2 Disability, Repressive Regimes, and Health

Disparity: Assessing Country Conditions in

North Korea
Jae-Chun Won,* Janet E. Lord,** Michael Ashley Stein*** and
Yosung Song****

Abstract

This article examines the potential of international human rights

standards to account for heightened risk and vulnerability to human
rights abuses for persons with disabilities in politically repressive en-
vironments. We offer a preliminary assessment of whether and how a
disability-cognizant accounting of human rights in repressive regimes
can lead to a more credible and comprehensive understanding of dis-
ability in such contexts. In so doing, we make the case for a more thor-
ough and thoughtful application of international disability rights stand-
ards to better inform human rights investigations, transitional justice
approaches, and international criminal law proceedings. To illustrate
this methodology, we analyze health and human rights disparities for
North Koreans with disabilities by framing health disparity within a
socio-contextual and rights-based understanding of disability. Specifi-
cally, we consider the social determinants of health in health outcomes
for persons with disabilities using the human rights frame offered by
the Convention on the Rights of Persons with Disabilities. Using North
Korea as a case study, we argue that assessing the social determinants of
health and the disabling impact of social, physical, and other exogenous
factors is likely to yield insights on health disparity in repressive (and
other) environments.

* Professor, Handong International Law School, Handong Global University; Po-

hang, South Korea.
** Senior Research Associate, Harvard Law School Project on Disability, Cam-
bridge, MA, USA.
*** Executive Director, Harvard Law School Project on Disability; Visiting Professor,
Harvard Law School, Cambridge, MA, USA; Extraordinary Professor, University
of Pretoria Faculty of Law, Centre for Human Rights, Pretoria, South Africa.
**** PhD Candidate, Syracuse University; Syracuse, New York, USA.

Jure Vidmar, Ruth Kok, et al. (eds.), Hague Yearbook of International Law 2014.
© 2016 Koninklijke Brill nv. isbn 978-90-04-32485-5. pp. 27-53.
28 2 – Won, Lord, Stein and Song

1 Introduction

It has been ten years since the United Nations General Assembly adopt-
ed the first core human rights treaty of this century – the Convention
on the Rights of Persons with Disabilities (CRPD or Convention).1 The
explicit embrace of disability-specific protections represented a quan-
tum leap in international human rights law. Before the CRPD, the rights
of persons with disabilities were marginal at best, and contingent, par-
tial, and undermined at worst, whether in the United Nations human
rights system or beyond.2 A decade on, some 162 countries have ratified
the Convention, and some 88 its Optional Protocol,3 a treaty body has
travelled a reasonably substantive journey since its work commenced in
2008,4 and United Nations agencies and progammes are being animated
by its principles.5 Nationally, legislatures are churning out a consider-

1 This work was supported by a National Research Foundation of Korea grant

funded by the Korean Government (NRF-2014S1A2A2028692). We thank Daniel
Chungman Hwang, Sophia Senge, and Lauren Shryne for research assistance,
and the Citizen Alliance for North Korean Human Rights for feedback and sup-
port.
Convention on the Rights of Persons with Disabilities, G.A. Res. 61/106 (2007)
[hereinafter CRPD]. The CRPD text, along with its drafting history, resolutions,
and updated list of States Parties is posted on the United Nations Enable website,
<www.un.org/esa/socdev/enable/rights/convtexte.htm>, visited on 5 April 2016.
2 See G. Quinn and T. Degener, Human Rights and Disability: The Current Use and
Future Potential of United Nations Human Rights Instruments in the Context of
Disability, February 2002, OHCHR, p. 1, <www.nhri.net/pdf/disability.pdf>, vis-
ited on 4 April 2016.
3 Optional Protocol to the Convention on the Rights of Persons with Disabilities,
G.A. Res. 61/106 (2007) [hereinafter Optional Protocol].
4 For information regarding the Committee’s work and its sessions, see CRPD,
Treaty Bodies Sessions, <tbinternet.ohchr.org/_layouts/TreatyBodyExternal/
SessionsList.aspx?Treaty=CRPD>, visited on 4 April 2016.
5 In September 2006, the United Nations System Chief Executives Board for Co-
ordination (CEB) established the Inter-Agency Support Group on the CRPD in
recognition of the commitment of the United Nations system in “promoting,
protecting, and ensuring [the CRPD’s] general principles, as defined in Article
3, both in the work of the United Nations system, and in its internal policies.”
For a summary of the work of the Inter-Agency Support Group, see Status of the
Convention on the Rights of Persons with Disabilities and the Optional Protocol
thereto, Report of the Secretary-General (UN Doc. A/64/128) para. 6, 7 July 2009,
<documents-dds-ny.un.org/doc/UNDOC/GEN/N09/393/77/PDF/N0939377.
pdf?OpenElement>, visited on 12 April 2016.
Disabilit y, Repressive Regimes, and Health Disparit y 29

able quantity of disability rights legislation and domestic and regional

courts are invoking the CRPD in their jurisprudence.6
A road less travelled in scholarship or in practice drives forward an
inquiry as to how disability rights principles of the CRPD can animate
and inform work on some of the most egregious human rights violations
against persons with disabilities. This lacuna is ironic and paradoxical.
Some of the most important human rights standards were inspired by
atrocities committed against persons with disabilities – the Nuremberg
Code and Article 7 of the International Covenant on Civil and Political
Rights among them7 – yet international criminal law, international hu-
manitarian law, and emerging schemes covering mass atrocities, survi-
vorship, and reintegration do not reflect the disability rights narrative
espoused by the CRPD.8 As such, transnational legal practice has yet to
reflect the current state of human rights law in the context of disability.
One historical and continuing exemplar is the differential human rights
reporting on political prisoners from that of persons with disabilities
experiencing identical treatment in psychiatric hospitals: the plight of
political prisoners detained in psychiatric hospitals has long and cor-
rectly been deemed an egregious human rights violation, while indi-

6 Examples abound, but to illustrate this global trend in legislative action, see
Hungary, Act CXXV of 2009 on Hungarian Sign Language and the Use of Hun-
garian Sign Language (2009); New Zealand, Sign Language Act of 2006; Uruguay,
Law 18.437, General Education Law (2008). CRPD-inspired jurisprudence is like-
wise too extensive to capture herein, but some diverse examples include: Alajos
Kiss v. Hungary, 20 May 2010, EHCR, no. 38832/06, <www.unhcr.org/refworld/
pdfid/4bf665f58.pdf>, visited on 8 April 2016; Western Cape Forum for Intellectual
Disability v. Government of the Republic of South Africa and Another 11 November
2010, Western Cape High Court, Cape Town, no. 18678/2007, <www.saflii.org/za/
cases/ZAWCHC/2010/544.html>, visited on 8 April 2016.
7 See J.E. Lord, ‘Genocide, Crimes against Humanity and Human Rights Abuses
against People with Disabilities’, in D.L. Shelton (ed.), Encyclopedia of Genocide
and Crimes Against Humanity (Macmillan Reference, New York, USA, 2004),
pp. 253-258.
8 Two notable exceptions are J.E. Lord and M.A. Stein, ‘Peacebuilding and Rein-
tegrating Ex-Combatants with Disabilities’, 19 International Journal of Human
Rights (2015) pp. 277-292; M.A. Stein and J.E. Lord, ‘Implications of the UN Dis-
ability Convention for Refugees and Internally Displaced Persons with Disabili-
ties’, 28 Arizona Journal of International & Comparative Law (2012) pp. 401-433.
See also W.I. Pons, J.E. Lord and M.A. Stein, ‘Disability, Human Rights Violations,
and Crimes against Humanity’, Harvard Law School Project on Disability Working
Paper (2016) (on file with authors).
30 2 – Won, Lord, Stein and Song

viduals with mental disabilities involuntarily committed in the same

conditions have been ignored. 9

2 Framings of Disability in International Law

International standards on disability, as set forth in the CRPD, offer

a distinctive conceptual framing of disability as a social-contextual
phenomenon and a broad human rights issue.10 The CRPD offers a cor-
rective response to received framings of disability grounded solely in
a biomedical paradigm that led inevitably to a neglect of research and
analyses of the broader social, political, and environmental factors that
persons with disabilities must mediate. These limiting and retrogressive
perspectives are apparent in the framing of disability in international
law generally.11
The adoption of a socio-contextual understanding of disability by
the drafters of the CRPD was inspired by the “social model” of disabil-
ity that evolved through disability studies literature and advocacy, and
which opposed the retrograde “medical model” of disability rooted in
individual biology as a condition to be cured or pitied.12 The CRPD rec-

