If you are sick in North Korea, we often say you will die.
In a country long sealed from the world's scrutiny, North Korea has acknowledged what it could no longer conceal: a COVID-19 outbreak of significant scale, touching roughly two million lives in a population with no vaccines, no antivirals, and a medical system built more on ideology than infrastructure. The regime's response — willow leaf tea, army medics, and state reassurance — reveals the distance between a government's narrative and the reality its people must survive. As the United Nations warns of compounding hunger and isolation, and as defectors describe fear spreading as fast as the virus itself, the crisis invites the oldest of questions: what does a state owe its people when the cost of honesty is the admission of vulnerability?
- Two million suspected infections have emerged in a country that had officially reported zero COVID cases for over two years, making the scale of denial as staggering as the outbreak itself.
- With no vaccines, no antivirals, and no functioning intensive care infrastructure, citizens have been instructed to brew herbal teas and seek medical help only when they are already near death.
- Defectors maintaining contact with family inside North Korea describe mounting fear, enforced silence, and people running out of food as travel bans sever supply lines to rural communities.
- The regime has rejected international medical aid from South Korea and the United States, choosing image preservation over outside assistance, even as the UN warns of catastrophic consequences for the most vulnerable.
- Official figures — 63 deaths among 2 million cases — are widely dismissed by experts as instruments of propaganda, with the true toll obscured by a state that controls all information and cannot afford to appear weak.
In mid-May 2022, North Korea admitted what it had long denied: COVID-19 was spreading across the country. By the time officials made the announcement, roughly two million people had already been infected, hundreds of thousands were quarantined, and the official death toll stood at sixty-three — a figure almost no outside observer believed.
Kim Jong Un appeared in state media visiting Pyongyang pharmacies before dawn, visibly concerned about medicine shortages. His government mobilized a million public workers to identify fever cases and deployed army medics to pharmacies. But the tools available to ordinary citizens were strikingly limited: state television aired instructions to brew willow leaf or honeysuckle tea for mild symptoms, and advised seeking a doctor only if someone was coughing blood or losing consciousness. As one defector observed, by that point they would already be nearly dead.
The crisis laid bare the hollowness of North Korea's medical infrastructure — no vaccines, no antivirals, no intensive care. Travel between regions was banned, yet farming and industrial work continued, allowing the virus to move through communities unimpeded. The economy was too fragile for a true lockdown.
Defectors in South Korea described a population gripped by fear. One woman had lost contact with her farmer sister since February, when the sister had mentioned neighbors falling ill with fevers and coughs. The silence since, she believed, was due to movement restrictions — and her sister would be running out of food, reduced to foraging for wild greens.
The United Nations warned that quarantine measures threatened children, the elderly, nursing mothers, and the homeless — populations already struggling with food insecurity. North Korea rejected medical aid offers from both South Korea and the United States. Former officials and defectors suspected the regime was deliberately suppressing the death toll, not to protect its people, but to protect Kim Jong Un's image — planning, once the crisis passed, to declare victory and cite the low numbers as proof of the regime's superiority.
In a country where state media controls all narrative and most citizens have no means to verify information, the gap between official calm and lived reality remained impossible to measure — and, for those inside it, impossible to escape.
In mid-May, North Korea admitted what it had long denied: a domestic outbreak of COVID-19 was spreading across the country. By the time officials made the announcement, the virus had already infected roughly two million people, killed sixty-three according to state figures that few outside observers believed, and forced hundreds of thousands into quarantine. The response was distinctly North Korean—a mixture of state propaganda, traditional remedies, and isolation so severe it threatened to worsen an already fragile humanitarian situation.
Kim Jong Un himself appeared in state media visiting pharmacies in Pyongyang before dawn, double-masked and visibly concerned about the slow pace of medicine delivery. Behind the scenes, his government mobilized a million public workers to identify fever cases and deployed army medics to support pharmacy operations. The official line, broadcast through state television and the party newspaper Rodong Sinmun, was reassuring: the outbreak was under control, and citizens had tools to manage it. Those tools, however, consisted largely of home remedies. People with mild symptoms were instructed to brew willow leaf or honeysuckle tea—four to five grams steeped in hot water, three times daily. State television aired infomercials with animated characters explaining when to see a doctor: only if someone was coughing blood, struggling to breathe, or losing consciousness. By then, as one defector put it, they would be nearly dead.
