Chinese Doctors and North Korea: Reviewing the Pattern
Kim Jong-un has for a brief moment achieved the near-impossible, replacing the spiralling human and economic costs of a global pandemic on no small number of front pages. As Andray Abrahamian notes here, everything and anything about the North Korean leader’s health or lack thereof now counts as news. Regrettably, the signal-to-noise ratio of it all makes it difficult to assess the merits of the intelligence (except on those occasions when there is none whatsoever) being presented.
But given what we know, a recent Reuters report on Chinese doctors travelling across the Yalu to help treat Kim seems more credible than most, resting though it does on the presumption that the Chinese visitors would not be subject to a two-week quarantine period after entering the DPRK. It is that Reuters report that provides the jumping off point for Adam Cathcart to investigate the background of cross-border medical ties, and the historical precedents (albeit not during pandemics) for North Korea opening up their leaders’ surgery rooms to foreign leaders and specialists. – Christopher Green, Senior Editor
Chinese Doctors and North Korea: Reviewing the Pattern
by Adam Cathcart
“China has dispatched a team to North Korea including medical experts to advise on North Korean leader Kim Jong Un, according to three people familiar with the situation,” read the slender but powerful lede of a Reuters story published last Thursday. Two of the three sources cited told Reuters that a delegation of the Chinese Communist Party’s International Liaison Department, or ILD (Chinese: 中国共产党中央委员会对外联络部) had gone to North Korea on Thursday, 23 April. None of the sources were willing to go on the record, so we are left with a shorter and tidier version of events as depicted in this Chinese-language story from Duowei News published on April 24, addressing the rumors.
During the period of his physical absence, Kim Jong-un has been attributed with a number of writings, a phenomenon which NK News has analysed. Largely unnoticed, the Chinese Communist Party has been using the same method for Song Tao, the head of the ILD now ostensibly in North Korea.
Chinese state media attributed Song Tao w/ a "written address" (发表书面致辞) to an online One Belt, One Road symposium on 24 April praising China's anti-COVID-19 efforts & "Health Silk Road"; no mention of North Korea. https://t.co/mVQMNQskqh @niubi @joshjonsmith pic.twitter.com/BaGO6zh83s— Sino-NK (@Sino_NK) April 26, 2020
If open-source material is not going to lead to hard answers, perhaps it is worth thinking about how we know what we know from the Reuters report.
Archival materials provide a degree of insight into the quality of transmission chains of rumors about previous instances of North Korean and Chinese high level interactions. These materials would appear to caution us today that the individuals willing (or possibly encouraged) to speak to Reuters’s relevant overseas bureaux are themselves approaching the information from a certain remove.
For a good example of how the process works, a document which I fished out from the UK National Archives shows one variant on a similar information chain: Chinese Foreign Ministry officials give unattributed background to Hungarian diplomats in Beijing and Pyongyang, who then given unattributed background to British diplomats. (The document, which dates from 1991, was declassified two years ago in 2018.) By the time it gets to the British, a high-level meeting between the Chinese and North Korean leaders is treated as fact, not speculation, and the contents of the meeting relayed as such:
Deng Xiaoping urged Kim [Il Sung] to stand aside and hand over nominal power to somebody else, while remaining in position of influence behind the scenes, as he, Deng, had done. Kim allegedly responded by saying that he would do so on his 80th birthday.
Deng Xiaoping is thus credited with talking tough to his neighbor, but if this thread leaks into the media atmosphere, the Chinese government has full deniability. Given the apparently authoritative nature of this insight, caveat emptor. As the British diplomat in Seoul concluded in the above document, “I am in no position to judge the reliability or otherwise of such reports,” threading in a more artful version of the disclaimer that CIA analysts used to get at the top of certain documents: “This is unevaluated intelligence.”
So much for one type of pattern. Yet before we get to the surgery, what about Song Tao, the current head of the ILD, known informally in its abbreviated form as the zhonglianbu (中联部)? For more detailed background on how such interactions normally function between China and North Korea, Sino-NK previously described the approach of the ILD toward North Korea in essays by former Sino-NK analyst Nathan Beauchamp-Mustafaga (currently at the RAND Corporation) along with other analyses.