9 See, e.g., Human Rights Watch, ‘Uzbekistan: Dissident Forced into Psychiatric
Detention,’ 2 September 2005, <hrw.org/english/docs/2005/09/03/uzbeki11684.
htm>, visited on 8 April 2016; Human Rights Watch, ‘Uzbekistan: Psychiatric
Punishment Used to Quash Dissent: Government Deploys Stalinist-Era Tactic
against Leading Human Rights Defender,’ 19 October 2005, <hrw.org/english/
docs/2005/10/20/uzbeki11905.htm>, visited on 2 April 2016 (illustrating this
trend of highlighting abuses against political dissidents held in unacceptable
conditions in psychiatric institutions but paying no attention to the human
rights situation of others held under the same conditions).
10 See M.A. Stein, ‘Disability Human Rights’, 95 California Law Review (2007) pp. 75-
121; J.E. Lord and M.A. Stein, ‘The Domestic Incorporation of Human Rights Law
and the United Nations Convention on the Rights of Persons with Disabilities’, 83
University of Washington Law Review (2008) pp. 449-456.
11 For further discussion of this gap, see J.E. Lord, ‘International Humanitarian Law
and Disability: Paternalism, protection or rights?’, in M. Gill and C. Schlund-Vi-
als, eds., Disability, Human Rights and the Limits of Humanitarianism (Ashgate,
Vermont, USA, 2014), pp. 155-178.
12 We note here, however, that social and medical models of disability, although
frequently presented in stark opposition, can overlap. In keeping with the view
expressed in the World Report on Disability that disability “should be viewed nei-
ther as purely medical nor as purely social”, we recognize the complexity and
Disabilit y, Repressive Regimes, and Health Disparit y 31

ognizes that “disability is an evolving concept” and an expression of “hu-

man variation” that “results from the interaction between persons with
impairments and attitudinal and environmental barriers” that impedes
“their full and effective participation in society on an equal basis with
others.”13 In doing so, the CRPD acknowledges a social model under-
standing of disability and seeks to ameliorate environmental barriers
that create disabling conditions. Viewing disability as contextual and
dependent on exogenous factors brings to the fore an array of societal
barriers that inhibit access to and enjoyment of human rights protec-
tions.14
This approach is now reflected increasingly in other spheres of re-
search in which disability issues are being amplified. For example,
research in the social, engineering, and health sciences increasingly
underscores the role that physical, technological, institutional, and at-
titudinal barriers play in inhibiting the full and equal social participa-
tion of persons with disabilities.15 The fields of social epidemiology and
social medicine likewise emphasize the link between human health
and the broader social contexts within which health outcomes hinge.16
Likewise, scholars working at the intersection of health and disability
emphasize the limitations of accounts of disability in which unsupport-

multifaceted nature of disability that is too often glossed over in commentary

on the models. World Health Organization and World Bank, World Report on
Disability (2011), <www.who.int/disabilities/world_report/2011/en/>, visited on 8
April 2016.
13 CRPD, supra note 1, preamble and art. 1. Here it should be noted that the Inter-
national Classification of Functioning, Disability and Health (ICF), a framework
promulgated by the World Health Organization, understands functioning and
disability as a dynamic interaction between health conditions and contextual
factors, both personal and environmental, and attempts to mainstream the
lived experience of disability as part of universal human experience. See J.E.
Bickenbach, S. Chatterji, E.M. Badley and T.B. Üstün, ‘Models of disablement,
universalism and the international classification of impairments, disabilities
and handicaps’, 48 Social Science & Medicine (1999) pp. 1173-1187.
14 See J.E. Lord and M.A. Stein, supra note 10, pp. 449-456.
15 See P. Blanck, eQuality: The struggle for web accessibility by persons with cognitive
disabilities (Cambridge University Press, Cambridge, UK, 2014).
16 See, e.g., L.F. Berkman and I. Kawachi, Social epidemiology, (Oxford University
Press, New York, USA, 2000); J.E. Bickenbach, S. Chatterji, E.M. Badley and T.B.
Üstün, supra note 13.
32 2 – Won, Lord, Stein and Song

ed empirical assumptions are made about the quality of life of persons

with disabilities.17

2.1 Framing Human Rights and the Right to Health

This article examines the human rights implications for persons with
disabilities engendered by politically repressive environments, with par-
ticular emphasis on public health consequences, in North Korea.18 The
core elements of the right to health under international human rights
law compel an analysis that is acutely sensitive to environmental varia-
bles. This is in line with the concept of health found in the World Health
Organization’s 1946 Constitution, whose preamble defines health as “a
state of complete physical, mental and social well-being.”19 The pream-
ble further states that “the enjoyment of the highest attainable standard
of health is one of the fundamental rights of every human being.”20This
conceptualization invokes a broad understanding of health that goes
beyond formulations as an absence of disease, and forges a link to hu-
man rights by underscoring non-discrimination in the enjoyment of the
right to health.
The right to health, moreover, encompasses freedoms as well as enti-
tlements. Freedoms, as articulated in the CRPD and other human rights
instruments, include the right of persons with disabilities to be free
from non-consensual medical treatment; torture and other cruel, inhu-
man or degrading treatment; and forced labor and detention.21 In ad-
dition, the right to health mandates equal opportunity for everyone to
enjoy the highest attainable level of health. This includes, among other
entitlements, rights of prevention; treatment and control of diseases; ac-
cess to essential medicines and assistive devices; maternal, child and
reproductive health; equally timely access to basic health services; pro-

17 R. Lang, N.E. Groce and E. Cole, ‘Conceptualising the linkages between the So-
cial Determinants of Health and Disability’, 19 Leonard Cheshire Disability and
Inclusive Development Centre working paper series (2013); P. Blanck, ‘The right to
live in the world: Disability yesterday, today, and tomorrow’, 13 Texas Journal on
Civil Liberties & Civil Rights (2008) pp. 367-401.
18 This article is part of a larger program studying country conditions for persons
with disabilities in North Korea that aims to strengthen research and documen-
tation of their status using evidence-based methods.
19 World Health Organization, Constitution of the World Health Organization (1946),
preamble.
20 Ibid.
21 CRPD, supra note 1, arts. 15, 17, 25, 27.
Disabilit y, Repressive Regimes, and Health Disparit y 33

vision of health and rehabilitation-related education and information;

and participation by persons with disabilities in health and rehabilita-
tion-related decision-making at the national and community levels.22
As an inclusive, expansive right encompassing environmental fac-
tors that facilitate human health, the right to health identifies a range of
underlying determinants of health. These conditions are understood as
essential in protecting and promoting the right to health beyond health
services, goods, and facilities, and demonstrate the interconnectedness
of health and other human rights.23 Examples reflected in the CRPD
and other core human rights treaties include the right to an adequate
standard of living (including food and nutrition, clean water, and hous-
ing); freedom from torture and other forms of abuse; freedom from
discrimination; freedom of movement; disability equality; and gender
equality. International human rights law in the context of disability also
includes rights to privacy; health-related education and information in
accessible formats; healthy working and environmental conditions in-
clusive of reasonable accommodations and support; participation; and
benefitting from scientific progress and its applications, including, for
instance, rehabilitation medicine.24
Our methodology also draws on health disparity research – mean-
ing “differences in the incidence, prevalence, mortality, and burden of
diseases and other adverse health conditions that exist among specific
population groups”25 – in recognition of the fact that, as demonstrated
below, research on human rights in North Korea discloses environmen-
tally-driven health disparities for North Koreans with disabilities. Our
human rights analysis thus underscores the importance of social de-
terminants in health outcomes for persons with disabilities generally,
and also warrants further research into the lived experiences of persons
with disabilities in North Korea and other repressive regimes.

