Millions of North Koreans experience chronic food shortages, which have had a dramatic impact on their health and wellbeing, says the World Food Programme (WFP).
The mountainous country cannot produce enough food to feed its people because it lacks agricultural land, high-quality seeds, fuel, fertiliser, and even decent storage facilities, says Human Rights Watch. Floods and droughts often make matters worse.
During the annual April-October "lean season" before the autumn harvests, many North Koreans are forced to eat fewer and smaller meals and gather wild foods. Urban residents often rely on remittances from friends and relatives in rural areas, who generally have better access to food.
The country's northeast has the worst food shortages, according to FAO.
Humanitarian aid – which includes food and much-needed fertilisers – is limited by donor fatigue, and international sanctions have shrunk the country's foreign exchange earnings and affected its ability to buy food from overseas. A disastrous currency reform in November 2009 wiped out ordinary people's savings, triggered spiralling inflation and led to a further drop in food imports.
The country's public distribution system was the main source of food for most North Koreans until the system broke down during the famine in the mid-1990s. Gradually the regime allowed a limited form of commercial trading to develop and the majority – bar high-ranking officials who receive full food rations – began to rely on markets to survive.
But in 2005 the state began to clamp down on the market system, and reimposed its control over the population by reverting to the public distribution system which was in fact unable to meet people's needs. The botched currency reform in 2009 was aimed at cutting into the power of the burgeoning merchant class. It prompted rare social unrest.
"What should not be forgotten, however, is that the country is not poor ... the resources of the country are misspent, misallocated and misused on the elite and the 'military first' policy to the detriment of the populace. Such is the injustice – latent, patent and blatant," the former U.N. Special Rapporteur on human rights in North Korea, Vitit Muntarbhorn, said in February 2010.
The country's healthcare has also deteriorated since the 1990s. North Korea has no shortage of doctors and nurses, but drugs, equipment and even antiseptics are in short supply or non-existent. Many people do not have access to clean water, according to the 2012 survey carried out by Korean authorities and U.N. agencies.
The world has committed billions of dollars in food aid, but comprehensive aid programmes have been hampered by government obstruction and international fears over North Korea's nuclear ambitions.
A critical issue has been the restrictions the North places on aid workers' ability to check where the food ends up. WFP donors say monitoring is vital to ensure that aid is not diverted to the military or the ruling party which has been accused of appalling human rights abuses.
WFP has a principle of "no access-no food" and international staff monitor distribution. But aid workers have to obtain official permission to access areas and are often obliged to use local interpreters. However, WFP was allowed to use interpreters of any nationality in its emergency operation launched in April 2011, and its staff were given unprecedented access to vulnerable regions to oversee WFP’s operations.
North Korea has also relied heavily on bilateral aid from China and South Korea, which do not insist on monitoring.
But the South turned off the tap in 2008 with a new government saying its future generosity would depend on Pyongyang's progress in abiding by an international nuclear pact and other political issues.
In 2008, the United States pledged to give 500,000 tonnes of food aid to North Korea – its first bilateral assistance in eight years. The bulk of it was to be distributed through the WFP, and 100,000 tonnes of food through five U.S. non-governmental organisations (NGOs). Distribution began in July after North Korea agreed to relax restrictions on aid agencies' ability to monitor deliveries in an unprecedented deal. But this was stalled by the North Korean government in 2009, and the NGOs distributing the food were thrown out of the country.
In 2010, former U.N. Special Rapporteur Muntarbhorn said this may have been because the government rejected closer international monitoring of aid procedures and because of fears the aid groups might start using Korean-speaking interpreters from outside the country.
Pyongyang has since reached out to dozens of countries and organisations around the world for aid, complaining that bad weather, rising global food prices and the termination of aid had slashed supplies.
In March 2011, the United Nations estimated that more than 6 million people needed food aid, , and a third of children were chronically malnourished or 'stunted'.
In May, South Korea said it suspected Pyongyang of exaggerating the food crisis and of trying to hoard food ahead of a nuclear test, which would likely provoke a tightening of international sanctions. Some South Korean officials also said the North might be trying to stockpile food to give away as part of the 2012 celebrations to mark the centenary of the birth of the state's founder, Kim Il-sung.
In July, the European Commission said it was convinced that the North's pleas for help were genuine and announced an aid package aimed at severely malnourished children under five years old who had already been hospitalised.
In 2012, North Korea asked the United Nations for urgent food aid after devastating floods in July.
A survey carried out by the government and U.N. agencies in late 2012, found that nearly 28 percent of children under the age of five were chronically malnourished.
Chronic food insecurity affects two-thirds of the country's 24 million people, the Assessment Capacities Project said in April 2013.
And an estimated 2.8 million people face severe hunger and need international food aid, most of them in the northeast provinces of the country, an April 2013 report by the United Nations’ Food and Agriculture Organization (FAO) said.
