During the North Korean famine of the 1990s, orphanages bore a disproportionate share of the crisis’s impact, struggling to care for children amid widespread food shortages and limited governmental support. The famine, which devastated the country’s population, was largely unacknowledged by North Korean authorities, who reported that approximately 225,000 people had died. However, estimates from outside sources, including a U.S. Agency for International Development (USAID) administrator, suggest that the death toll may have reached as high as 3.5 million, representing between 10% and 19% of North Korea’s population at the time.

The famine left many residents without access to sufficient food, as the government, previously the primary provider, was unable or unwilling to meet the population’s needs. Orphanages and children’s homes became focal points of the crisis, facing the challenge of caring for hungry and malnourished children without the necessary resources. Aid workers who operated during this period recalled the stark conditions in these facilities. According to Kathi Zellweger, an aid worker featured in the book "Miss Kathi: Saving Lives in North Korea," orphanage staff expressed bewilderment over the sudden necessity of addressing child hunger, a situation they had never previously encountered.

Despite facing hardship themselves, the orphanage workers demonstrated dedication and care toward the children in their charge, striving to provide support amid scarcity and distress. Zellweger detailed visits to several children’s homes, highlighting both the visible effects of starvation on children and the efforts of staff to maintain their welfare in an extremely challenging environment.

The book also features interviews with North Korean families whom aid workers encountered during their missions. One account describes a family that outwardly appeared to possess luxury items, such as a cassette recorder playing country music by Kenny Rogers. This anecdote underscores the complex layers of survival and perception during the famine, with some families maintaining certain possessions despite pervasive deprivation.

The full scope of the famine’s human toll remains subject to debate, due in part to North Korea’s tight control over information. Nevertheless, available accounts emphasize the severe hardships faced by society’s most vulnerable groups, particularly children in state-run facilities left largely to endure the crisis with minimal external assistance.