Mass casualty incidents such as building collapses and bus crashes are perhaps just the tip of the iceberg when it comes to the injury burden in the DPRK – only the worst cases of injury are highlighted in the media. Current economic and geopolitical developments within and surrounding the DPRK point towards more future activity in sectors such as construction, traffic, and tourism. Thus, it is not unreasonable to anticipate a surge in accidents and injuries inside the DPRK. In this context, it is necessary to understand the North Korean healthcare system and its needs to be able to deal with the current and anticipated injury burden.