As the international community struggles to cope with the political ramifications of a nuclear North Korea, a growing exodus of refugees into China is threatening a humanitarian crisis on the Korean peninsula.
It is a crisis that is taking place almost invisibly as the world's attention is focused on the North Koreans' nuclear test on 9 October, which led to concerns about whether the secretive Stalinist state is stable or on the brink of collapse.
"Clearly, the primary responsibility for the mounting humanitarian tragedy lies with North Korea but the international community has failed to find an effective means of dealing with the situation," said Peter Beck, a Korea specialist at the International Crisis Group (ICG), which has just launched a report, Perilous Journeys: The Plight of North Koreans in China and Beyond".
The International Crisis Group says famine is approaching in the North. This winter is expected to be a cold one and summer floods destroyed a portion of the country's harvest.
This natural disaster combined with less aid because of the nuclear crisis and Pyongyang's refusal to allow charities to monitor distribution, could mean no food this winter, as it did in the mid-1990s when millions died of hunger. Thousands of North Koreans are risking their lives trying to escape their country's hardships.
Already, around 100,000 North Korean asylum-seekers are hiding in China, many in the north-east, facing anything from imprisonment to execution if they are caught and deported by Chinese police. Pregnant women who conceive abroad suffer forced abortions, the report says.
In his book Aquariums of Pyongyang - reportedly one of President George Bush's favourite reads - the North Korean gulag survivor Kang Chol-hwan describes the difficult routes and complex underground networks that defectors must follow to escape to freedom. Mr Kang, who survived the notorious Yodok gulag, was protected by prostitutes in a brothel in Dalian and eventually made his way to the South. He was one of the lucky ones - China repatriates between 150 and 300 North Koreans a week. To date, an estimated 9,000 North Koreans have made it to South Korea.
In situations that have parallels with East and West Germany before the Berlin Wall came down in 1989, defectors say many North Koreans are now aware of the better living standards in the South, having watched videos from the south and heard broadcasts on Radio Free Asia or Voice of America.
Increased cross-border trade is also helping information to spread.
The international community needs to do more to help thousands of desperate North Koreans who are fleeing their country or it may find the nuclear crisis with Pyongyang even more difficult to resolve.
The ICG said the key to improving the situation was China, which is still Pyongyang's main ally despite a strain on relations since the North tested a nuclear device seemingly against Beijing's wishes.
China should be encouraged to treat the refugees more humanely, by ending forced repatriation, removing fines for those who shield refugees and abolishing bounties of over £200 for information on anyone helping those fleeing the North.
Also, neighbouring countries should not turn North Koreans crossing from China back to Chinese authorities, but instead contact either South Korea or the UN High Commissioner for Refugees (UNHCR).
"Having been most vocal about North Korean human rights, the US and the EU member states should recognise and accept many more of these people for resettlement," the ICG report said.
China is worried that what is currently a sizeable trickle of refugees could become a deluge if North Korea's economy collapses under too-tough sanctions. It insists the North Koreans are illegal immigrants and has recently been building a wire fence on its side of the river border with North Korea.
Many embassies in Beijing have also had wire fences installed in recent years to stop a regular stream of North Korean defectors scaling the walls. In the past few years, desperate North Koreans have sought asylum in the German and Canadian missions, arriving in the compounds with their hands torn by razor wire and their clothing ripped to shreds.
"We have tried our utmost to give humanitarian treatment to those people, but on the other hand, they have entered Chinese territory illegally. We will deal with them in accordance with domestic and international law," said Liu Jianchao a Foreign Ministry spokesman.