But reluctance by donors continue to hamper WFP’s operations in the country. Its emergency food aid operation that ran from April 2011 to June 2012 was only 30 percent funded.
In the 1990s North Korea suffered one of the most destructive famines of the 20th century. No one knows how many people died, although analysts say it killed at least 1 million people, and between 3 and 5 percent of the population.
Since then the country has been heavily reliant on international food aid.
So how did the country end up in this mess?
Pyongyang points the finger at a series of natural catastrophes but this is not the whole story.
After World War Two the Korean peninsula split in two. The U.S.-backed Republic of Korea proclaimed sovereignty in the South and the Soviet-backed Democratic People's Republic of Korea (DPRK) did the same in the North.
The North invaded the South in 1950 hoping to unify the peninsula. The conflict ended with an armistice in 1953. Since then South Korea has grown into one of Asia's most affluent countries, while the North has slid into poverty.
Before the split, the southern part of the Korean peninsula was the traditional rice basket for the whole country. After the split, the Communist north collectivised agriculture and set up a public distribution system to distribute food according to age, occupation, region, and political loyalty. This was an important means of political control and the main source of food for most North Koreans until the system broke down during the famine in the mid-1990s.
The man who shaped North Korea was its founding father and "eternal president" Kim Il-sung who introduced a philosophy of juche, or self-reliance. But this strategy has caused major problems given that only a fifth of the land is arable and the climate is less than favourable.
Despite its commitment to self-sufficiency, North Korea actually relied heavily on its socialist allies for products including fertiliser and insecticides. With the collapse of the Soviet Union it found itself in dire straits.
Although China continued to supply petroleum and food, this was no match for the help once received from the Soviet Union. And China itself was changing and increasingly wanted hard currency for its exports.
As outside assistance fell, so did government rations via the public distribution system and the annual farm workers' grain allowance. In 1991, the government initiated a "Let's eat two meals a day" campaign.
Kim Il-sung died in 1994 and was succeeded by his son, Kim Jong-il, referred to as "Dear Leader" in state media. The succession marked the only time in history that rule of a communist state has passed from a father to a son.
Death rates in North Korea were rising by 1994, if not earlier, and by the spring of 1995 the situation had grown desperate enough for Pyongyang to ask Japan and South Korea for emergency assistance. But things were about to get worse.
In the summer of 1995 the country was hit by floods. The effects were exacerbated by soil erosion and river silting caused by previous deforestation that was the result of North Korea's efforts to increase cultivation. There were more floods in 1996.
But as aid began arriving in North Korea, the country took the curious step of reducing its commercial imports, diverting the money it saved to other priorities including the military, according to the Hunger and human rights in North Korea report by the U.S. Committee for Human Rights in North Korea.
In 1999, at the same time as North Korea was cutting grain imports, it spent scarce foreign exchange on 40 MiG-21 fighters and eight military helicopters from Kazakhstan, the report's authors say.
"Times would have been tough under almost any policy, but a famine killing 3-5 percent of the population was not pre-ordained," they add.
1945 - Independence from Japan
1948 - Democratic People's Republic of Korea (DPRK) formally established
1950 - North Korea invades South Korea
1953 - Korean war ends in an armistice
1987 - Government food rations reduced following first cut in Soviet assistance
1991 - DPRK initiates a "Let's eat two meals a day" campaign
1994 - Kim Il-sung dies. Mortality rates are on the rise. Severe hailstorms
1995 - As food shortages worsen the DPRK asks for help from Japan and South Korea. First shipment leaves for DPRK in June. WFP begins operations in North Korea
Jul-Aug - Severe floods. DPRK says a fifth of the population is affected
Oct - DPRK signs a framework agreement with the U.S. to freeze its nuclear programme in exchange for two light-water nuclear reactors
1996 - Severe floods. Some 16 percent of arable land is destroyed in 1995-1996
1997 - Drought hits fertile west coast June to August
1998 - Kim Il-sung declared Eternal President
Aug - U.S. congressional team says famine has killed 300,000 to 800,000 people a year in the past three years. U.N. food brought in to help famine victims
1998 - Kim Jong-il named head of state
2000 - The leaders of North and South Korea meet for first time in Pyongyang. Drought and serious tropical storms strike
2001 - DPRK says has worst spring drought in its history
2002 - Piecemeal economic reforms. Unemployment rises, as do prices of staple foods
Jan - North Korea withdraws from Nuclear Non Proliferation Treaty aimed at preventing spread of atomic weapons. American officials say North Korea has told the United States it has nuclear weapons and might test them or transfer them to other countries
2004 - DPRK cereal rations are 200-250g - half the recommended daily amount
Aug - DPRK asks WFP to switch from humanitarian assistance to long-term development programmes
