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The United Nations says six million North Koreans, a quarter of the population, could be at risk of starvation. It's warning of a humanitarian crisis, with the country's public distribution system set to run out of food in May.

North Korean food shortages are no longer news, but NPR's Louisa Lim reports that this year, Pyongyang has made unusually public pleas for food aid, raising fears, as well as suspicions.

LOUISA LIM: In North Korea, from May until July is called the lean season. This year, they're already using other Orwellian euphemisms, too, like alternative food.

Mr. DAVID AUSTIN (Program Director for North Korea, Mercy Corps): They take wild grasses or straw and twigs, and they cut it up real fine and mix it with their ground-up corn, which is a staple of their diet.

LIM: That's David Austin from the NGO Mercy Corps.

In mid-February, as part of a seven-person team, he was invited by North Korea to spend a week there assessing whether food aid is needed. He believes it is.

Mr. AUSTIN: I would say they're dying of hunger-related causes. A child who ingests this alternative food who's 3 years old, her stomach can't absorb that. So we saw a little girl who's 3 and a half. She weighed about 15 or 16 pounds, and she was completely unresponsive during our visit. That child probably won't make it.

LIM: The U.N. has also found that health indicators are worsening. In some parts of the country, up to half the children have acute malnutrition or stunted growth. And worse could be to come: Austin's team estimates 50 to 80 percent of the wheat and barley harvest has died due to a bitterly cold winter.

Rising food prices mean North Korea has scaled back plans to buy food on the world market. It had wanted to buy 325,000 tons. So far, it's only bought 40,000, according to Ken Isaacs from Samaritan's Purse.

Mr. KEN ISAACS (Vice President of Programs and Government Relations, Samaritan's Purse): With the loss of the winter harvest and the limit of food that are in the storehouses, our expectation is that you're going to see a significant impact from about the middle of March through July. That's when the stocks will run out.

(Soundbite of video)

Unidentified Woman: (Foreign language spoken)

Unidentified Child: (Foreign language spoken)

Unidentified Woman: (Foreign language spoken)

LIM: Exhibit A is a video shot by a citizen journalist inside North Korea. It includes an interview with an emaciated girl covered in filth, picking grass. When asked, what do you eat? She replies, nothing. It was shot in June. Her body was found in October.

But Tae-keung Ha from Open Radio for North Korea, who has sources inside the country, says there is food in the markets, but people can't afford it. He blames economic mismanagement, hyperinflation, following botched currency reforms in 2009.

Mr. TAE-KEUNG HA (President, Open Radio for North Korea): The price of rice has inflated about 100 times compared to one year ago. The main reason is the value of North Korean currency is plummeting down because North Korean government is just printing more and more North Korean currency.

LIM: This year, multiple reports say even the favored military is going hungry, as the public distribution system has largely broken down. This comes at a time when North Korea has requested food aid from overseas, reportedly even from poorer African countries. Ha fears food aid could be stockpiled for the upcoming Strong and Prosperous Nation campaign.

Mr. HA: Maybe almost all the food from the rest of the world to North Korea could be used for the military, and they say that 2012 is the first year of Strong and Prosperous Nation. So that's another reason why they need save rice for the next year.

LIM: The NGO team wants a targeted feeding program for the most vulnerable members of society. They say such a mission should be strictly monitored to avoid abuse. U.S. officials say they're considering whether to resume food aid. This is politically sensitive following Pyongyang's deadly attacks on a South Korean island late last year.

But Mercy Corps' David Austin says there are humanitarian and political imperatives to act.

Mr. AUSTIN: All of the food that comes in when it's donated from the United States arrives in a bag with a U.S. flag on it, and in Korean and in English, it says a free gift of the American people. And the 900,000 people that we were feeding in 2008-2009, every two weeks, they would go to the distribution center, and they would see that flag, and they would see that statement, and then they would get their food.

LIM: The recent U.N. assessment found only 4 percent of households were eating properly. It fears the public distribution system - on which many depend - will run out of food in May. The U.N. programs in North Korea are severely underfunded, and fears are growing that time is running out to organize an appeal.

Hard choices lie ahead: Food aid could help the survival of the regime, but withholding it will cost lives.

Louisa Lim, NPR News, Beijing.

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