North Korea often tries to hide from the world the results of decades of Communist authoritarian leadership and financial mismanagement. But for those who've seen past that facade, the results are devastating on a deeply human level: Food is hoarded, hunger is rampant and mass starvation is common, even as the rest of the world has plenty to share or sell. Just last month, the Red Cross warned the country was on the verge of a “full-blown food security crisis” caused by lack of rain this past summer.

And yet, as aid workers and foreign governments have both found, providing aid may inadvertently help the very regime that keeps its people hungry, and sanctions are often ineffective at curbing the excesses of the elites while further harming the vulnerable we are trying to assist.

But discussions with aid workers from the region can provide interesting insights into one of the key dilemmas the United States must face as it considers a path forward to engage with the good, the bad and the ugly of North Korea's actions.

While harsh, sanctions, for instance, can be evaded — and often are, which is why items on the banned list, including luxury items from around the world, still make their way into North Korea. An American aid worker we interviewed described previous trips where he saw cars that are supposed to be subject to sanctions on the streets of Pyongyang.Food items, while among the few things not included in U.N. and U.S. sanctions, remain rationed as sanctions broadly inhibit transportation links, reduce employment, and discourage companies from seeking markets. And sanctions on fertilizer and fuel, while perhaps necessary to inhibit regime leaders, have the potential to exacerbate food shortages this year by reducing crop yields.

The international response to repeated sanctions violations, meanwhile, has led to a vast reduction in international foreign aid to North Korea out of a fear that any assistance will benefit the Kim regime and its nuclear weapons program. Those fears are not unfounded: the aid worker we spoke to explained that "it was common knowledge that the army got the best of everything” and that “the distribution of aid is very opaque.”

No one, however, denies that the need for aid exists; North Koreans still go hungry. The food provided through the government voucher program — part of the songbun caste system — is often insufficient. But when asked whether the risks outweigh the benefits of aid, our contact responded: “It is very hard to say. I would say that if China and Russia were not supporting the Kim regime behind the scenes, then it would be a much easier decision... foreign aid groups would have much more bargaining power."

A few organizations continue their attempts to deliver help to the suffering. Of the private humanitarian organizations still delivering aid, a significant number of them are Christian groups that originate in the United States, who provide approximately $10 million in aid per year.

Many other humanitarian organizations, such as Doctors Without Borders, have halted operations in North Korea. What’s more, the Trump administration issued a ban on people traveling to the country at all, which both prevents aspiring aid workers from going there but has also forced American workers already in North Korea to return home.

Problems with aid may run even deeper. Last September, Moses Lee, a Presbyterian minister who writes on North Korean humanitarian work, argued that cooperation between evangelical humanitarian workers and the Kim regime could taint the reputation of said workers in the eyes of the North Korean people.

We've seen that happen recently with NGOs in China. Legislation put into effect January 2017 now requires foreign NGOs to allow the Chinese government to closely inspect and question workers, locations and documents, as well as other assets. The law is more than just another layer of onerous bureaucracy. The Chinese government views foreign NGOs as a potential threat to its national security, and the oversight is so burdensome that it’s already hindering the ability of NGOs to operate. As a result, by April, approximately 350 organizations have registered offices in mainland China but several other NGOs had withdrawn from the country.

Despite its problems, though, aid may be one of the few positive symbols of the United States to which North Koreans are exposed. Until the recent Trump-Kim summit, humanitarian workers were the only non-threatening Americans North Koreans saw. And, as one-time U.S. ambassador to the U.N. Bill Richardson has said, aid has traditionally served as a “potential bridge” that spanned to a less threatening America.

The question then becomes, how can aid be delivered in a way that minimizes supporting the government and maximizes supporting the people?

First, the on-the-ground system of delivering aid should strategically emphasize interactions with people over shipments. My contact advocates "personal interaction,” arguing that “going and helping (providing medical care, teaching, etc.) is less likely to be ‘aid diverted to the army' than simply sending money or rice or boxes of medical supplies." Of course, this would necessitate a change in the travel policy and potential support from the U.S. government to ensure the safe deliverance of aid and the safety of aid workers.

Second, whenever possible, aid workers should avoid cooperation with the regime in circumstances that could reduce their legitimacy in the eyes of the people — especially given the otherwise ingrained negative view North Koreans have of the United States.

Finally, the United States can and should use diplomacy to pressure North Korea to halt the active oppression of its citizens. This country has said that we are a champion of human rights. However, the recent meeting between Trump and Kim Jong Un could lead to concerns that America’s moral values have been set aside in favor of playing political hardball with dictators. No matter what other goals the Trump administration chooses to aim for, no strategy would be morally complete without pressuring Pyongyang to address the suffering of the North Korean people.