22 Ibid., arts. 25 and 26.

23 World Conference on Human Rights, Vienna Declaration and Programme of Ac-
tion, 1993, <www.ohchr.org/EN/ProfessionalInterest/Pages/Vienna.aspx>, visited
on 4 April 2016.
24 J.E. Lord, D. Souzzi and A. Taylor, ‘Lessons from the Experience of the UN Con-
vention on the Rights of Persons with Disabilities: Addressing the Democratic
Deficit in Global Health Governance’, 38 J. Law., Med. & Ethics (2010) p. 564.
25 United States, An Act to Amend the Public Health Service Act to Improve the Health
of Minority Individuals (G.P.O., Washington, D.C., USA, 2000) pp. 2495-2511.
34 2 – Won, Lord, Stein and Song

We therefore conclude that adopting a socio-contextual model of dis-

ability together with a rights-based analysis yields deeper knowledge of
the social and environmental determinants of public health for individ-
uals with disabilities than does a traditional approach concentrating on
access to medical and rehabilitation services. Such methodology is also
better suited to address the impact of social, physical, and environmen-
tal factors on human health and elicit greater insight into the determi-
nants of health disparity.26

3 Repressive Regimes and the Case of North Korea

Repressive regimes are environments in which States exert pervasive

control over daily life, severely restrict freedom of speech and assembly,
are intolerant of political opposition, and practice severe human rights
violations. People living in repressive regimes often find their health to
be the single asset on which they can draw to exercise other economic
and social rights, for example the right to work or education.27 In re-
pressive regimes where access to basic needs is restricted, physical and
mental health enables adults to work and children to learn, whereas ill
health is a liability to the individuals themselves and to those who must
care for them. And individuals’ right to health cannot be achieved with-
out realizing other rights such as the right to information, food, housing,
and to be free from discrimination. Notably, repressive regimes create
disability and exacerbate risk, disadvantage, and secondary disabilities
for persons with existing disabilities.
Emerging testamentary evidence suggests that the health disparity
among persons with disabilities in North Korea is significant and ren-
ders those individuals and their families at particular risk. Yet little com-
prehensive evidence-based documentation exists to provide a detailed
and coherent picture of the situation of persons with disabilities.28 The

26 See M.A. Stein, J.E. Lord, and D.W. Tolchin, ‘Equal Access to Health Care under
the UN Disability Rights Convention,’in R. Rhodes, M. Battin and A. Silvers, eds.,
Medicine and Social Justice: Essays on the Distribution and Care (Oxford Univer-
sity Press, New York, USA, 2d ed. 2012), pp. 245-254.
27 A. Puddington, Freedom in the World 2007: Freedom stagnation amid pushback
against democracy (Freedom House, Washington, DC, USA, 2007).
28 In our literature review, we examined existing material on the nexus between
health disparity, repressive environments, and disability in order to see to
Disabilit y, Repressive Regimes, and Health Disparit y 35

United Nations Human Rights Council adopted a resolution in March

2013 establishing a Commission of Inquiry to investigate human rights
country conditions in the Democratic People’s Republic of Korea and to
determine whether such circumstances constituted crimes against hu-
manity.29 The Commission’s first report was published in early 2014.30
While it paid some attention to discrimination on the basis of disability
and referenced reports of grave violations, it also noted that some of the
reporting could not be verified by eyewitnesses. Further, it pointed to
the adoption of national legislation in 2003 as evidence of a possible im-
provement in status of persons with disabilities, even though testimony
on disability discrimination suggested otherwise.31
The Commission’s scant recommendations on disability reaffirm the
need for more focused attention on the human rights status of North Ko-
reans with disabilities. It points also to the broader need to ensure that
international inquiries take into account the experience of disabled pop-
ulations living in other repressive regimes. Further, it begs the need for

whether extant research addressed this area. Second, we examined existing

documentation on country conditions in North Korea to assess whether and
how health disparity for individuals with disabilities was included. To evalu-
ate the links between health disparity and disability in repressive regimes, we
conducted a comprehensive literature review of the coverage of disability as a
risk factor for health disparity in repressive regimes. We searched the following
major legal, social science, and international development databases: Abstracts
in Anthropology; Google Scholar; EconLit; Disability and Society Studies; IBBS;
Index of Foreign Legal Periodicals; JSTOR; JSTOR Anthropology; Legal Journals
Index; PubMed; PsychInfo; SSCI; Web of Science; Women’s Studies International.
In addition, we examined the principal journals on disability, including: Disa-
bility Studies Quarterly, Disability and Society, Review of Disability Studies, and
Scandinavian Journal of Disability Research, and performed a detailed scan of
human rights reporting going back ten years (with particular emphasis on re-
ports issued by Amnesty International and Human Rights Watch).
29 UN General Assembly, Situation of Human Rights in the Democratic People’s Re-
public of Korea (Sixty-sixth Session Third Committee, 2015), <www.ohchr.org/
EN/HRBodies/HRC/CoIDPRK/Pages/Documents.aspx>, visited on 25 March
2015.
30 UN Commission of Inquiry on Human Rights in the Democratic People’s Repub-
lic of Korea, Report of the detailed findings of the commission of inquiry on human
rights in the Democratic People’s Republic of Korea (February 2014), <www.ohchr.
org/EN/HRBodies/HRC/CoIDPRK/Pages/CommissionInquiryonHRinDPRK.
aspx>, visited on 8 April 2016.
31 Ibid., paras. 321-329.
36 2 – Won, Lord, Stein and Song

rigorous empirical research conducted through a disability-cognizant

framework likely to elicit information specifically relating to persons
with disabilities. The existing lacunae can only be filled by utilizing a
rights-based, social model framing of disability to effectively document
country conditions for individuals with disabilities. The development of
human rights standards in the CRPD and the emerging jurisprudence of
human rights bodies specifically addressing obligations in the context
of disability offer the framework for doing so.32 Accordingly, the account
that follows seeks to amplify how disability works as a marker of height-
ened risk and vulnerability in repressive regimes and how application of
a new international law frameworks establishes these links.

