Original ResearchThe effect of unusual social experience on the global health of North Korean asylum seekers
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.
Section snippets
Methods
This study utilized the North Korean Health Care System Data Set (NKHCS). The Ajou Institute of Korean Unification and Health Care (AIKUHC) constructed this data set by surveying North Korean asylum seekers housed in Hanawon, a governmental shelter facility funded and operated by the Ministry of Unification, South Korea. Hanawon provides an intensive two-month resettlement training programme to North Korean asylum seekers who have just entered South Korea, to help them reduce psychological
Results
Table 1 shows that the self-rating of global health of North Korean asylum seekers becomes more favourable as the duration within the intermediate country increases. Asylum seekers using China as a major route to South Korea rate their own health more favourably than those migrating through other countries. To be accompanied by friends, neighbours, or strangers during migration seems to negatively affect the self-rated health of this population, compared to being alone or accompanied by family
Discussion
This research had two specific purposes. The first was to examine whether variables related to the unusual social experiences accumulated during the migration event through intermediate countries, exert any influence on the global health status of North Korean asylum seekers. The second was to investigate whether standard demographic and socioeconomic characteristics are associated with global health status in the generally expected patterns even among this unique and understudied population.
Acknowledgement
This study is supported by Korean Research Foundation (KRF-2005-078-BS0004).
References (26)
- et al.
Trauma experience of North Korean refugees in China
Am J Prev Med
(2001) - et al.
Mortality in North Korean migrant households: a retrospective study
Lancet
(1999) - et al.
Country of birth, instrumental activities of daily living, self-rated health and mortality: a Swedish population-based survey of people aged 55–74
Soc Sci Med
(2003) Ethnicity, social class and health: a population-based study on the influence of social factors on self-reported illness in 223 Latin American refugees, 333 Finish and 126 South European labour migrants and 841 Swedish controls
Soc Sci Med
(1995)- et al.
Measuring culture: a critical review of acculturation and health in Asian immigrant populations
Soc Sci Med
(2003) - et al.
Acculturation and health in Korean Americans
Soc Sci Med
(2000) - et al.
Understanding self-rated health
Lancet
(2002) - et al.
Community-based public health interventions in North Korea: one non-governmental organization's experience with tuberculosis and hepatitis B
Public Health
(2005) - Korean Ministry of Unification. 2005 White Paper on Korean unification: Chapter 4, Section III. Resettlement support...
- et al.
North Korean defectors: their life and well-being after defection
Asian Perspect
(2004)
North Korean asylum-seekers: their adaptation and resettlement
East Asian Rev
Cross-border movement of North Korean citizens
East Asian Rev
Cited by (6)
Correlates of depressive symptoms among North Korean refugees adapting to South Korean society: The moderating role of perceived discrimination
2015, Social Science and MedicineCitation Excerpt :Moreover, the majority of NK refugees face language barriers that cause difficulties in their daily life (J. U. Kim and Jang, 2007; Min, 2008); some have expressed that they are unable to comprehend the South Korean language (Lankov, 2006). Although both countries use the same language, more than 60 years of separation has created a wide linguistic gap (D. S. Kim et al., 2007; Park et al., 2009) in dialects, word meanings, and expressions (Lankov, 2006). NK refugees are easily identified by South Koreans by their dialect during verbal exchanges.
Can technology break the invisible wall? Exploring mobile application needs and preferences among North Korean refugees in South Korea
2023, Asian and Pacific Migration JournalSocioeconomic Determinants of Health Status Among Older Adults in Poland
2020, Eurasian Studies in Business and EconomicsNorth Korean refugee health in South Korea (NORNS) study: Study design and methods
2012, BMC Public HealthSocial inclusion and length of stay as determinants of health among North Korean refugees in South Korea
2009, International Journal of Public Health