During the Cold War era, health care was at the forefront of ideological battles between the two Koreas. North Korea boasted of constructing one of the top-ranked public health systems in the 1970s. However, the North Korean health care system virtually collapsed after the prolonged economic hardships during the ‘Arduous March’ in the late 1990s. According to a survey conducted in 1999, 89 percent of North Korean refugees reported the experience of ‘illness without access to medical care’ (Lee et al., 2001). The current status of mental health in North Korea should be understood in the light of this historical context.