The crisis exposed the hollowness of North Korea's medical infrastructure. The country had no vaccines, no antiviral medications, no intensive care units. What it had were isolation measures and propaganda. Since May 12, travel between regions had been banned, though the government stopped short of the kind of strict lockdowns China had imposed. The economy was too fragile. Farming, construction, and industrial work continued, which meant people still left their homes, still went to work, still moved through communities where the virus spread unchecked.
Defectors in South Korea, maintaining contact with family members still in the North, painted a picture of mounting fear. Kang Mi-jin, who spoke regularly with people in the northern city of Hyesan, said North Koreans understood the virus had killed millions worldwide and worried it would kill them too. Those with money were buying traditional medicines not because they believed in their efficacy but because they needed to do something, anything, to feel less helpless. Others were simply disconnected—literally. Choi Song-juk hadn't heard from her farmer sister since February, when the woman had mentioned that her daughter and neighbors were sick with high fevers and coughs. The silence that followed, Choi believed, was due to movement restrictions. Her sister would be running out of food by now, she said, reduced to foraging for wild greens.
The United Nations Human Rights Office warned that quarantine measures and travel restrictions would have catastrophic consequences for a population already struggling to eat. Children, nursing mothers, elderly people, the homeless, and those in remote rural areas were especially vulnerable. Yet North Korea rejected offers of medical aid from South Korea and the United States. The World Health Organization expressed deep concern about the lack of reliable information and the risk of further spread.
Former North Korean officials and defectors offered a darker interpretation of events. Cho Chung Hui, who had fled in 2011, said the government's guidelines made no medical sense—they seemed designed to discourage people from seeking help until it was too late. Choi Jung Hun, a former North Korean doctor now researching in South Korea, suspected the outbreak was being weaponized for propaganda purposes. Once the crisis passed, he predicted, North Korea would declare victory and use its low death toll as proof of the regime's superiority. The numbers were being kept artificially low not to protect people but to protect Kim Jong Un's image.
What remained unclear was whether the official figures bore any relationship to reality. Experts widely doubted them. The scale of the outbreak, many believed, was being systematically underreported to prevent the kind of public panic that might destabilize the regime. In a country where most people had no internet access and no way to verify information, state media controlled the narrative entirely. And that narrative, for now, was one of calm competence in the face of crisis—even as defectors reported fear, disconnection, and the creeping specter of hunger returning to a population already accustomed to scarcity.
Notable Quotes
North Koreans know so many people around the world have died because of COVID-19, so they have fear that some of them could die, too.— Kang Mi-jin, North Korean defector
Their guidelines don't make sense at all. It's like the government is asking people to contact doctors only if they have breathing difficulties, which means just before they die.— Cho Chung Hui, former North Korean agriculture official
The Hearth Conversation Another angle on the story
Why would North Korea reject international medical aid when its people are clearly suffering?
Because accepting help would mean admitting the system has failed. It would show weakness. The regime's legitimacy depends on the idea that it can handle anything internally, that it doesn't need the outside world.
But people are dying. Doesn't that matter more than image?
It matters to the people dying. It doesn't matter to the people in power. And in North Korea, those are two very different groups.
What about the tea remedy—is there any actual medical basis for willow leaf and honeysuckle?
Maybe some anti-inflammatory properties. But that's not really the point. The point is it's something to tell people to do when you have nothing else to give them. It's theater dressed up as medicine.
The defectors seem most worried about food, not the virus itself.
Because in North Korea, the virus is just one more crisis on top of chronic hunger. The quarantine measures make it worse—people can't move, can't work, can't access markets. The virus doesn't kill most people there. Starvation does.
Do you think the real death toll is much higher than sixty-three?
Almost certainly. But we'll never know. The regime controls all the numbers. What we know is what defectors tell us—that people are sick, that people are scared, and that the official story doesn't match what's actually happening on the ground.