More than 1 million people perished in the devastating famine in the mid-1990s due to natural disasters, the collapse of the PDS (Public Distribution System) and gross government neglect and mismanagement. Thirty-three percent of the population is undernourished, 23 percent of children under the age of 5 are underweight, and a near-total breakdown in the public health system has left an entire generation of children physically and mentally impaired.

North Korea relies heavily on international food aid. Less than 23 percent of its land is arable, as farmers removed trees for food, resulting in deforestation, soil erosion, nutrient depletion and increased susceptibility to flooding. As of April 2010, North Korea's grain shortfall has been estimated at 1.3 million tons, and the World Food Programme has estimated that 6.2 million North Koreans are short of food.

Because of discriminatory food distribution and transparency issues, continuing food aid has been a challenge for many NGOs inside North Korea. Due to these issues and a decrease in donor support, World Food Programme may be forced to withdraw efforts by summer 2010.