3.1 Accounting for Disability-related Persecution

Research into the literature on and first-person accounts of country con-
ditions for persons with disabilities in North Korea yields a relatively
clear and coherent picture, albeit pieced together from fragmented and
limited data and lacking disability-specific legal analysis.33 However,
aligning evidence against the categorization provided by international
human rights law and adopting a lens that refocuses on socio-contex-
tual understanding of disability provides a preliminary set of results,
and a useful framework for assessing country conditions in repressive
regimes for disabled persons.34 The discussion below is organized by us-

32 See, e.g., J. Mendez, Report of the Special Rapporteur on Torture and Other Cruel,
Inhuman or Degrading Treatment or Punishment, Human Rights Council, 22nd
Session, 1 February 2013 (UN Doc. A/HRC/22/53), <www.un.org/Docs/journal/
asp/ws.asp?m=A/HRC/22/53>, visited on 8 April 2016.
33 Because we were interested in identifying any information on topic, we looked
beyond peer reviewed journals and international and human rights law reviews
to autobiographies and biographies, newspapers, online web articles and publi-
cations, and other articles and book chapters, including, for instance, a general
Google and Nexis search. Searches were also conducted of UN documents on
websites (e.g., Refworld) to track related documentation.
34 Our research gauged existing documentation on country conditions in North
Korea to assess the extent to which such work could yield more concrete find-
ings about health disparity among North Koreans with disabilities by utilizing
a socio-contextual frame of analysis. A socio-contextual understanding of dis-
ability human rights is sensitive to the range of environmental barriers exoge-
nous to the individual that enhance health and human rights risk for individuals
with disabilities. We applied that conceptual model to evidence-based accounts
of country conditions in North Korea and analyzed that documentation against
international legal standards on the rights of persons with disabilities. Thus,
Disabilit y, Repressive Regimes, and Health Disparit y 37

ing disability rights typology as set forth in the CRPD, and aligning the
results alongside its legal benchmarks.
Our principal method of analysis for the country assessment employs
the international human rights law framework reflected in the CRPD,
with particular emphasis on health-related conditions and their impact
on persons with disabilities in North Korea as it is in this context that
much of the extant research yields evidence regarding individuals with
disabilities. That said, we acknowledge the shortcomings of existing
research insofar as it cabins disability issues within a narrow, medical
model conceptualization unlikely to yield a more comprehensive and
holistic understanding of country conditions for person with disabili-
ties in repressive regimes. It is precisely this shortcoming that develop-
ments in international human rights law regarding persons with dis-
abilities are designed to redress.35 As set forth below, findings based
on extant documentation explain characteristics relating to disability
and to general human rights issues. These findings very often connect
back to maintaining regime power and control. Societies that are closed
and repressive heighten risk for persons with disabilities and thus merit
careful application of international human rights law in the context of
disability.

4 Disability Human Rights Violations as Framed by the CRPD

This Part presents the findings from our research on disability human
rights violations, and in particular those implicating the right to health
and engendering health disparities, through the framework of the
CRPD’s articles. In so doing, we offer preliminary evidence of how an
accounting of human rights conditions for persons with disabilities in
repressive regimes can inform human rights investigations and other

we used the CRPD and related international human rights law standards as a
benchmark for assessing country conditions reported by eye-witness accounts
and surveys, and through an analysis of North Korean law and policy.
35 For more on the failure of the mainstream human rights movement to account
for the human rights of persons with disabilities in human rights documenta-
tion exercises, see J.E. Lord, ‘Forging an International Advocacy Network on Dis-
ability Rights’, in C. Bob, ed., The International Struggle for New Human Rights
(University of Pennsylvania Press, Philadelphia, USA, 2008), p. 161.
38 2 – Won, Lord, Stein and Song

international law processes in ways that prior accounts of repressive re-

gimes have failed to do.

4.1 Stigma, Stereotyping, and Discrimination – Articles 5 and 8

Repressive regimes often seek to bolster their grip on power by exercis-
ing extreme control over their populations. Under some models of re-
pression, status is determined, in part, on perceived utility of citizenry
in maintaining regime order and control. In North Korea, the social and
political status of individuals hinges on the extent to which citizens
are perceived as being “fit” and thus to be contributors to the regime.
Moreover, under the strong social caste system in North Korea, which
classifies citizens based on their family background, ability, and loyalty
towards the regime, individuals with disabilities historically have been
subjected to discrimination. Perceptions of physical and mental health
are therefore highly determinative of one’s standing in society. Accord-
ing to one defector:

For the Party, all that counts is the degree of a person’s usefulness…
The notion of ‘usefulness’ beams harshly on the fate of the ‘handi-
capped’ [who are] seen as sub-humans, useless to society, and no
one speaks to them in the street… This attitude, molded by the
propaganda which puts them at the bottom of the social ladder, is
very widespread.36

In addition, disability traditionally has been understood as a curse in

North Korean society. Taken together, these stereotypes reinforce deep-
seated social conventions whereby disabled persons are routinely re-
moved from society and/or neglected by their home communities and
the authorities. This marginalization impacts the well-being of persons
with disabilities and their families who struggle with shame, helpless-
ness, denial, and depression in response to mental and physical disabili-
ties.37
One manifestation of disability-based animus in North Korea is stig-
matization through the use of degrading terminology that centers on a
perceived characteristic of impairment. Thus, interviews with defectors

36 H. Kang and P. Grangereau, This is Paradise! My North Korean Childhood (Aba-

cus, London, UK, 2007), p. 21.
37 See K. Zellweger, People with Disabilities in a Changing North Korea (Walter H.
Shorenstein Asia-Pacific Research Center, 2013).
Disabilit y, Repressive Regimes, and Health Disparit y 39

reveal the prevalent use of terminology that roughly translates into pe-
jorative terms such as “idiot” and “imbecile.”38 Other accounts disclose
that persons with intellectual disabilities are routinely referred to as
“No. 49 patient” or “Hospital 49” or similar variant, referring to the loca-
tion of psychiatric wards.39 This contrasts with the terminology used in
Article 19 of the Protection of Persons with Disabilities Act which roughly
corresponds to less pejorative terms like: “blind or deaf, or developmen-
tal delays” to describe persons with disabilities.40 Accounts from recent
North Korean defectors indicate that children with disabilities are more
likely to experience bullying or isolation in their social networks than
their non-disabled counterparts, such as being called derogatory names
related to their disabilities by peers.41
The most serious and notorious disability-based discrimination in
North Korea is widespread segregation and isolation. Testimony by
North Korean defectors reveals that State authorities limit the areas
where persons with certain disabilities are allowed to move within and
reside, especially in cities exposed to foreign scrutiny such as Pyong-
yang, Nampo, Kaeseong, and Chongjin.42 Defectors consistently report
that controlling freedom to choose one’s residence impacts individuals
with disabilities as well as their families and is driven by concern that
the existence of disability will reflect poorly on the regime (which touts
genetic superiority) and leave an unpleasant impression on visiting for-
eigners. While some defectors report that persons with disabilities ap-
pear in Pyongyang more frequently than elsewhere, they remain largely

38 Y. Song, Interview Data (Syracuse University, Syracuse, New York, USA) (inter-
view data from March 2015 interviews with North Korean defectors in Seoul,
Korea).
39 D. McElroy, ‘North Korea locks up disabled in ‘subhuman’ gulags, says UN’,
The Daily Telegraph, 21 October, 2006, <www.telegraph.co.uk/news/world-
news/1532036/North-Korea-locks-up-disabled-in-subhuman-gulags-says-UN.
html>, visited on 4 April 2016.
40 Democratic Republic of North Korea, Protection of Persons with Disabilities Act,
June 2003, art. 9.
41 Korean Institute for National Unification, White Paper on Human Rights in North
Korea (2012), <www.kinu.or.kr/eng/pub/pub_04_01.jsp>, visited on 4 April 2016.
See also UN Commission of Inquiry on Human Rights in the Democratic People’s
Republic of Korea, supra note 30, para. 323.
42 Korean Institute for National Unification (2012), supra note 41, p. 472.
40 2 – Won, Lord, Stein and Song

invisible in the capital.43 Even more egregiously, North Korea operates

segregated facilities for people with dwarfism and forces their sterili-
zation. In 2011, 80% of refugee respondents indicated that North Korea
segregated and relocated little people, and 67% indicated that the State
forced these individuals to undergo sterilization.44