China's Ambassador to North Korea hasn't made an appearance for two months https://t.co/aiNUYAkbqL but 17 March marked his five year anniversary in the job (previously vice-director of International Liaison Department/中联部). https://t.co/dxcpVHcLaR pic.twitter.com/vUnjrP5cSm— Sino-NK (@Sino_NK) March 24, 2020
China’s ambassador to North Korea, Li Jinjun, has an ILD background, reinforcing the point that, in spite of flirting for a while with treating the North Korean party-state more like a “normal” state-to-state relationship, communications between the Chinese Communist Party and the Korean Workers’ Party continues to be the main avenue of Sino-North Korean relations.1)A comprehensive open-source dive on how the Chinese Communist party and the ILD responded to the last death of a North Korean leader was produced by Sino-NK in 2012 and is available here.
Specifically regarding Song Tao, Kim Jong-un has met him twice in the past two years on short stopovers in the border city of Dandong, along with CCP party secretaries of Liaoning province and Dandong city who were invited onto the North Korean leader’s train for a meeting.
Relatively detailed breakdown of Kim Jong-un's meeting with Song Tao in January 2019 in the border city of Dandong. https://t.co/ldAGdXRjDs (Image from the two of them in March 2018, also on Kim's special train.) pic.twitter.com/ktDlLsgLj3— Sino-NK (@Sino_NK) April 26, 2020
A previous echo of these journeys to the border region exists, and, fortunately for us, there is a perfect tie-in to the CCP’s explicit discussion of the health of the DPRK supreme leadership.
Kim Family Surgery and the Chinese Communist Party | Personal meetings with top North Korean interlocutors grant access to the elite North Korean perspective on geopolitical barriers to prosperous confederation or violent regime collapse, and, along the way, permit the gathering of some basic information about the health, capability, and personal disposition of the leadership or the team advising Kim Jong-un.
In September 1962, Zhou Enlai travelled from Beijing to the northeastern city of Shenyang, the biggest node of Koreans, commerce, and military power near the North Korean border. A transcript of his discussions there, as provided by the essential scholars of the Woodrow Wilson Center, offers an important insight: the CCP has previously accorded high-level attention to the Kim family leadership’s health, and the North Koreans have been forthcoming with providing details about surgery.
Getting straight to the point with his Supreme People’s Assembly guests, Zhou inquired about how Kim Il Sung’s recent surgery had gone, asking “Is Premier Kim in good health?” The response and dialog is worth quoting in full:
Pak Kum-chol: The Comrade Premier’s health is good. Before departing I went to see the Premier. He told me after arriving in Beijing to give his regards to Chairman Mao [Zedong], Chairman Liu [Shaoqi], Chairman Zhu [De], Premier Zhou [Enlai], Comrade [Deng] Xiaoping, Comrade Peng Zhen and other leading comrades. He also wanted me to inform the leading comrades of the Chinese Party that he is in fine health and that he will be able to leave the hospital today or tomorrow.
Zhou Enlai: My thanks to the Comrade Premier. We are all very happy to hear that the Comrade Premier is healthy. Did your doctor perform surgery?
Pak: Yes, our doctor performed surgery (following portion blacked out).
Not long after undergoing surgery, the Comrade Premier received Chairman Mao’s letter of sympathy. The Comrade Premier was exceptionally moved and happy. This has played a great role in the Comrade Premier’s rapid recovery.
Zhou Enlai: Chairman Mao represents us and represents the entire Chinese people in expressing sympathy for the Comrade Premier’s health. This is because he is not only the brilliant leader of the Korean people, but also the close friend of the Chinese people.
And so we get closer to the full, if partially redacted, story, and only fifty years after the fact.
Medical connections between China and North Korea reached profound levels during the Korean War, when cross-boundary surgeries and recuperations were a regularity. The war also stimulated aid from Eastern European allies in building North Korean health and surgery capacity and training. In more recent years, Chinese doctors from Sichuan and other provinces have regularly made journeys into North Korea, performing surgeries on North Koreans. The PRC Embassy in Pyongyang has been publicising its medical concerns since early February for North Koreans living and working in China under the difficult pandemic conditions — although the information took over two months to emerge, and the Chinese Ambassador has not done a public event since late January 2020.
North Koreans perusing a detailed Chinese photo exhibition of the "people's war" against #coronavirus, including care for North Koreans in China. Was posted by PRC Embassy in early February and since viewed by "over 7000" citizens in Pyongyang. https://t.co/i1h12lSRol pic.twitter.com/3c2N0fVm49— Sino-NK (@Sino_NK) April 26, 2020
Foreigners and Surgery in North Korea: Game-changers or Meaningless? | Like making a mockery of the current rumors without engaging the structural context of the moment, answering contemporary rumors with hard documents and patterns from the past obviously is a method that has its limits.
