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The land in the mountainous north is largely unsuitable for farming, and deforestation and outmoded agricultural techniques mean farms are vulnerable to the natural disasters, including flooding, drought and harsh, cold winters, the U.N. report said.

Provinces in the southern “cereal bowl” produce most of the country’s grains, but the food does not always reach the rugged far northeastern provinces, the report said. A crop assessment in October 2011 indicated that 3 million people will need outside food help this year.

Many donor countries suspect food aid will be diverted to the nation’s powerful elite or million-man military.

The World Food Program issued a global appeal for $218 million in emergency food aid in 2011, saying a quarter of North Korea’s population needed foreign food handouts to keep from going hungry. It received just $85 million.

South Korea halts aid

South Korea had been one of North Korea’s biggest benefactors until conservative President Lee Myung-bak took office in 2008, ending unconditional aid by linking it to progress on North Korea’s nuclear disarmament process.

Seoul has no immediate plans to resume massive direct food and fertilizer aid to North Korea, South Korean Unification Ministry spokeswoman Park Soo-jin said.

A North Korean long-range rocket launch in April also scuttled a deal with the United States that would have sent 240,000 metric tons of food aid in exchange for a moratorium on nuclear and missile tests.

Mr. Sauvage noted a welcome focus on agriculture, including crop rotation and organic farming, in this year’s joint New Year editorial laying out the government’s policies for 2012.

He noted that North Korea runs spotlessly clean hospitals but with limited facilities.

“The health care system is on paper quite sophisticated. The proportion of doctors per household is very high,” Mr. Sauvage said. “Unfortunately, there’s not a lot in the doctor’s tool kit.

“You go and visit a hospital in winter, and it will not be heated. Never. There will most likely be no water. There will likely be no medicine other than the medicine that agencies are delivering.

“They have shown us orphanages, kindergartens and hospitals, and I’ve been able myself to see children who I was told were 9 years old but had physical signs that they were much older than 9, probably 13 or 14 years old, and were evidently undernourished.”