Relief agencies estimate that around two million people may have died in total, but precise information is hard to obtain because of the closed and secretive nature of the regime.

Refugees who escaped over the border to China say that the world is only seeing a fraction of the suffering.

In April, one 26-year-old refugee told the BBC: "In my home town there has been no distribution at all since 1994.

"Half the people in the town have either died or disappeared".

Others reported that food aid was being siphoned off by the military and government officials.

Roots of famine

In the past 50 years, North Korean has made much of its policy of Juche or self reliance, but despite the use of improved seeds, fertilisers and irrigation, it is still unable to feed itself.

The situation has become more difficult with the near-collapse of the centrally-controlled economy.

And negative growth for most of the past decade has been combined recently with a series of natural disasters.

Two successive years of floods in 1995 and 1996, followed by a typhoon and a drought in 1997 destroyed much of the country's crops and left hundreds of thousands of people homeless.

But disasters such as these have also been blamed on North Korea's push for self-sufficiency.

For example, by trying to expand land under cultivation, trees were cut down making vast areas of the country even more prone to flooding.

Even the most optimistic projections for 1998 suggest domestic cereal production will cover less than half the country's minimum food needs.

Food Aid as a cold war weapon

Aid is arriving but is it reaching those who matter?

The United Nations launched its fourth appeal for North Korea in February 1998, including nearly 700,000 tonnes of food from the World Food Programme and support to health services to prevent widespread malnutrition and disease among children.

The aid is targeted to meet the needs of nearly 7m people, of which more than 5m are children.

But the worsening situation and the necessary calls from more aid is also creating an acute dilemma for foreign governments.

Many critics, in the US and elsewhere, say that providing too much aid will merely prolong and stabilise the regime.

They also say the North exaggerates the crisis to gain increased aid and political concessions.