As the coronavirus spreads around the globe, infecting more than 92,000 people and killing at least 3,125 to date, it raises an unsettling question: Will the outbreak spread to North Korea? And if it does, will the famously insular and impoverished state be able to cope?

North Korea is uniquely unprepared for a medical emergency of this magnitude. With a crumbling health-care system that is starved of public investment, it is arguably more vulnerable to a viral outbreak of this kind than any other country in the world. Pyongyang is well aware of this. It has hermetically sealed its borders, suspended all tourism, quarantined all foreign nationals, shut down many public sites, and closed all schools for a month.

So far, these measures have kept the number of infections in North Korea at zero, at least if the government’s official figures are to be believed. (Both the South Korean and the U.S. news media have reported on multiple suspected cases in the country.) If the virus does gain a foothold in the country, or indeed if it already has, the humanitarian consequences will likely be severe. But even if Pyongyang manages to prevent an outbreak, doing so will have second-order economic effects that will prove extremely damaging—and could weaken the regime’s hold on power.

A CRISIS WAITING TO HAPPEN

North Korea is sandwiched between two major centers of the coronavirus epidemic: China, with over 80,000 confirmed cases, and South Korea, with over 5,000 confirmed cases. Even for a country known as the Hermit Kingdom, sealing itself off completely will be hard to do. The outbreak in South Korea is not especially worrisome: the 150-mile-long demilitarized zone along the border bristles with hundreds of thousands of soldiers who closely guard any entry points—and rarely would a South Korean try to go to the North, anyway. But North Korea’s 880-mile border with China is a different story. That border is porous, and people on both sides survive by smuggling goods across it, so there is a considerable risk of the virus crossing over—if it hasn’t already. The two provinces on the Chinese side, Liaoning and Jilin, saw a nearly threefold increase in confirmed coronavirus cases in February, with reports that at least 200 people have fallen ill. The actual figure may be much higher, given concerns about the undercounting of mild cases and doubts about whether Beijing is being truthful.

North Korea is uniquely unprepared for a medical emergency of this magnitude.

If the virus does reach North Korea, it is likely to spread rapidly. Some 43 percent of the population, or 11 million people, are already malnourished, making them highly vulnerable to infectious diseases. North Korea also does not have the infrastructure to fight a pandemic. Its public health system is underdeveloped and dilapidated; its hospitals are barely functional and lack medicines. North Korea spends less on health care than any other country in the world (under $1 per person per year), and many citizens resort to self-medicating. Half of the country’s health facilities don’t have adequate access to water and sanitation. The North Korean energy grid, too, is a risk factor. Electricity networks have decayed to the point that many hospitals have only intermittent power. And it is highly unlikely that the state has the technical capability to test for the coronavirus or to treat the infected, unless it imports medical equipment from China.

Pyongyang no doubt realizes the danger it is in. State news media have reported extensively on the global outbreak, providing daily updates on the state’s containment efforts and advising citizens on what to do to avoid infection. The regime has also sent pleas for international help to UNICEF, the International Federation of Red Cross and Red Crescent Societies, Doctors Without Borders, and the World Health Organization; some of these organizations have already secured sanctions exemptions to ship vital equipment to the country.

KNOCK-ON EFFECTS

Pyongyang may succeed in keeping the epidemic at bay. But the extreme measures it has taken will damage its already fragile economy either way, with unpredictable consequences. Since 2016, the UN Security Council has expanded its sanctions regime to cover roughly 90 percent of North Korea’s commercial exports and to prevent the country from importing oil, gas, and refined petroleum products, among other goods. The United States has imposed additional unilateral sanctions that cover even more economic activities, although it makes exceptions for humanitarian assistance. The impact of the sanctions has been punishing. According to the most recently available estimate by South Korea’s Central Bank, the North’s GDP shrank by over four percent in 2018 for a second consecutive year. Cordoning off the country will further reduce trade with its major trade partners, China and Russia, and cut off vital foreign currency inflows.

Since U.S. President Donald Trump and Korean leader Kim Jong Un first met in 2018, Pyongyang has managed to circumvent some UN sanctions; China and Russia have relaxed their sanctions enforcement and in some cases have assisted North Korea in evading sanctions. North Korean vessels hauling coal and oil have been engaging in covert ship-to-ship transfers with Chinese vessels at sea. These practices, too, will have to come to a halt if the regime wishes to prevent a coronavirus outbreak.

The Kim family dynasty has survived terrible tragedies in the past.

The main reason North Korea has so far survived the sanctions regime is not because of its state-directed command economy but thanks to its informal private sector. Since Kim assumed power in 2011, private markets have exploded in size and influence, and most North Koreans are no longer dependent on the dysfunctional central government for food or work. A coronavirus outbreak could bring these markets to a standstill, putting extra strain on a population that is already struggling just to get by.

The prices of essential items such as rice, soybeans, oil, and fuel have shot up since the border to China was closed, and the regime has responded by imposing price controls. In the past, however, such measures have backfired. In 2009, for example, the regime launched a confiscatory currency reform aimed at cracking down on burgeoning private markets. The move, which was sprung on the populace without warning, drastically limited people’s ability to convert their cash holdings. It effectively wiped out most household savings and the working capital of many private entrepreneurs, creating chaos that only exacerbated the country’s economic woes.

WILL KIM SURVIVE?

It is impossible to guess what the ultimate fallout of the crisis will be, but the consequences could be dramatic. One could imagine the regime stepping up its cybercrime activities, the only remaining source of income that doesn’t come with an increased risk of importing the virus. Alternatively, Pyongyang might soften its hard line in nuclear talks with Washington in order to gain sanctions relief and urgently needed economic breathing room. The worst-case scenario—an economic meltdown—could prompt large numbers of desperate North Koreans to try to flee the country.

Still, even a severe coronavirus outbreak is unlikely to bring the regime to heel. The Kim family dynasty has survived terrible tragedies in the past—an estimated two million to three million people died during a famine in the 1990s. But the longer the current suite of emergency measures remains in place, the greater the pressure on the government will be. Kim’s power depends on the support of elites in the Workers’ Party, the military, and the intelligence services—and the relatively affluent lifestyle of those elites, in turn, depends on North Korea’s ability to successfully evade at least some of the sanctions. If the coronavirus keeps the country from doing so, elite support will suffer accordingly. Over the past decade, Kim Jong Un has consolidated power far more successfully than many had expected, often by brutally cracking down on real or perceived rivals. But in the coronavirus, he could soon be facing an adversary that can be neither shot nor jailed.