For aid-givers to North Korea, the overriding concern is keeping North Koreans from starvation regardless of sanctions.
"We take the news that the internal situation is deteriorating very seriously," says Kay Seok, North Korean researcher for Human Rights Watch. "The right of food is one of the most fundamental human rights. If you die of hunger, what is the point of talking about freedom?"
But others wonder about the degree to which food aid is alleviating suffering.
"Reports show the malnutrition rate did not improve very much" as a result of food donations, says Joanna Hosaniak, senior officer with the Citizens Alliance for North Korean Human Rights, which aids North Korean refugees.
"Refugees from the northern part of North Korea say they didn't receive humanitarian assistance, or it was diverted after the monitoring group was gone," she adds.
The only solution, she says, is for North Korea to "divert resources from developing nuclear weapons to feeding its people."
Erica Kang at Good Friends, a South Korean group that analyzes North Korean issues and advises on policies, summarizes the aid conundrum.
"Everyone wonders if they should go on with humanitarian aid," she says. "It's pretty much the ordinary people who suffer the most. This is a winter coming. Thousands of North Koreans are suffering the consequences of problems they didn't make."
[Excerpt of an article by Donald Kirk, The Christian Science Monitor]