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He described visiting pediatric wards in the city of Haeju filled with sick, starving children. They lay listless on blankets on the floor, bones protruding from skinny arms, legs jutting out from baggy sweat clothes, lacerations on their discolored, sallow faces.

One bout of diarrhea would be enough to kill a child already weakened from years of malnutrition, he said.

“I’m sure there are kids there who are dead now,” Mr. White said. “They were pretty far gone.”

In April, the U.N. appealed to its member nations for $218 million in food aid for North Korea.

Six months later, donor nations have coughed up less than a third of that amount, and the question of whether to help feed the North Koreans remains mired in political calculations by governments cautious about offering help to a regime with a history of defiance.

Washington approved $900,000 in emergency flood aid, mostly tents and plastic sheeting, in August.

But the Obama administration is still mulling whether to offer food aid, even after sending officials to North Korea to assess the food situation four months ago following a direct plea from Pyongyang in January.

The North Koreans raised the issue of food aid at nuclear talks with the U.S. in New York in July, State Department spokeswoman Victoria Nuland said, and a new round of U.S.-North Korea talks on disarmament is set to take place next week in Geneva.

The U.S. reluctance to commit to more food aid reflects a familiar dilemma for Washington: whether to help North Korea when its own officials plow scant national resources into developing atomic weapons and ballistic missiles.

Providing aid also risks alienating U.S. ally South Korea, whose president has linked aid to nuclear disarmament and has all but stopped aid and money to Pyongyang after the sinking of a South Korean warship last year that killed 46 sailors.

Michael Green, an analyst at the Center for Strategic and International Studies think tank and a former Asia adviser to former President George W. Bush, says the food and nuclear issues should be separate.

“If you don’t get satisfaction on the nuclear deal and you don’t give food aid, what you’re at least implicitly doing is suggesting that the North Korean people should not get food because of the regime’s stance on nuclear issues,” he said.

Ms. Amos said she hopes to be able to reassure donors that funding for the U.N. appeal will make it to the hungry and not to the plates of the political and military elite.

North Korean officials have expressed a willingness to allow rigorous monitoring of aid distribution, Mr. White said.