4.2 Adequate Standard of Living – Article 28

Repressive regimes very often channel resources toward maintenance
of regime control, thereby adversely impacting adequate living for the
general population. The consequences of such neglect are aggravated
for groups already at risk in addition to propelling new entrants into
vulnerable categories. Due to nationwide famine attributable to major
abuses of power by the country’s dictatorship,45 North Korea decreased
food rations in 1996 and ceased them for individual families in 1998.46
In consequence, 16% of children were acutely malnourished and 62%
were suffering chronic malnutrition.47 The account of one defector of
the death of two secondary school classmates is typical of famine survi-
vors and points to the vulnerability of children with disabilities:

One of the two boys was called Kang Jin. His elder brother, who
had done everything they could to help him, also died shortly af-
terwards. His name was Chang Song-Ho, and he had a slight men-
tal handicap. I don’t know what happened to him, but he stopped
coming to school, and a few days later we learned that he had per-
ished at home.48

Consistent with research in other parts of the world, accounts by survi-

vors of the famine indicate that persons with disabilities fared markedly

43 K. Zellweger, supra note 36; J. Hosaniak, Status of Women’s Rights in the Context
of Socio-Economic Changes in the DPRK (Citizens’ Alliance for North Korean Hu-
man Rights, Seoul, South Korea, 2013).
44 Korean Institute for National Unification (2012), supra note 41, p. 482.
45 H. Kang and P. Grangereau, supra note 36, p. xii.
46 See Amnesty International, North Korea: Starved of Rights-Human Rights and
the Food Crisis in the Democratic People’s Republic of Korea (North Korea) (2004),
<www.refworld.org/docid/402f8d6f4.html>, visited on 4 April 2016.
47 EU, UNICEF and WFP, Nutrition Survey of the Democratic People’s Republic of Ko-
rea (1998), <www.pwdigby.co.uk/pdf/Report_on_the_DPRK_Nutrition_Assess-
ment_1998.pdf>, visited on 4 April 2016.
48 H. Kang, and P. Grangereau, supra note 36, p. 105.
Disabilit y, Repressive Regimes, and Health Disparit y 41

poorer, especially those without family support. One defector spoke of a

man in his fifties with mental disability who would walk around with-
out pants, his crotch exposed:

His clothes were in rags and he was always scratching lice from his
head… Everyone would always laugh at him, but he was one of the
first victims of the famine. He would get thinner and thinner and
he was one day found with his nose in the snow.49

While the overall number of starvation deaths has fallen since 2000,
reports and studies indicate that large portions of the population still
face hunger and malnutrition. Notably, up to one third of recent mili-
tary recruits were deemed unfit for service based on cognitive disability
rooted in poor nutrition and general health.50 Such evidence implicates
disability on several fronts and underscores the need to appropriately
account for disability in human rights investigations, whether those di-
rected at improving conditions, shaping transitional justice strategies
or other ends.

4.3 Children with Disabilities – Article 6

Research on developing countries generally reveals that children un-
der the age of five face numerous risks, including poverty, malnutri-
tion, poor health, and home environments with little stimulation, all
of which can compromise cognitive, motor, and social-emotional de-
velopment.51 Research further discloses that under-nutrition renders
children more likely to acquire a disability,52 and negatively impacts
physical growth and psychosocial development in young children.53

49 Ibid., p. 81.
50 Korean Central News Agency, <http://www.kcna.kp/kcna.user.home.retrieve-
HomeInfoList.kcmsf>, visited on 4 April 2016; Korean Institute for National Uni-
fication, White Paper on Human Rights in North Korea (2014), <http://www.kinu.
or.kr/eng/pub/pub_04_01.jsp>, visited on 4 April 2016.
51 World Health Organization and World Bank, supra note 12, p. 36.
52 Ibid. See also N. Groce, E. Challenger and M. Kerac, Stronger Together: Nutrition-
Disability Links and Synergies - Briefing Note, <www.unicef.org/disabilities/files/
Stronger-Together_Nutrition_Disability_Groce_Challenger_Kerac.pdf>, visited
on 15 April 2016.
53 UNICEF and University of Wisconsin. Monitoring child disability in developing
countries: results from the multiple indicator cluster surveys (United Nations
Children’s Fund, New York, USA, 2008).
42 2 – Won, Lord, Stein and Song

As defined by UNICEF, under-nutrition is “the outcome of insufficient

food intake (hunger)” and includes being underweight for one’s age, too
short for one’s age (stunted), dangerously thin (wasted), and deficient
in vitamins and minerals (micronutrient malnutrition), all of which are
chronic in North Korea.54
The UN Committee on the Rights of the Child repeatedly expressed
concern over discrimination against children with disabilities and the
inadequacy of North Korean measures to ensure their effective access to
health, education, and social services.55 Despite slight improvements in
dietary nutrition, as of 2012, one in four North Korean children experi-
enced chronic malnutrition and its effects, including stunted growth.56
According to an American neurosurgeon who has visited Pyongyang
Medical College yearly since 2007, malnutrition-related disabilities like
spina bifida are highly prevalent.57 Girls with disabilities in North Korea
are arguably at greater risk for complications arising from malnutrition:
it is well established that in communities with limited resources and
food shortages, families will frequently adhere to cultural norms and
prioritize the nutritional needs of boys over that of girls.58 Moreover,
links between malnutrition and disability in highly repressive regimes
are well-established, for instance, malnutrition in utero in the Neth-
erlands during World War II resulted in impaired cognitive function,

54 UNICEF, Progress for Children, A Report Card on Nutrition (2006), p. 4, <www.

unicef.org/progressforchildren/2006n4/index_undernutrition.html>, visited on
15 July 2015.
55 UN Committee on the Rights of the Child, Consideration of reports submitted by
States parties under article 44 of the Convention: Convention on the Rights of the
Child: concluding observations: Democratic People’s Republic of Korea (27 March
2009, CRC/C/PRK/CO/4), <www.refworld.org/docid/49d5f79e0.html>, visited on
4 April 2016; UN Committee on the Rights of the Child, UN Committee on the
Rights of the Child: Concluding Observations: Democratic People’s Republic of Ko-
rea (1 July 2004, CRC/C/15/Add.239), <www.refworld.org/docid/42d3b1ac4.htm>,
visited on 4 April 2016; UN Committee on the Rights of the Child, UN Committee
on the Rights of the Child: Concluding Observations: Democratic People’s Republic
of Korea (24 June 1998, CRC/C/15/Add.88), <www.refworld.org/docid/3ae6af5a4.
html>, visited on 4 April 2016.
56 UNICEF, supra note 54.
57 M. Hill, ‘North Korea’s treatment of disabled improving: organization’, NKNews.
org, 28 March 2015, <www.nknews.org/2015/03/north-koreas-treatment-of-disa-
bled-improving-organization>, visited on 4 April 2016.
58 N. Groce, E. Challenger and M. Kerac, supra note 52.
Disabilit y, Repressive Regimes, and Health Disparit y 43

