North Korea's public food distribution broke down in the nineties, and ever since then, the nation has careened between beggary and starvation.  Other governments, meanwhile, have glumly faced two unappetizing choices: donate food which will be diverted to prop up the regime, or allow even more North Koreans to starve.

Amid the food shortages, though, humanitarian experts describe another failure: the international aid effort. Outsiders have yet to devise a formula that reaches basic standards for monitoring or effectiveness. After 15 years and about $2 billion of aid efforts, one in four pregnant women is malnourished and one in three children is stunted.

The government places obstacles at every step of the distribution process - the top complaint from U.S. officials, who demand better transparency before aid resumes.

Sen. Richard G. Lugar (Ind.), the ranking Republican on the Senate Foreign Relations Committee, released a statement this week calling it "essential" that U.S. assistance is "actually received by hungry North Korean children and their families, rather than reinforcing the North Korean military whose care is already a priority over the rest of the population."

Researchers and nongovernmental organizations disagree on the proportion of food aid the North Korean government diverts, with estimates ranging from 10 to 50 percent. Diverted food aid, according to experts, is given to the military, redistributed as gifts for elites or resold - at a steep profit - to vendors in markets. John Everard, the British ambassador in Pyongyang from 2006 to 2008, said he saw rice bags labeled "World Food Program" in market halls.

In recent years, North Korea has often banned food aid monitors from traveling to the most vulnerable provinces. It also demands that monitors do not know Korean. Though North Korea makes exceptions, Prior said, it generally demands seven days' notice before monitors can visit an area.

Kim Seong-min, a former North Korean army propaganda officer who defected, said he once saw a ton of rice aid arrive at a distribution center. The military distributed the food in a village at a monitor's request but later went door to door retrieving it.

"I remember some of the collection officers were complaining about not being able to collect 100 percent of the rice," Kim said.

Partly influenced by earlier distribution challenges, the WFP last July tailored its operation in North Korea exclusively to women and children, targeting hospitals, orphanages and schools. The program gave out blends of milk and rice or milk and cereal - concoctions unlikely to be presented as gifts to the most loyal cadres.

The US ceased to give aid two years ago, and I can't say the government is wrong.  I can't say the government is right, either--as I once heard a former emerging market government official say about his work, "the choice always seemed to be between the horrible and the disastrous, and it was never obvious which was better."  There's no question that any food aid helps prop up the regime, ensuring that the semi-starvation of huge swathes of North Korea's population will continue.  On the other hand, if we don't deliver it, even more people will go hungry right now.

Policy choices are often framed for us as a choice between compassion and something else--selfishness, moralism, rigid rule-following.  But when you take into account systemic effects, the "obvious" compassionate choice--the one that our hearts urgently impel us towards--often isn't so obviously the best one.  North Korea had a bad harvest this year, but the problem isn't their bad harvest--it's a political and economic system that leaves the country forever one harvest away from utter disaster.  

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.