The effect of unusual social experience on the global health of North Korean asylum seekers

Summary

Objectives

This study examined the risk factors associated with a negative self-rating of subjective health among North Korean asylum seekers, paying particular attention to the unusual social experiences of this population.

Study design

This study utilized the North Korean Health Care System Data Set (NKHCS). This data set is comprised of information on 221 North Korean asylum seekers (aged 20 years and over) who were housed in Hanawon, a South Korean government facility. We specifically examined the effect of three separate risk factors (major country of residence after exiting North Korea, duration of stay in country, and whom they were accompanied by during their migration event) associated with the unusual social experiences of North Korean asylum seekers on their global health.

Methods

Multivariate logistic regression analyses were carried out in order to assess the consistency and validity of extant hypotheses and general expectations.

Results

North Korean asylum seekers who entered South Korea within one year of their defection or were accompanied by non-family members tended to negatively self-report their health status. However, major intermediate country of residence after exiting North Korea showed no effect. Higher educational attainment and membership of the Labour Party of North Korea were negatively associated with the global health of this population, though this was not statistically significant.

Conclusions

We found that the unusual social experiences of North Korean asylum-seekers, particularly intermediate country duration and companionship characteristics, were significantly associated with their health. Future studies need to examine the relationship between diverse social experiences during residence in intermediate countries and the health of this population.

Introduction

The number of North Korean asylum seekers has increased sharply in recent years (148 in 1999, 1139 in 2002, and 1894 in 2004).1, 2 Virtually all asylum seekers are forced to use neighbouring countries, such as China, Mongolia, or Vietnam, as an intermediate stop en route to their final destination, South Korea, since civilian traffic across the border between the two Koreas is almost impossible due to the North and South Korean demilitarized zone (DMZ).²

Although both political and diplomatic concerns have arisen in relation to the issue of North Korean asylum seekers, this population, including their legal status, continues to be understudied. Particularly noticeable is the paucity of research on the health of North Korean asylum seekers. To our knowledge, there have only been a few empirical studies published internationally:3, 4, 5 (1) studies on psychological and emotional instability during the process of adaptation and resettlement in South Korea; (2) studies on the relationship between mental health and traumatic experience; and (3) studies on mortality patterns and trends in Yanbian, a Chinese border city. Although these studies are noteworthy, we do not yet know which, and to what extent, the extraordinary social conditions experienced by North Korean asylum seekers within these intermediate (or ‘third’) countries, are associated with the health of this population.

The present legal status of North Korean asylum seekers residing in third countries is unclear. For example, South Korea regards them as citizens based on Article 3 in the Korean Constitution that specifies that North Korea is part of South Korea, although geopolitical constraints prevent widespread governmental action on the part of asylum seekers. The United Nations High Commissioner for Refugees (UNHCR) categorizes them as political asylum-seeking refugees who should be internationally protected. However, China has refused to grant refugee status to North Korean asylum seekers, considering them illegal migrants who cross the border for economic purposes.2, 3, 6 Such inconsistency in the legal status of this population implies that they are in an unprotected and unstable situation, which makes them vulnerable to highly stressful social experiences in third countries and this may function as a propagator of serious health hazards.

It is important to note that there is a diversity of social experience among North Korean asylum seekers based upon their immediate destination country. While the majority of North Korean asylum seekers use China as a major route toward eventual South Korean migration, others enter Vietnam, Russia, Mongolia, or another neighbouring country. Some spend a short period of time (less than one year) in a third country before entering South Korea, while others spend longer periods. Some exit North Korea and seek asylum in South Korea with family members, while others undertake these procedures alone or with non-family members. Besides their general demographic and socioeconomic characteristics, it is probable that these unique sets of factors make the link between unusual social experience after exiting North Korea and the health of this population highly variable.

As noted above, China considers North Korean asylum seekers illegal economic migrants and maintains a strict repatriation policy under ‘An Agreement on Repatriation of Border Crossers’ with North Korea since 1987.2, 3 Asylum seekers in China have to hide themselves from the authorities or move to other neighbouring countries with weaker policies concerning their status, although the move itself guarantees neither complete freedom nor admission to South Korea.2, 3, 6 Due to their general lack of social and economic resources as well as an unstable legal status, North Korean asylum seekers may encounter increased levels of mental and/or physical trauma as their duration of sojourn increases. The relationship between residential duration and the health of migrants and refugees has previously been studied,7, 8, 9, 10, 11, 12, 13, 14, 15, 16 although the duration was mostly measured at the destination rather than the intermediate country. The hardships of exiting North Korea, both alone and with family members, are numerous. The ‘hide-and-seek’ lifestyles within intermediate countries may lengthen or prevent the asylum-seeking pathway to South Korea,2, 3 even though the family itself can be a stress-reliever during the flight.

Thus this research had two objectives. The first was to examine the function of three major factors associated with unusual social experiences of North Korean asylum seekers (major routing country, duration of flight, and family status during migration) on their health. The second was to investigate the relationship between demographic and socioeconomic characteristics and the health of North Korean asylum seekers in order to assess the consistency and validity of extant hypotheses and general expectations. The second objective was worthwhile since this population is under unique social situations and little has previously been recorded.