increased response to stress, and an increased risk of serious mental ill-

ness including schizophrenia.59
In addition, North Korea lags far behind international standards
with respect to eliminating barriers to education for children with dis-
abilities. For instance, in its second regular report to the Committee on
Economic, Social, and Cultural Rights, North Korea claimed they main-
tained three specialized schools for “blind, deaf and mute” children, as
well as nine schools for children with speech impairment, thereby pro-
viding very limited and segregated access.60Moreover, regional training
facilities for persons with disabilities are not functioning properly and
there is vast disparity in the operation of special education facilities de-
pending on location.61 Testimony by North Korean defectors suggests
that students with disabilities are rarely seen in regular schools. A lack
of common devices and assistive equipment for people with disabilities,
as well as the inaccessibility of streets and buildings, pose environmen-
tal barriers for persons with disabilities and contribute to their exclu-
sion from participation in North Korean society, including schools.62
Further, many North Korean interviewees believed that children
with genetic disabilities are not being born in that country.63 However,
testimony by women defectors reveals that parents often decide to kill
or abandon the child with disabilities because of the social discrimi-
nation and economic hardship that accompanies raising such a child
in North Korean society. Doctors have informed parents that placing a
child face down will cause quick death through suffocation.64 In addi-
tion, human rights reports recount that children with multiple disabili-
ties are confined to their homes because of stigma, maltreatment, and

59 N. Groce et al., ‘Malnutrition and disability: unexplored opportunities for col-

laboration’, 34(4) Pediatrics and International Child Health (2014) pp. 308-314.
60 UN Committee on Economic, Social and Cultural Rights, Concluding Observa-
tions: Democratic People’s Republic of Korea (2003), <www.refworld.org/publishe
r,CESCR,,PRK,403f20524,0.html>, visited on 11 April 2016.
61 Korean Institute for National Unification, White Paper on Human Rights in North
Korea (2013), <http://www.kinu.or.kr/eng/pub/pub_04_01.jsp>, visited on 4 April
2016.
62 J. Hosaniak, supra note 43.
63 Ibid.
64 Ibid.
44 2 – Won, Lord, Stein and Song

feared social repercussions.65 There are, however, cases of resistance.

One defector reported:

A family looked after their young, mentally disabled son very lov-
ingly. One day his uncle came by from the city with a view to sub-
jecting him to euthanasia. However, the child’s parents refused to
let him do it, and in the end he left… .66

Finally, North Korean defectors who were formerly high ranking offi-
cials in the People’s Safety Agency (i.e., police) and in government posts
spoke of the existence of a facility named “Hospital 83.” Allegedly lo-
cated on an island under the administration of the South Hamgyong
Province, Hospital 83 is purportedly an institution to which children
with disabilities are sent for medical experiments such as the dissec-
tion of body parts and tests of biological and chemical weapons.67 Such
accounts cannot be verified as they were not based on eyewitness tes-
timony. However, credible accounts of segregation and quarantine and
extreme disability-based stigma render such accounts certainly plausi-
ble. Lack of access to institutions housing persons with disabilities is a
primary risk factor for institutionalized persons and is a closed society,
is all the more dangerous.68 Put simply, international standards on dis-
ability are as crucial for analyzing country conditions for children in
repressive regimes as are standards concerning the human rights impli-
cations of, for instance, child soldiering.

65 Citizens’ Alliance for North Korean Human Rights, Publications and Related
Content <eng.nkhumanrights.or.kr/nkhr/bbs/board.php?bo_table=r_content>,
visited on 4 April 2016.
66 See H. Kang, and P. Grangereau, supra note 36, p. 23.
67 UN Commission of Inquiry on Human Rights in the Democratic People’s Repub-
lic of Korea, supra note 29, para. 328; UN Special Rapporteur, Report of the Special
Rapporteur on the situation of human rights in the Democratic People’s Republic of
Korea, 14 August 2013, paras. 32-34.
68 For more on the inherent dangers of institutionalization of children with dis-
abilities, see E. Rosenthal and L. Ahern, ‘Segregation of children worldwide: the
human rights imperative to end institutionalization,’ 12(4) Journal of Public Men-
tal Health (2013) pp. 193-200.
Disabilit y, Repressive Regimes, and Health Disparit y 45

4.4 Access to Health and Rehabilitation Services – Articles 25

and 26
Autobiographical accounts of defectors and defector interviews suggest
that persons with disabilities are particularly disadvantaged in their
access to health and rehabilitation services.69 North Korea purports to
provide free access to medical services for all citizens but in practice
provides protection for special groups related to military operations.70
While in theory patients may access hospitals for free, medical equip-
ment and medication are unavailable to the masses and must be bought
on the private market by those who can afford them.71 In other instanc-
es medicines and first aid supplies are smuggled into North Korea from
China and only are available on the black market.72 All evidence indi-
cates that medicine and medical equipment “rarely went to the people
who needed them”.73
In 2007, North Korea opened its first rehabilitation center for persons
with disabilities, which is operated jointly with North Korea’s Chosun
Disabled Persons Protection League.74 However, according to a 2012 sur-
vey of North Korean defectors, only 6% were aware of organizations and
rehabilitation facilities for people with disabilities.75 In 2013, the Korean
Federation for Protection of Persons with Disabilities opened the Munsu
Recovery Center, a rehabilitation facility for individuals with disabilities
in Pyongyang. With modern technology and medical equipment, Mun-
su Recovery Center serves individuals with disabilities in Pyongyang at
no cost.76 However, the opportunity for people with disabilities to ac-
cess either of these facilities remains in question, especially given the
severe restrictions on movement for North Koreans generally, the poor
state of infrastructure making transport difficult and the historical and
possibly persisting restriction on persons with disabilities living and
being seen in the capital city. In addition, access to information is se-

69 Korean Institute for National Unification (2014), supra note 51.

70 Ibid.
71 K. Yong and K. Suk-Young, Long Road Home–Testimony of a North Korean Camp
Survivor (Columbia University Press, New York, USA, 2009), p. 116.
72 Ibid., p. 134.
73 Ibid., p. 116.
74 Radio Free Asia, <www.rfa.org/english/news/korea/nkorea_disabled-20080305.
html>, visited on 4 April 2016.
75 Korean Institute for National Unification (2012), supra note 41.
76 Korean Central News Agency, <www.kcna.kp/kcna.user.home.retrieveHomeIn-
foList.kcmsf>, visited on 4 April 2016.
46 2 – Won, Lord, Stein and Song

verely restricted in North Korea as are other means of communication,

such as the use of computers, cell phones and other methods of receiv-
ing information which present additional barriers to individuals with
disabilities. The failure to capture salient information on access to such
services will undoubtedly compromise efforts to improve country con-
ditions and, in the case of North Korea, inform agendas for the future.

