The United States has become one of the largest donors of food to impoverished North Korea, sending shiploads of corn, rice, flour and other food despite misgivings about where some donations end up.
The Bush administration intends to continue the assistance, officials say, in spite of those concerns as well as recently renewed tensions over nuclear weapons.
The United States has given a total of about 1.9 million metric tons of food since 1995 -- ranging from corn, rice, wheat, and flour to vegetable oil and powdered milk. The European Union, Japan and South Korea also have chipped in to try to reverse a famine that has been blamed for more than 3 million deaths.
But not every hungry North Korean is fed.
The communist government restricted the United Nations' World Food Program, which distributes the food aid, to serving 162 of the country's 206 counties. That leaves 13 percent of the 22.6 million North Koreans without aid.
The limitation has frustrated program officials.
"We have a serious issue with access because we would wish to see food assistance provided to all the people in the country who need it," said John Powell, director of the World Food Program's Asia bureau.
Powell said the North Korean government has blocked UN food aid workers from randomly checking distribution sites to ensure the food is going to hungry people.
The United Nations is urging countries worldwide to support a new $201 million emergency operation in North Korea with the hope of feeding 6.4 million vulnerable people, including children, mothers who are nursing newborns, and the elderly.
Tensions have flared recently between the United States and Pyongyang over North Korea's renewed pursuit of nuclear weapons. And President Bush this week accused North Korean leader Kim Jong Il of starving his people. "One of the reasons why the people are starving is because the leader of North Korea hasn't seen to it that their economy is strong or that they be fed," Bush said.
Despite those concerns, the Bush administration remains committed to providing food to feed the country's hungry, Agriculture Department Undersecretary J.B. Penn said Thursday.
North Korea has relied on donations partly because it hasn't been able to grow enough food to nourish its people, even though it has tried, said Marcus Noland, an economist at the Institute for International Economics.
Hunger became more prevalent when North Korea's industrial economy started to collapse in the 1990s. To ward off the problem and boost its economy, the country expanded food production, but the effort required an intensive and costly system of agriculture.
The mountainous land is not ideal for farming. Heavy rain soaks the country in the summer and the growing season is short. To increase production, farmers had to use more pesticides, chemicals and high-powered equipment, said Noland, author of the book "Avoiding the Apocalypse: The Future of the Two Koreas."
The government also began using more land for food production by chopping forests. It was a mistake that disrupted the ecosystem, exposing land to the monsoons that washed away top soil and caused floods, Noland said.
Although North Korean officials blame the starvation problem on nature, "the fact of the matter is that's simply the icing on the cake," Noland said. "It was really the collapse of the industrial economy. It was the deforestation of the hillsides."
It's estimated that nearly 3 million North Koreans died of famine in the mid- to late 1990s, but Noland said he suspects many more than that have suffered.
"My gut feeling is when we finally pull the rock up, we're going to find something that's pretty ugly," he said.