Christian Friends of Korea grew out of Graham’s visit to North Korea in the early 1990s. Linton, the group’s executive director, traveled to North Korea in August for a routine visit with a team of eight other Americans, three Norwegians and an Australian, all volunteers, to install clean-water systems and continue their hepatitis B treatment program. Linton often visits the two Protestant churches and the one Catholic-heritage church in Pyongyang, but she does not proselytize or preach. Her team of volunteers works alongside Korean officials during every trip.

When American doctor Stephen Yoon thinks of North Korea, he does not think of ballistic missile tests or the threat of nuclear war. He remembers instead a 10-year-old girl with cerebral palsy, who suffered from spastic quadriplegia that made her unable to stand or sit. Five years ago, she went to Yoon’s developmental-disability program at Pyongyang Medical University Hospital, where she received treatments from Yoon and his team of local doctors. After almost a year of exercise therapy and some surgeries, she walked out of the hospital on her own.

The event was heralded in North Korean state media as a national victory, but it received no notice in the U.S., where few people even know about the roughly 200 Americans like Yoon who work and live under the rule of Kim Jong Un. Carefully monitored by the regime, they have come and gone for years, doing educational, medical or infrastructural work, and sometimes raising families in a nation that has been officially at war with the U.S. since 1950. Yoon, 45, moved to North Korea 10 years ago. “We were able to convince and convey to the North Korean government that the kids with disabilities have value and they can be part of society,” says Yoon. “I really believe in our presence.”

Heidi Linton, a mother of three from Asheville, N.C., who leads the organization Christian Friends of Korea, has helped to deliver millions in aid to North Korea since 1995 and spends as much as three months a year in the country to support hepatitis and tuberculosis care centers. About 50 other Americans work in North Korea’s Rason Special Economic Zone, near the Russian border, on social entrepreneurship and humanitarian projects. There’s also a predominately American-run school, the Pyongyang University of Science and Technology, that has brought nearly 70 American professors and staff members each semester.

The Americans in North Korea are controversial because they provide services that indirectly help the North Korean regime. But career diplomats say they create a thin but important connection to the Hermit Kingdom. “They are very dedicated aid workers, they care deeply about the North Korean people,” former U.S. ambassador to the U.N. Bill Richardson says of the expatriate community. “We have no diplomatic contact, we have no commercial contact, so some kind of humanitarian contact as a potential bridge to improve the relationship would be helpful.”

But that is set to change. Amid escalating military tensions and after the recent death of Otto Warmbier–the U.S. student who died after he was detained in North Korea–the Trump Administration announced in July that U.S. passports will become invalid for travel in, to or through the country starting on Sept. 1. The official reason for the travel ban is the “mounting risk of arrest and long-term detention of U.S. citizens” by the Kim regime, but the move could signal that Washington is preparing for relations to further deteriorate. North Korea continues to hold three U.S. citizens, including two former staff members of the Pyongyang University of Science and Technology, in its political-detention system.

The news has prompted concern from the small community of Americans who have been working in the country, many of whom are evangelical Christians, a key part of Trump’s base. The very nature of their work is so sensitive and carefully negotiated that they are often reluctant to draw attention to their projects, though the new travel ban has prompted many to break that rule. They say they respect the State Department’s national-security concerns but that the cost of withdrawing aid is severe. “The President has to make a strong stand,” says Franklin Graham, whose global aid organization has done work in North Korea for 20 years. But, he adds, “we’ve got to continue to try to work.”

Many of the Americans who call North Korea home are pushing the Trump Administration for new permission to return. The State Department may allow limited exceptions, but the scope is not yet clear. “It’s an abhorrent moral algebra that has overtaken us, that if moral evil is visited on great numbers, then the plight of individuals–and thus [the] work to relieve the suffering of individuals–somehow doesn’t matter,” says Robert Carlin, a former U.S. official and behind-the-scenes diplomat during the Clinton, Bush and Obama years. “Have we lost our moral compass?”

The U.S.–North Korea relationship has long wavered between delicate and dangerous. Although the Korean War ended in 1953, leaving more than 1 million North Koreans and 36,000 Americans dead, a peace treaty was never signed, and enmity remains. Attempts to restart relations in the decades since have been short-lived, poisoned by distrust. Time and again, nuclear-nonproliferation negotiations have fallen apart or deals have been broken, with tensions spiking, though they have recently receded since North Korea stopped testing missiles in mid-August. As recently as early August, North Korean state media threatened torching the mainland U.S. with “an unimaginable sea of fire.” President Trump, meanwhile, counterthreatened with “fire and fury like the world has never seen.”

The quiet U.S. humanitarian effort in North Korea began as a response to a famine there in the mid-1990s, which killed hundreds of thousands of people. Groups like UNICEF, Mercy Corps and World Vision delivered food aid. When the world’s focus shifted away, Christian charities stuck around and deepened their ties. The Eugene Bell Foundation, which was founded by a Southern Presbyterian minister, began supporting tuberculosis treatment efforts in North Korea around that time, starting the first program for multidrug-resistant TB. “These efforts are really outliers, in part because they are completely going against the grain of the body language that both governments are sending to their people,” says Scott Snyder, a senior fellow for Korea studies at the Council on Foreign Relations.

The new relationships were fragile at the start. A century ago, Christianity thrived in the region, and American evangelist Billy Graham’s late wife Ruth even attended school in Pyongyang. Today North Korea’s constitution allows for freedom of religion, but the country forbids proselytizing. Such subtle distinctions may be lost on an outside world preoccupied with North Korea’s outlaw status: in 2014, the U.N. condemned its leaders for alleged crimes against humanity, including persecution for political crimes with torture, starvation and forced labor. But the U.S. groups are careful to respect the rules, and their focus is service projects.

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