It is of course useful to recall that North Korea has highly-skilled surgeons of its own, the result of decades of careful cultivation. In the case of neurosurgery, as Kee Park, et. al. have shown, the Romanian professor Constantin Arseni is a significant figure, and the DPRK has spent extensively on building up a surgical capacity. It is also useful to note that for leaders and citizens, North Korea has built up what appears to be a workable telemedicine capacity, which may be serving it well in this era of COVID-19, in such hospitals as the North Hwanghae People’s Hospital.
Rather than driving two hours over semi-wrecked roads to the capital, doctors in Sariwon connect via DPRK Intranet pic.twitter.com/6B2yYWxhCz— Adam Cathcart (@adamcathcart) August 27, 2016
But, to take the tweet above as an example, so what if the Hungarian links to hospital capacity at Hwanghae are, like a lot of history, simultaneously foundational and at best residual? To spread the metaphor slightly thinner, the existence of a history of foreigners and medicine in North Korea is either insight which illuminates possibilities for the present, or it is mere trivia which has little to do with North Korean thinking today and fizzles into nothingness.
More recent stories of foreign surgeons in North Korea for leadership purposes come not from China or Eastern Europe, but Paris instead. In 2008, the story of a respected French doctor at a neurosurgery conference in Beijing was picked up by French media and mushroomed into his having performed brain surgery on Kim Jong-il, a story which then jumped into The Guardian and the New York Times, among others. Having provided what looked like the rarest of glimpses into both the North Korean leadership and its dire health, Dr. Roux then said he had never met Kim Jong-il, blaming the Japanese media for manipulating French journalists. So far, so good — irresponsible rumor spread and then knocked down, if not retracted in the publications that reported it.
But then three years later, the story twisted again. Just after Kim Jong-il’s death, Roux was again interviewed by the Associated Press, the same agency which had clarified in 2008 that he had very little first-hand knowledge and had certainly never met Kim Jong-il, let alone performed brain surgery on him. This time the narrative was different. Interviewed as Kim Jong-un was coming into power, Roux was not asked about his previous denial or why he had changed his story. Instead, he returned as a comprehensive authority now not only on Kim Jong-il’s health but also as a rare Westerner who had laid eyes in person on Kim Jong-un, who Roux now indicated he had seen during the treatment of the ailing North Korean supreme leader.
So which Roux do we believe? Did he deny the rumors in 2008 because North Korean diplomats or counterparts had pressured him to do so? Or was he exaggerating his experiences in North Korea in the aftermath of his ostensible client’s death, clinging to patient-doctor privilege during a news-making interview? In Anna Fifield’s biography, The Great Successor, the Washington Post journalist goes with the December 2011 version of events and Roux is depicted as a credible witness, if voiced completely via the AP publications.
In the end, all the archival research in the world is really no barrier at all when it comes to rumors of North Korean leadership and foreign knowledge of, or assistance on, the ostensible surgical procedures of the Kim family. Looking back at relevant past patterns with the help of declassified archives may ultimately yield little more than a voyage through the “media vortex” around the Kim Jong-un health scare, but given the potential gravity of the present moment, it might be worth the effort.
“Record of Conversation from Premier Zhou’s Reception of the Delegation of the North Korean Supreme People’s Assembly in Shenyang,” June 15, 1962, History and Public Policy Program Digital Archive, PRC FMA 106-01379-13, 16-19. Translated by Stephen Mercado. https://digitalarchive.wilsoncenter.org/document/119012
‘Visit of Kim Il-Sung to China,’ 5 November 1991, by M.D. Reilly in UK Embassy, Seoul, sent to I. Davies, Far Eastern Division of the Foreign and Commonwealth Office (FCO) in London and Dr. J. E. Hoare, UK Embassy in Peking, in folder FCO 21/4803, Sino-North Korean Relations, United Kingdom National Archives, Kew Gardens, London. [full text]
‘History of Neurosurgery in Democratic People’s Republic of Korea,’ by Kee B. Park, Young Han Roh, Owen Lee-Park, and Sophie Park, World Neurosurgery Vol. 84, No. 3 (September 2015), p. 855-859. https://www.sciencedirect.com/science/article/pii/S1878875015002557