4.5 Occupational Safety and Health – Article 27

Many North Korean defectors described working conditions in the
military and prisons as seriously deficient in terms of health and oc-
cupational safety, with little to no enforcement of regulations. During
military enrollment, where mandatory service can extend to some
dozen years, inherently dangerous and grueling labor exposed soldiers
to enhanced risk of injury. In addition, neither adequate treatment nor
compensation was provided for soldiers disabled while serving military
duty. As an example, one veteran who lost vision in an eye from an ac-
cident while on military duty in a mine testified that his compensation
from the government was two pounds of rice.77
Successive accounts of the prison system suggest that all people were
expected to work in the labor camps, with little to no relief given to
those for whom harsh labor would be difficult and even more dangerous
than for others.78 No accommodations were provided for prisoners with
disabilities, and prisoners were expected to redouble their efforts even
during the famine.79 Conditions for guards are likewise grim, especially
in the prison camps for political prisoners. According to one account,
there was a high prevalence of disability among the children of prison
guards, and prisoners believed this was a consequence of exposure to
chemicals at a lab reportedly used for medical experimentation.80
Numerous accounts tell of forced prison labor resulting in frequent
accidents, with some of the worst occurring in gypsum and copper
mines and logging operations that lacked adequate medical facilities:
“The work unit’s hospital took charge of everything on such occasions,

77 Y. Song (Syracuse University, Syracuse, New York, USA). Personal communica-

tion, 2015.
78 B. Harden, Escape from Camp 14: One man’s remarkable odyssey from North Korea
to Freedom in the West (Viking, New York, USA, 2012).
79 Ibid.
80 K. Zellweger, supra note 37.
Disabilit y, Repressive Regimes, and Health Disparit y 47

but its methods were pretty basic. Amputation was the general rule, and
medication was still impossible to find.”81

4.6 Exile and Quarantine

According to a 2013 survey of North Korean defectors, 58.7% of respond-
ents indicated that persons with disabilities are subjected to segregation
in North Korea.82 Many accounts by North Korean defectors support the
prevalence of a practice where people with disabilities are removed from
their communities in popular tourist cities such as Pyonyang, Nampo,
Gaeseong, and Chongjjin, and forced to relocate to a more remote city or
town.83 And, as noted previously, a number of witness testimonies col-
lected provide evidence of segregating individuals with short stature to
isolated areas. Besides forced segregation, other examples of inhumane
discrimination include forced abortion and sterilization upon this seg-
ment of the disabled population. Further, such persons reportedly do
not receive citizen cards, meaning they are not recognized as North Ko-
rean citizens that compromises what little access they may have to gov-
ernment supports. These practices fall afoul of numerous provisions in
the CRPD, including the prohibition against discrimination on the basis
of disability, the right to community integration, freedom of liberty and
movement on an equal basis with others, legal recognition before the
law, among others.
Of serious concern are reports of the existence of “Hospital 49” a re-
portedly segregated institution for people with mental health issues or
severe intellectual disabilities. Although the primary purpose is the re-
habilitation and treatment of mental health, inhumane conditions for
the patients are disclosed by many North Korean defectors.84 Thus, a
former worker in “Hospital 49” revealed the inhumane conditions and
treatment of patients in the institution. He also testified that individu-
als lose their citizenship once they are institutionalized in the hospital.
The public knowledge of “Hospital 49” has led to increased stigma for
persons with mental health issues or intellectual disabilities in North

81 See H. Kang, and P. Grangereau, supra note 35, pp. 31-32. See also C. Kang and
P. Rigoulot, The Aquariums of Pyongyang: Ten Years in the North Korean Gulag
(Basic Books, New York, USA, 2005), pp. 122-123.
82 Korean Institute for National Unification (2013), supra note 61.
83 Korean Institute for National Unification (2014), supra note 51.
84 D. McElroy, supra note 39.
48 2 – Won, Lord, Stein and Song

Korean society.85 Here, as in other accounts of disability-based persecu-

tion, human rights violations must be brought to the fore, fully investi-
gated and addressed in any justice mechanism established.

4.7 Forced Sterilization – Articles 15, 23 and 25

Research appears to support a widespread practice according to which
North Korean authorities pursued the practice of forced sterilization, es-
pecially the population of “little people” or persons with Dwarfism. Nu-
merous witnesses reported that involuntary vasectomy was performed
against males in government-run facilities.86 Other accounts point to
deception whereby persons of short stature who have intellectual dis-
ability received a sterility injection, as they were told the treatment
would make them grow taller.87 Some of these victims of forced sterili-
zation reportedly learned what happened to them and made appeals to
the government which were unsuccessful as compulsory sterilization of
such individuals was made by order of the Party. This practice violates
international human rights standards, including the right to health and
provisions protecting reproductive rights, including Article 23(1) of the
CRPD, “persons with disabilities, including children, retain their fertil-
ity on an equal basis with others” and most surely constitutes a violation
of the prohibition against torture or other cruel, inhuman or degrading
treatment.88 The practice of isolating and segregating segments of the
population deemed threatening to the North Korean regime on account
of an undesired characteristic, therefore further facilitates the practice
of sterilization among persons with disabilities who are put into a facil-
ity or who end up in the prison system. While the extent of this prac-
tice is not known, consistent reporting by defectors suggests that it is
relatively common. Further research could clarify the extent to which
sterilization and disability-based persecution serves eugenic State poli-
cies in North Korea akin to those well-documented in Nazi Germany.89

85 Y. Song, supra note 38.

86 Korean Institute for National Unification, White Paper on Human Rights in North
Korea (2007), <www.kinu.or.kr/eng/pub/pub_04_01.jsp>, visited on 4 April 2016.
87 Korean Institute for National Unification (2013), supra note 61.
88 CRPD, supra note 1, art. 23(1).
89 See, e.g., J.E. Lord, supra note 7.
Disabilit y, Repressive Regimes, and Health Disparit y 49

4.8 Access to Medical Care in Prison System – Articles 15 and 25

Numerous autobiographical accounts and human rights reports speak
in detail about the disabling effects of the prison system in North Korea.
People in prison camps are not regarded as human beings and are de-
nied internationally recognized standards on prisoner rights.90 Due to
severe forced labor in poor surroundings, prisoners in the prison camp
system are at high risk of disease, including pneumonia, tuberculosis,
and the ill effects of malnutrition which can contribute to long term
disability.91 Prisoners are mobilized to the workplace without excep-
tion, however research discloses a consistent practice of quarantining of
sick and disabled prisoners in “medical rooms” without medical help or
medicine in what former prisoners have called “death rooms,” particu-
larly in the most severe prison camps.92
Labor in the political prison camps is particularly harsh. With no
equipment, prisoners must perform intensive manual labor daily and
low productivity in the prison camp becomes a reason for torture or
public punishment, which often results in physical disability or death.
Minimal access to food for prisoners is a primary cause of persistent
malnutrition. According to the testimony by former prisoners, no con-
sideration for the wellbeing of the prisoners exists. Prisoners, who are
judged by foremen when they are no longer able to work, are sent to
sanitarium, where critical patients are confined. Because there are no
doctors or medicine to treat their disease, the prisoners are usually left
alone in an isolated accommodation.93
In the prison camps, disability prevalence is high, based on the ac-
counts of defectors. This is attributed to extremely dangerous working
conditions, for instance in coal mines and other high risk labor in the
absence of occupational safety and health measures. Injuries are not

90 See, e.g., Standard Minimum Rules for the Treatment of Prisoners, adopted by the
First United Nations Congress on the Prevention of Crime and the Treatment
of Offenders, held at Geneva in 1955, and approved by the Economic and Social
Council by its resolution 663 C (XXIV) of 31 July 1957 and amended by ECS Res.
2076 (LXII) of 13 May 1977; Code of Conduct for Law Enforcement Officials, adopt-
ed by General Assembly resolution 34/169 of 17 December 1979.
91 Korean Institute for National Unification (2014), supra note 51.
92 UN Commission of Inquiry on Human Rights in the Democratic People’s Repub-
lic of Korea, supra note 30, para. 328. See also B. Harden, supra note 78.
93 Korean Institute for National Unification (2014), supra note 51. See also UN Com-
mission of Inquiry on Human Rights in the Democratic People’s Republic of Ko-
rea, supra note 30, para. 774.
50 2 – Won, Lord, Stein and Song

treated adequately, where they are treated at all. Harsh living condi-
tions as well as punishment constituting torture other inhuman treat-
ment also leads to disabling conditions for prisoners. According to one
defector, there are two types of hospitals in the prison camps: one is
for security service agents or guards, and another is for prisoners. The
hospital for security service agents or guards is equal to hospital facili-
ties in Pyeongyang, but the hospital for prisoners is extremely inferior
because its purpose is not for medical treatment but for keeping prison-
ers in labor.94
Access to health care for women prisoners is likewise inadequate
and can expose women of child-bearing age to particular health haz-
ards which can result in disability. Coerced infanticide by new mothers
and forced abortion for female prisoners is an ongoing and consistent
practice.95 Numerous accounts from defectors detail their time in the
camps, in which they were eyewitnesses to forced abortions and killing
of babies born to prisoners. These practices enhance risk of disability by
exposing women to mental anguish and disabling injury.

