(AP) -- The World Health Organization found itself Friday in the strange position of defending North Korea's health care system from an Amnesty International report, three months after WHO's director described medicine in the totalitarian state as the envy of the developing world.
WHO spokesman Paul Garwood insisted he wasn't criticizing Amnesty's work, but the public relations flap illustrated an essential quandary for aid groups in unfree states: how to help innocent people without playing into the hands of their leaders.
Amnesty's report on Thursday described North Korea's health care system in shambles, with doctors sometimes performing amputations without anesthesia and working by candlelight in hospitals lacking essential medicine, heat and power. It also raised questions about whether coverage is universal as it - and WHO - claimed, noting most interviewees said they or a family member had given doctors cigarettes, alcohol or money to receive medical care. And those without any of these reported that they could get no health assistance at all.
Garwood said Thursday's report by Amnesty was mainly anecdotal, with stories dating back to 2001, and not up to the U.N. agency's scientific approach to evaluating health care.
"All the facts are from people who aren't in the country," Garwood told reporters in Geneva. "There's no science in the research."
The issue is sensitive for WHO because its director-general, Margaret Chan, praised the communist country after a visit in April and described its health care as the "envy" of most developing nations.
Major global relief agencies have been quietly fighting for years to save the lives of impoverished and malnourished North Koreans, even as the country's go-it-alone government joined the exclusive club of nuclear weapons powers and wasted millions on confrontational military programs.
Some groups may fear being expelled from the country if they are openly critical of Pyongyang, which is highly sensitive to outside criticism. Still, Chan's comments were uncommonly ebullient.
Garwood and WHO spokeswoman Fadela Chaib insisted that Amnesty's report was complementary to their boss' observations, and sought to downplay Chan's praise for North Korea. Instead, they focused on the challenges she outlined for North Korea, from poor infrastructure and equipment to malnutrition and an inadequate supply of medicines.
But whereas Chan had noted that North Korea "has no lack of doctors and nurses," Amnesty said some people had to walk two hours to get to a hospital for surgery. Chan cited the government's "notable public health achievements," while Amnesty said health care remained at a low level or was "progressively getting worse."
Asked Friday what countries were envious of North Korea's health, Chaib said she couldn't name any. But she highlighted the importance of maintaining the health body's presence in the country, where officials do their best to save lives despite "persisting challenges."
"We are an organization dealing with member states, and we respect the sovereignty of all countries," Chaib said. "We need to work there to improve the lives of people."
Sam Zarifi, head of Amnesty's Asia-Pacific program, said the human rights group stood by its findings.
"We certainly have a lot of restrictions in terms of working in North Korea, but we did our best in terms of capturing the information we could verify," Zarifi said. "We don't take the WHO's statements as criticizing or rejecting Amnesty's findings."
He said Amnesty had spoken to North Koreans as well as to foreign health care and aid workers, and relied heavily on WHO for information - including the assessment that North Korea spends $1 per person per year on health care, the lowest level in the world.
The U.N. estimates that 8.7 million people need food in North Korea. The country has relied on foreign assistance to feed much of its population since the mid-1990s when its economy was hit by natural disasters and the loss of the regime's Soviet benefactor.
North Korea, ruled by Kim Jong Il, is routinely described by U.N. and other reports as one of the world's most repressive regimes.
Garwood said Amnesty's research added a needed element to understanding health conditions in North Korea, but added that it didn't even mention recent improvements in the country as the result of a program funded by South Korea and aided by WHO.
The U.N. body claims that maternal mortality has declined by over 20 percent since 2005, and diarrhea cases and deaths in operations have also dropped. It says more than 6,000 doctors and nurses have been trained in emergency obstetric care, newborn care and child illnesses, while clinics have received better material for operations, blood transplants and other medical interventions.
As for Chan's April claim that "people in the country do not have to worry about a lack of financial resources to access care," Garwood said hundreds of field missions have been conducted in North Korea.
"None have come back reporting the kinds of things in the Amnesty report in terms of payment for services," he said.
"I'm not saying they're not credible accounts," he added. "But it's not taking into account some of the things that are happening today."
Zarifi, of Amnesty, said the whole debate would be ended if North Korea's government provided access to monitors so that everyone had a better understanding of the country's health care system.
"Every indication we have indicates the state of health care in North Korea is dire," he said.