Who are the rural hospitals really being built for?
Kim Jong-un inspects a hospital under construction. Image: KCNA
North Korean leader Kim Jong-un recently inspected a rural hospital construction site and praised the project as “a great revolution in the backward health sector.”
On the surface, his appearance and the honesty about the healthcare system appears to have been a gesture highlighting government efforts to make improvements. But when we look more closely, we can’t help but question whether Kim is truly concerned about the people’s wellbeing.
Kim has spent the last several years tirelessly cultivating his image as a “leader for the people.” In March 2020, amid the COVID-19 pandemic, he broke ground on a modern hospital in Pyongyang, and in February this year, he attended its completion ceremony, where he claimed, “The health of our citizens is our top priority.”
As the capital, Pyongyang is home to those with privileged backgrounds, the donju (moneyed elite), and high-ranking officials. It is the heart of the regime’s power, wealth, and loyalty.
Despite this, the Pyongyang General Hospital – touted as one of Kim’s most significant achievements – has continually faced allegations of understaffing and inadequate medical equipment.
According to testimony from locals, patients often experience delays or are denied treatment due to a lack of qualified staff and functioning equipment. This has reportedly caused significant inconvenience for those seeking care.
Now, Kim has pledged to build hospitals in the provinces. On June 2, he visited a construction site in Kangdong County and announced that pilot hospitals would also be built this year in Ryonggang County, which is in Nampo special city, and in Kusong, a city in North Pyongan Province. Starting in 2026, he plans to construct 20 hospitals annually across various cities and counties.
While this initiative may seem like a commitment to medical access for all citizens, it is, in reality, more illusion than substance. It closely mirrors the legacy-building strategies favored by his father and grandfather when they ran the country.
For North Korea’s leaders, construction projects have long served as an easy tool for self-promotion. The term “hospital construction” has a benevolent ring to it, and it lends itself well to propaganda aimed at rallying public sentiment. But the troubling reality is that these projects often demand an unsustainable level of sacrifice from ordinary citizens.
In the past, whether for housing construction or disaster recovery, the regime has shifted the burden for materials, labor, and finances almost entirely onto the people. It is likely the same will happen with this rural hospital initiative. This raises the unavoidable question: Is this really for the people’s health, or just another feather in Kim Jong-un’s cap?
North Korea’s hospital construction projects rely heavily on forced labor and compulsory donations from citizens. People in the targeted construction areas are required to provide building materials and manpower.
“Any construction means collecting bricks, cement, even money and food from local residents,” said an escapee who arrived in South Korea in 2018. “Depending on the project, locals may be forcibly assigned to work on-site.”
He said that those who refuse can face punishment ranging from mandatory street cleaning and mobilization to detention in labor camps.
If Kim’s plan to build hospitals in 20 locations simultaneously proceeds next year, many citizens will be forced to give up their daily lives to supply labor and resources.
This, combined with ongoing projects like Pyongyang’s 50,000-unit housing construction, and the country’s worsening economic crisis, means the burden of these new plans will only inflict more suffering on the public.
The irony is that, once the construction is completed and the hospitals start operating, they are unlikely to provide any real benefit. North Korea’s medical facilities are notorious for chronic shortages of medicine and poor-quality equipment. A brand-new building means little if there are no medicines and no competent doctors.
It is already well known that patients often must go to the black market to obtain medicine and bribe doctors to receive treatment. Given these realities, it’s likely that the newly built provincial hospitals will look impressive only in propaganda photos and videos, offering little real improvement to public health.
So why is Kim so fixated on them? The likely answer lies not in benevolence, but in strategic image-building and internal control.
Facing mounting challenges from international sanctions, economic hardship, and food shortages, Kim has sought to maintain regime legitimacy by emphasizing his “love for the people.” His promotion of the provincial hospital project, following the Pyongyang General Hospital initiative, is the one of the reasons there is criticism that this project is aimed at placating public discontent and diverting their attention.
When citizens are mobilized for large-scale projects like hospital construction, they lose the ability to focus on their personal livelihoods and are less likely to voice dissatisfaction with the regime.
Of course, rural hospitals are a genuine necessity. But if the regime truly wants to build hospitals for the people, it must go beyond erecting buildings. It should prioritize the acquisition of medicines and modern medical equipment, and invest in training qualified medical personnel. The quality of healthcare depends not just on infrastructure but on the professionals and support systems behind it.
Additionally, the state should take responsibility for securing and allocating the necessary resources for construction, instead of leaning on the people.
Only then will the new hospitals be seen as reflecting a genuine commitment to improving the lives of ordinary people. When that sincerity is finally communicated to the people – who live in some of the world’s harshest conditions – only then will the regime’s claim to a “people-first policy” begin to hold any weight.
Sewon is the North Korean-born founder and CEO of NK Times, a Seoul-based media outlet focused on North Korea. Drawing on his personal experience living there, he strives for transparency and accuracy in reporting, working to inform readers worldwide about the realities of North Korea.
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