Medecins sans Frontieres (MSF) announced yesterday it had been forced out of North Korea by the Stalinist government which was diverting aid.
The MSF director-general, Mr Eric Goemaere, said that since early June there had been a clear, high-level policy change to restrict humanitarian aid in the famine-stricken country. "It is never easy to leave a country when thousands of people are in danger, but humanitarian aid cannot help the most needy unless it is freely distributed."
The Paris-based charity, which had a team of nine doctors in North Korea, urged the international community to put pressure on Pyongyang to let aid agencies work freely across the country.
MSF had been told North Korea was able to return to self-sufficiency and instead of medicine wanted raw materials supplied to its state pharmaceutical factories.
Mr Goemaere said: "They told us the emergency was over and they want to go back to structural aid."
Some reports have spoken of up to three million dead from famine, but Mr Goemaere said this was difficult to confirm as international monitors had consistently been denied access to the provinces.
"In the provinces in which MSF was working we did not see people dying in the streets . . . certainly nothing like famine in the Sudan," said Ms Rose Marie Pecchio, former MSF head of mission to North Korea. "I think there is famine in the country . . . "
"When international aid arrives in North Korea, the cargo is loaded on trucks and sent to army warehouses," one couple with a young child told MSF.
A US Congress delegation report has estimated the food crisis was claiming between 300,000 to 800,000 lives a year.
MSF said it was convinced food and medical aid was being distributed along political lines, with party faithful receiving food while others starved. It also expressed concern about orphans and homeless children wandering the countryside. It was convinced children were being rounded up and put into institutions to which the aid group was refused access.
The agency came across extremely malnourished children in some 64 feeding centres around the country. "We think they are the peak of an iceberg," Mr Gomaere said.
"A huge population of homeless children, a vagabond population who do not benefit from aid, they were for us a definite priority," he added. "But when we said that, the authorities told us they are not a priority." Refugees in China told of children in public places with grotesquely swollen heads.
"Their legs are also swollen and straight like pillars from the tops of their thighs to their ankles. Their skin is black and they have skin infections all over their bodies," one witness said.