North Korea’s ‘free healthcare’ reality: Citizens turn to black market for medicine

North Korea promotes its free healthcare system as proof of socialism’s superiority, but North Koreans say what they actually experience isn’t “free healthcare” but something closer to “no healthcare at all.”

Medical facilities can’t provide proper diagnoses or treatments, and medicines are scarce. This has created a widespread belief that “imported drugs” are the only real solution for treating illnesses.

A Daily NK source in North Korea said recently that “various drugs imported through trade are sold in the markets and used to treat seasonal enteritis and food poisoning.”

According to the source, these drugs—about 70% of them made in Russia—were a major import for Ponghwa General Trading Corporation between early and mid-July. Kumgang Trading Corporation also imported medications for state hospitals, including products made in China.

Imported medications go first to the country’s top hospitals, including those in Pyongyang and military hospitals, as well as sanatoriums and other facilities for party and government officials. Some of these drugs eventually make their way to markets for public sale.

From state hospitals to street markets

The problem is that unlicensed drug merchants sell these foreign medications outside the state’s official hospitals and healthcare facilities.

With drug ingredients labeled in languages few North Koreans can read, people often buy medicines based on “word of mouth” or “gut feeling” without knowing what’s actually in them.

“Nobody believes you can get treated for free in a hospital,” the source said. “So people go to drug merchants and buy medications based entirely on the merchant’s explanation of foreign-language labels—and merchants make it sound like these drugs can cure anything.”

Most medications imported for state hospitals, like Russian-made levofloxacin, ciprofloxacin, and 5-25% glucose bags, make their way from Pyongyang to intermediate regions like Pyongsong and Kaechon through backroom deals. From there, they spread to markets throughout the country.

These Russian-made drugs are in high demand. While Chinese medications are more widely available, many people doubt they work. Demand for Russian drugs keeps growing thanks to merchants who claim they’re immediately effective and positive word-of-mouth from locals.

Most importantly, people buy foreign-made medications because they have little faith in drugs made locally by companies like Sunchon Pharmaceutical Factory and Hamhung Pharmaceutical Factory, the source said.

“The state constantly brags about free healthcare, but people actually depend on the market—not the state’s free healthcare—to survive,” the source said. “In North Korea, you have to go to the market to buy medicine, and markets depend on foreign trade for medicines.”

“You can starve without food, but you can’t cure an illness just by enduring it. People don’t trust the free healthcare system. So people say they wish the state would let them buy effective medicine—even if they have to pay for it—by allowing trade with foreign countries to flourish.”

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