4.9 Psychosocial Effects of Repression – Article 15

The World Report on Disability describes the disabling effects of trauma
and repression.96 Psychosocial disability reportedly contributes high
suicide rates for prisoners facing transfer to notorious camps. According
to one North Korean prison survivor, “what was really killing us was psy-
chological and emotional torture” especially separation from family for
whom “there was no way of knowing whether other members were dead
or alive.”97 Inside the camps, conditions were detrimental to emotional
and mental well-being:

I could hear numerous voices of other detainees suffering from

physical torture, solitary confinement, and nervous breakdown,
but I never had a chance to talk to them. The guards were watching
us all the time. At some moments when I was not being tortured,
I thought of committing suicide, but there was simply no way.

94 J. Won (Handong Global University, Pohang, South Korea). Personal communica-

tion, 2015.
95 See J. Hosaniak, supra note 43.
96 World Health Organization and World Bank, supra note 12.
97 K. Yong and K. Suk-Young, supra note 71, p. 74.
Disabilit y, Repressive Regimes, and Health Disparit y 51

Guards were watching detainees everywhere around the clock, so

there was hardly any moment of privacy.98

There were other disabling effects of repression, most pronounced in the

prison camps. A survivor of the prison camp system revealed that “[a]
nother psychological punishment was the complete absence of any kind
of media- newspapers, TV, radio… the separation from the rest of the
world was unbearable.”99

4.10 Deficient Legal Framework – Article 4

North Korea has signed but not ratified the CRPD.100 It is incumbent
upon a signatory to undertake no measures that would undercut the ob-
ject and purpose of the treaty.101 In addition, North Korea is obliged to
respect the rights of persons with disabilities through its ratification of
other treaties, such as the International Covenant on Civil and Political
Rights, which is applicable to all human beings.102 Moreover, the CRPD
aims to reflect existing human rights law within the context of disabil-
ity, meaning that the CRPD reflects existing human rights standards,
such as those in the ICCPR, but places them within a disability frame-
work.
Much has been made in human rights commentary about a 2003 dis-
ability law on the books. Assessing that law against the social model of
disability and the standards set forth in the CRPD would likely result
in a more nuanced and meaningful account of human rights country
conditions in North Korea. It would, for example, examine the utility of
the law in the absence of implementing regulations and the adequacy
of institutional structures to support implementation of the national
law. It would also scrutinize the substantive obligations set out in the
legislation. It does not, however, lay out even the most basic obligations
attaching to State Parties. An illustration makes the point: using Article

98 Ibid. p. 80.
99 Ibid. p. 87.
100 On the current status of CRPD signature and ratification for DPRK, see United
Nations Enable website, <www.un.org/esa/socdev/enable/rights/convtexte.
htm>, visited on 5 April 2016.
101 See Vienna Convention on the Law of Treaties, G.A. Res. 2166 (XXI, 5 December
1966) and 2287 (XXII, 6 December 1967), 1150 U.N.T.S. 331.
102 International Covenant on Civil and Political Rights, G.A. Res. 2200A (XXI), U. N.
GAOR, Supp. No. 16 at 52, U.N. Doc. A/6316 (1966).
52 2 – Won, Lord, Stein and Song

25 (Health) and 26 (Habilitation and rehabilitation) of the CRPD as a

benchmark, the 2003 law provides no protection to ensure equal access
to health and rehabilitation services for persons with disabilities with-
out discrimination, does not provide for mechanisms of international
cooperation so that education, employment, health and rehabilitation
rights are achieved progressively, does not include persons with disabili-
ties in the formulation of law, policy and programming, does not afford
services that are accessible, available, acceptable and of good quality,
and does not protect privacy and confidentiality or adhere to informed
consent in the health sphere. In sum, the law does not meet even bare
minimum thresholds for compliance with the CRPD and should not, in
any instance, be cited as evidence of an improving legal – or other –
environment for North Koreans with disabilities. However, paying due
account of international disability law standards can yield concrete rec-
ommendations for the regime and inform more credible and reliable hu-
man rights reporting.

5 Conclusions

Responses to disability have transformed during the past few decades.

It is now recognized that environmental barriers and disability-based
discrimination collectively increase the vulnerability of persons with
disabilities to poverty and exclusion. These conditions are likely to be
exacerbated in repressive and closed societies where citizens face of-
ten insurmountable barriers in accessing health and rehabilitation,
adequate sanitation and shelter, and other basic needs. Put simply, dis-
ability can operate as an aggravating risk factor for disabled persons in
repressive regimes and repression likewise elevates the risk of acquiring
a disability. Understanding these dynamics and exposing country con-
ditions for persons with disabilities requires a conceptualization of hu-
man rights and disability not captured by traditional framings of either
disability or human rights and too often ignored in international legal
processes seeking to account for abuses by repressive regimes.
The human rights standards on disability outlined by the CRPD pro-
vide a conceptual framework for thinking about disability. The human
rights reporting on North Korea reveals that the underlying social de-
terminants of health for persons with disabilities in North Korea are se-
verely compromised and transgress not only the core obligations of the
right to the highest attainable standard of health, but also the gamut of
Disabilit y, Repressive Regimes, and Health Disparit y 53

human rights as set forth in the core human rigjts conventions. Con-
sistent witness accounts disclose exposure to poor sanitation, malnutri-
tion, and lack of access to health care or rehabilitation. These conditions,
combined with other social phenomena in North Korea, deepen the dis-
advantage for persons with disabilities and, additionally, enhance risk
factors for acquiring disability. Such factors, when combined with the
additional environmental barriers imposed by repressive government
that severely restricts access to information, liberty of movement and
directs expenditures to maintaining regime control as opposed to im-
provement in infrastructure or education, create additional risks for in-
dividuals with disabilities.
The results of our desk review suggest that country conditions in
North Korea result in disability (and aggravate pre-existing disability)
and, further, make life exceedingly difficult – and dangerous – for per-
sons with disabilities. Evidence suggests that they are often denied the
basic human rights and fundamental freedoms to work, pursue an edu-
cation, live where they choose, move freely about physical and cyber so-
ciety, and generally participate in the lives of their communities. More
research is required to expose whether and how in repressive regimes
persons with disabilities face a greater risk of being exposed to violence,
higher risk of injury, greater vulnerability to injury at work, higher risk
of premature death, enhanced risk of violations of physical and mental
integrity and elevated risk of developing secondary conditions.
Understanding disability within the broader contexts of the social
determinants of health, along with a disability rights lens, should also
yield greater understanding of the relationship between disability and
health promotional strategies, such as the inclusion of disability aware-
ness training for health professionals, and an improvement in the over-
all quality of health care services provided for people with disabilities.
The adoption of a legally binding treaty on the rights of persons with
disabilities should help to inform assessments of risk, vulnerability and
human rights enjoyment for individuals with disabilities and is par-
ticularly needed to expose country conditions in repressive regimes of
which North Korea is a paradigmatic case.