Grim conditions

Tensions ran high on the 57th anniversary of the armistice that ended the Korean War, as U.S. and South Korean ships conducted high-profile military exercises off the Korean peninsula aimed at warning North Korea against aggressive acts.

The maneuvers came four months after a North Korean submarine torpedoed a South Korean warship, killing 46 sailors in the worst attack on South Korean troops since the end of the Korean War in 1953.

North Korean officials denied the attack and warned against the military exercises in international waters, but the regime didn't show immediate signs of retaliation. The maneuvers included nearly 8,000 sailors and the USS George Washington-a massive U.S. naval ship that can accommodate 70 aircraft and 5,000 troops.

"It's a show of force, a deterrent," said U.S. Capt. Paul Hogue. "I think it's gotten their attention."

Meanwhile, deep in North Korea an internal catastrophe garnered far less attention: Amnesty International issued a devastating report on the country's healthcare system based on interviews with North Korean defectors. The witnesses told Amnesty that hospitals are ill equipped and that many citizens go without basic healthcare. They described grim conditions, including doctors sometimes performing amputations without anesthesia and working by candlelight in hospitals lacking electricity.

The report raised the hackles of the World Health Organization (WHO)-the UN body that issued a nearly glowing report on North Korea's healthcare system in April, reporting "no lack of doctors and nurses." WHO officials contended that Amnesty workers relied on a small number of witnesses removed from North Korea.

But since North Korean officials intensely monitor outside observation of conditions in the country, defectors or secret witnesses are often the only source of unfiltered information about true conditions. Open Doors International-a U.S.-based group supporting persecuted Christians-reported a conversation with a Christian from North Korea in July. The anonymous witness described frightening conditions. "It is downright chaos and utter panic," he told the group.

Part of the panic comes from North Korea's monetary policies that have badly devalued the currency since last November and wiped out the life savings of many citizens. Prices are soaring, and North Koreans are hoarding cash that has less and less value. Food shortages are gripping many regions, and some fear another famine akin to the disaster that killed massive numbers in the 1990s.

"Recently I saw a group of schoolchildren walking along the road," said the North Korean Christian. "They were picking up grass and plants. The school requires them to collect a daily amount of plants and herbs for the school [to eat]." The UN estimates that some 8.7 million people already need food aid in North Korea.

Helping North Korean citizens while punishing the regime's reckless policies remains a diplomatic and humanitarian tightrope. U.S. Secretary of State Hillary Clinton announced intensified sanctions against North Korea in response to the sunken South Korean ship, but she emphasized the actions "are not directed at the people of North Korea."