Sep - DPRK signs agreement to scrap its nuclear programmes in exchange for aid, security assurances and greater diplomatic recognition
Oct - Cereal rations raised to 500g per person per day
Nov - 19 food factories established by WFP are closed down
Dec - WFP pulls out amid disagreements over monitoring of future aid
May - WFP signs agreement with DPRK, paving the way for a two-year plan to help 1.9 million people
Jul - DPRK defies international warnings and test-fires seven missiles. The country is hit by major storms, causing floods that kill hundreds and displace tens of thousands
Aug - DPRK initially turns down offers of aid, but later accepts humanitarian assistance from South Korean Red Cross and WFP. The South Korean government suspends regular rice aid in protest at the missile tests
Oct - North Korea says it has carried out a nuclear test, prompting condemnation from around the world, including key aid supplier China
U.N. Security Council votes unanimously in favour of imposing sanctions in response to the nuclear test. International funding for relief programmes drops sharply, despite the fact the sanctions exclude humanitarian aid
Nov - Analysts and aid workers warn that North Korea is slipping back into a famine that could trigger a mass exodus of refugees
Dec - U.N. agencies issue dire warnings for North Korea. They report that summer floods decimated domestic food production, placing an already vulnerable population at risk of rising malnutrition during the harsh winter months
Feb - Six-nation talks in Beijing yield an agreement from Pyongyang to take steps towards nuclear disarmament in exchange for energy aid
Mar - Seoul announces it plans to resume fertiliser shipments to the North in time for spring sowing
North Korea admits to food shortages of a million tonnes. WFP warns millions of people are vulnerable to hunger in the absence of better donor support
Aug - U.N. appeals for $15 million to deal with the aftermath of severe flooding, which it says killed more than 450 people and affected over 960,000
Oct - Leaders of the two Koreas hold second summit. They agree to seek talks with China and the United States for a peace treaty
Nov - Prime ministers from both Koreas meet for first time in 15 years to discuss details of massive aid package to help rebuild impoverished North's infrastructure
Dec - The two Koreas start their first regular train service since the 1950-1953 war
Early 2008 - New South Korean government ties aid to Pyongyang's progress in nuclear disarmament
Apr - WFP says North Korea experiencing acute food shortages
May - United States announces 500,000 tonnes of food aid
Jul - WFP expands operations, and warns country is experiencing its worst food shortages since 1990s famine. WFP and five aid agencies start overseeing delivery of U.S. aid after North Korea eases restrictions on their ability to monitor distribution
Aug - Kim Jong-il suffers a stroke
Mar - United States says North Korea has refused any more U.S. food aid supplies, and thrown out five aid groups
Apr - North Korea walks out of six-nation talks on its nuclear programme, after U.N. Security Council criticises its launch of a rocket carrying what North Korea describes as a communications satellite. Parliament re-elects Kim Jong-il as leader
May - North Korea carries out underground nuclear test
North Korea says it is no longer bound by the terms of 1953 armistice
Jun - U.N. Security Council imposes tougher sanctions on North Korea
Oct - U.N. envoy describes human rights in North Korea as "abysmal"
Nov - Currency reform wipes out people's savings, worsens food shortages, causes spiralling inflation and triggers public protests
Feb - Reports emerge that government has eased restrictions on private markets
May - Investigators say North Korea sank South Korean warship in March
Sep - United States imposes new sanctions in response to sinking of South Korean warship
Two months of floods destroy crops. South Korea sends rice aid to North for first time in three years
Kim Jong-il gives his youngest son Kim Jong-un his first public title, naming him a general what analysts say is the first stage of dynastic succession
Oct - Kim Jong-un confirmed as heir apparent
Nov – Pyongyang discloses a uranium enrichment facility with potential to produce nuclear weapons, claiming it is for civilian nuclear power. ; Seoul turns down Pyongyang's requests for food and fertiliser aid
Feb – Foot and mouth disease threatens to worsen food crisis
Mar – United Nations says more than 6 million people are in urgent need of food aid
Apr - Former U.S. President Jimmy Carter visits North Korea and says withholding food aid is a human rights violation. WFP launches emergency operation to reach 3.5 million
May - U.S. special envoy for human rights, Robert King, leads a U.S. team to North Korea to assess its pleas for food
Jul – EU announces aid package targeting severely malnourished young children, saying over half a million people at risk of dying
Dec - Kim Jong-il dies of a heart attack at the age of 69, and is succeeded by his youngest son Kim Jong-un
Aug - Floods, that began in July and were followed by a typhoon, affect an estimated 700,000 people. The United Nations says North Korea is urgently seeking food aid
Feb - North Korea carries out a third nuclear test
Mar - U.N. Security Council approves fresh sanctions against North Korea in response to nuclear test
U.S. and South Korea begin annual joint military exercises
Apr - North Korea warns foreigners to leave the region to avoid the threat of war
North Korea asks Mongolia for food aid