This is a gripping book. The six defectors interviewed by Demick describe North Korea as a totalitarian state in a post-apocalypse condition. That's why the visions of Orwell and McCarthy come to mind.
North Korea suffered two tragedies. The first one was the split of the Korean peninsula at the end of WWII and Stalin installing a like-minded dictator at its helm, Kim Il-sung. The latter eradicates religion and replaces it by his own cult of personality. In achieving a God status in his country, he bests Stalin, Hitler and Fidel Castro. Upon his death in the early nineties, many North Koreans will commit suicides. And, North Koreans will believe (through intense political propaganda) that if they cry enough Kim Il-sung will come back from the dead. The son of Kim Il-sung, Kim Jong-il will succeed him as a son of God.
North Korea's second tragedy was the collapse of the Soviet Union. When the latter collapsed it interrupted its assistance in food and oil. North Korea did not have enough fuel on its own to maintain its electrical grid. On the first page of the first chapter you see a picture of the Korean peninsula at night. South Korea is full of bright spots (urban areas lit by electricity). But, North Korea is pitch dark! In the post Soviet Union era, North Korea suffers shortages of electricity, running water, and food. Millions have already died of starvation. People are not paid. They are compensated by food rations. But, if you don't work you don't eat. The ones who don't receive food attempt to survive by milling bark, grasses, shrubs, leaves.
The majority of the country still suffers from malnutrition. Millions more would die if not for foreign assistance. But, the government misallocates food assistance by giving it to the ones who need it the least such as the army and the Pyongyang residents. Meanwhile, rural areas are starving. Within the book, a defecting doctor describes it best as she crossed the border in China and finds a full bowl of rice served to a dog and stated "dogs in China eat better than doctors in North Korea."
While Koreans physical attributes were reasonably homogeneous a while back, they have since diverged dramatically. The North Koreans are half a foot shorter and tens of pounds lighter because of malnutrition. North Koreans born in the late eighties to early nineties are recognizable as they are shorter with heads disproportionately large relative to their bodies with overly thin and frail limbs.
In the early nineties before foreign aid rallied after the collapse of Soviet Union subsidies, society took a McCarthy's turn with many crimes, suicides, and even cannibalism (homeless orphans overtaken by starving adults in remote areas).
Only a totalitarian State could prevent such a society to fall into chaos. Kim Il-sung and Kim Jong-il have created a cult of personality supported by an obsessive self-surveillance society. North Koreans main activity is reporting on each other. The surveillance starts from the bottom up with "people's group" were everyone reports on everyone else. At dinner if you expressed a mild criticism of the current regime, you could be reported by a neighbor. Soon, after you could be abducted by the police and disappear in a camp forever. Many surveilling police forces are very specialized. If you sleep with your lover, a specialized police force can barge in the middle of the night and ask your lover for its travel permit. If the adequate documents are not produced the person can end up in prison. Another specialized police force watches that people wear the correct garments with the buttons showing support for the regime. Another one checks in that your TV or radio (a few people have electricity for a few moments a day) is set on the proper North Korean program. If you tweaked this equipment to listen to South Korean programs, you can incur severe punishment including death. Another police force makes sure that the portraits of the dictators are clean. If not you are in trouble.
Society is categorized in three classes: 1) the core class representing the professionals and government leaders; 2) the wavering class representing some sort of middle class; and 3) the hostile class representing entertainers, artists, nonproductive elements, and everyone of foreign origins. The hostile class is the one most intensely spied upon by others. Thus, it is most vulnerable to be imprisoned in camps and gulags for no obvious reason.
Propaganda is relentless. The dictator is the benevolent father of the nation. Without his hard work and superior intelligence you would be dying of starvation twice as fast as you are. Everybody else is the enemy. This includes Americans, Chinese, South Koreans, and even Russians and East-Europeans who failed at communism because of their genetic weakness. Capitalism is rotten. In other words, you have "Nothing to Envy."
Meanwhile, reality is stunningly bad. Chapter 7 describes the decrepit health care system. Hospitals lack all basic supplies and remedies. Many operations are conducted without anesthetic by tying the patient to boards. Children come in the hospitals and die because their weakening bodies from starvation can't fend off mild colds or flues that escalate into pneumonia. Chapter 8 describes the conditions in school that are equally horrible. Given that schools are broke, children are required to bring a ration of wood for heating and their own lunch. A teacher/defector observed a tragic pattern. At first, the children stop bringing their ration of wood. Next, the children don't bring their own lunch (and therefore don't eat during the day). And, soon after children do not even attend school.