On Tuesday, President Trump spoke to his South Korean counterpart, Moon Jae-in, and agreed that humanitarian relief by Seoul across the border “would be a timely and positive move,” South Korea’s presidential Blue House said.

At the same time, however, international sanctions on North Korea remain firmly in place in an attempt to force concessions in the North’s nuclear program.

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Analysts say there is no doubt that the ultimate blame for the humanitarian crisis rests with Pyongyang, which has spent hugely on nuclear advances and other military projects while neglecting the welfare of ordinary citizens.

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But leading medical and humanitarian experts also argue that U.S.-led sanctions — which include fuel imports — have also stifled North Korean agriculture and prevented the arrival of vital medical aid.

“Other than the most basic of subsistence agriculture, there is no agricultural sector in the world that can survive without oil-based inputs,” said Hazel Smith, a professor in Korean studies at the SOAS University of London.

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Smith argues North Korea can feed its citizens only if it can access oil and natural gas — to fuel farm machinery, power processing and storage facilities, used in irrigation and to transport crops and food.

A United Nations report issued Friday showed more than 10 million people do not have enough food to last until the next harvest. Last year’s crop was the worst in a decade, it said, and was buffeted by dry spells, heat waves and flooding.

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But it also found that “limited supplies of agricultural inputs, such as fuel, fertilizer and spare parts have had significant adverse impact.”

The Food and Agriculture Organization and World Food Program spelled out “the unintended impact of sanctions on agricultural production,” most obviously “the importation of certain items that are necessary for agricultural production.”

North Korea suffered a disastrous famine in the mid-1990s that left hundreds of thousands — or perhaps millions — of people dead, according to some estimates. While there is no indication of anything of that nature on the horizon, Smith predicts a looming crisis.

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While the North Korean government is responsible for the health and welfare of its citizens, Smith said that did not mean the U.N. or international community had the legal or ethical right to push sanctions to the point where they potentially “starve a population in retaliation for government wrongdoing.”

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There are several important caveats.

There is a serious lack of reliable information about what is happening inside North Korea, and access for even the U.N. is limited.

North Korea is extremely adept at circumventing sanctions, and residents have developed extensive coping mechanisms since the 1990s, including private markets, family sharing networks and kitchen gardens.

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Evidence collected by the Daily NK website suggests that rice prices in those private markets — at least in regions bordering China — have remained stable. But humanitarian workers say a shrinking economy has undermined people’s ability to pay at any price. The U.N. also recorded of prices of eggs, fish, cabbage and potatoes doubling or rising threefold.

In March, a U.N. panel of experts on North Korea argued that sanctions were impeding humanitarian work by, for example, restricting imports of machinery needed for food processing, as well as filters, pipes or drills needed to provide clean water.

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Many experts also believe U.S. and Japanese pressure prompted the Global Fund to Fight AIDS, Tuberculosis and Malaria to end its program to fight TB in North Korea last year, at the height of the “maximum pressure” campaign.

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Kee Park, director of North Korea programs for the Korean American Medical Association, said the decision to halt the TB work could lead to an additional 200,000 deaths over the next five years, as well as accelerate the spread of multi-drug-resistant strains of TB.

“While we’re trying to change the behavior of these regimes, innocent people are starving and not getting basic medical needs met,” he added. “To deny critical humanitarian assistance while we’re trying to put pressure on the government to change, I think is immoral.”

The State Department says the administration is aware of reports of food shortages in North Korea and “deeply concerned about the well-being of the North Korean people.”

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“U.S. policy is to ensure that the strict implementation of sanctions does not impede the delivery of legitimate humanitarian assistance to the North Korean people,” said a State Department email.

And with North Korea showing images of Kim “supervising” weapons tests, and of luxury goods in a Pyongyang department store, it can be hard to generate sympathy.

In March, Tapan Mishra, the U.N.’s resident representative in Pyongyang, asked donors to “rise above political and security considerations” and contribute $120 million for food and medical aid, mainly for women and children under 5.

But last year’s appeal received less than a quarter of requested funding, Mishra said. Without a better response this year, programs helping millions of people could be cut.

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North Korea’s public food distribution system — which many people depend upon — has cut rations to just 11 ounces a day, the lowest ever level for this time of year, the U.N. says. Further rations cuts are possible in the June-October lean season before the next harvests.

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The U.N. report also found “worryingly low food consumption levels, limited dietary diversity and families being forced to cut meals or eat less,” noting that young children and pregnant mothers were particularly at risk of malnutrition.

The State Department responded by saying the regime could fully meet the U.N. appeal by redirecting money from its nuclear and missile program.

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Joshua Stanton, a lawyer who worked on North Korea sanctions for the House Foreign Affairs Committee in 2013, argued that the U.N. has been pouring money into North Korea for decades without enough to show for it.

“Are we solving this problem, or are we unwittingly perpetuating Pyongyang’s use of food as a weapon and use of its hungry as human shields against sanctions?” he asked.

But Robert King, a former State Department special envoy for North Korea human rights issues, said this argument does not absolve outsiders of responsibility to help.

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