea's agriculture is centrally managed and based mostly on cooperative farms while a smaller portion are state industrial farms operated as government enterprises. The average farm in the country has nearly 3,000 people and gets its marching orders of what will be grown usually from the government.
Even so, Lewis said there have been reforms by North Korea in the past several years that have allowed farmers "more local discretion and individual control over decisions on allocated pieces of land." The government also allows farmers to sell or barter food when there's a surplus beyond certain production targets.
At the same time, changes in the management of agriculture by the government in the last five years have produced what Lewis calls "more resilience in the face of droughts."
Lewis said AFSC has operated a program on the ground in North Korea continuously since 1998 focused on increasing agricultural production. Specifically, the group's goal is greater production of corn and boosting the productivity of rice farming.
A decade ago, the American organization introduced plastic trays to plant rice seedlings in North Korea and also has helped with fertilizer issues and the construction greenhouses for vegetable production.
Lewis said the rice trays save labor, seeds and have increased production of rice by 10 to 15 percent. "The farms we work with do appreciate it," she said. "Now the government is pushing this throughout the whole country."
Regardless, North Korea still generally relies on older agricultural technology and machinery.
Some machinery used in the fields dates back to the 1970s. And international sanctions have curbed the shipment of new vehicles and metal products used in agriculture.
The Trump administration has said tough international trade sanctions with North Korea will remain in place until there's a "complete denuclearization " by the hermit regime. There's also been a reduction in fuel and certain fertilizers under the sanctions but reports of smuggling to get around the clampdown.
"Until the latest round of sanctions in January, we were able to send almost everything that we wanted," said Lewis. "But the latest round meant we couldn't send vehicles or metals. So no shovels or small equipment like tractors that can go on mountain roads."
She said backpack sprayers also are out due to sanctions. "We don't give them high-tech stuff just low tech-stuff. Things we send are very simple."
North Korea has developed domestic tractor manufacturing that helps it get around sanctions. North Korea's leader Kim was seen smiling in photos believed to have been taken last year at one such tractor factory.
Some of the tractors have been trotted out in military parades pulling wagons loaded with weapons.
AFSC can still send plastics to North Korea for greenhouses and water pumps to help with irrigation systems.
Along with water management issues, sanitation has been identified as a problem in North Korea by other non-governmental organizations and UN agencies. There's been reports of chronic diarrhea in the population due to the lack of clean water. Also, roughly one out of every four people in the country lack what's considered basic sanitation facilities.
Lewis, who last month returned from her sixteenth trip to the isolated country, said there's "quite a rigorous process" required for Americans to get State Department approval to travel to North Korea. "Many people we understand are being turned down."
She calls food security "one of the biggest humanitarian issues inside North Korea." She first went to the Korean peninsula in 1970 as Peace Corps worker in South Korea and helped with farming programs.
According to Lewis, AFSC has long advocated engagement with North Korea to solve tensions on the peninsula. "We support engagement as a opposed to maximum pressure. We see the summit at the beginning of a long process and not the end of the process."
The government provides some fertilizer for farms but chemical fertilizer has been in short supply in North Korea due in part to the ongoing sanctions. That has meant there's been the use of so-called "night soil" — a euphemistic name for human poop used as fertilizer.
The effects of using the human waste for farm fertilizer appear to have contributed to health problems such as worms and parasites in the population.
In November, a North Korean soldier who was shot while running across the heavily guarded DMZ and found to have an "enormous number" of parasitic worms, according to the South Korean doctor who treated him. There have been reports of several other defectors with similar health problems.
"One of the things we teach about is composting and providing equipment for it," said Lewis. "In a situation of scarcity of inputs for agriculture, there are a lot of problems."