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In this Saturday, June 25, 2016, file photo, people sit in front of a window display of household items at a department store in Pyongyang, North Korea.Wong Maye-E

The containers were already midway across the Pacific when Susan Ritchie got the bad news. It was no longer possible to deliver them to their destination, North Korea.

Filled with 137 tonnes of soybeans, the shipment of seven containers this summer was part of a continuing program to give 100,000 North Korean school children a nutrient-rich drink of soy milk each day. The contents were clearly humanitarian goods, and Ms. Ritchie, through Vancouver-based organization First Steps, has a long history of sending such materials to the isolated regime, 78 containers in total since 2013.

But amid the tensions provoked by North Korea's tests of nuclear devices and intercontinental ballistic missiles, the international community has retaliated with increasingly strict new sanctions. In that charged atmosphere, North Korea has become an even greater pariah state – and Ms. Ritchie is no longer certain she can send food to a country where nearly a third of those under the age of five have stunted growth.

"Difficulties in shipping are nothing new. But the fact that shipping lines are not willing to accept the cargo is unprecedented," she said.

After countless phone calls, she was finally able to get the seven containers to North Korea.

By that time, however, they had sat waiting for three weeks in the Chinese port of Dalian, incurring what she expects will be thousands of dollars in additional fees. And a series of other containers, containing micronutrient sprinkles and dried soup mix, are stuck on land, unable to begin shipment toward North Korea.

"We're just being told that none of the shipping lines will book," Ms. Ritchie said. "I don't understand why."

Her confusion stems from the sanctions themselves, which specifically allow for the continued movement of humanitarian goods to North Korea, even as many other products, particularly those potentially useful to its weapons program, are blocked.

But the unwillingness of shipping companies to touch any goods bound for North Korea comes amid a new international effort to coerce change among Pyongyang's recalcitrant leadership.

No longer are sanctions merely aimed at preventing North Korea from attaining nuclear weapons or luxury goods. The most recent import and export bans – which bar the purchase of North Korean iron, lead, coal and seafood – are bricks in a rising economic blockade, one designed to inflict pain.

Last week, Russian Foreign Minister Sergey Lavrov warned about the effect they could have.

"We are deeply convinced that the possibilities of economic pressure are almost exhausted. We cannot support the ideas that some of our partners continue to cherish. They are literally aimed at the economic strangulation of North Korea with all the negative consequences for the citizens of the DPRK," he said, calling North Korea by its formal name, the Democratic People's Republic of Korea.

Under the current policy, "the question becomes, can we stand to see as many North Koreans die as Kim Jong-un can stand to see North Koreans die? Who blinks first on watching the fringes of North Korean society starve?" said Carl Baker, a retired U.S. Air Force officer with experience in Korea who is now director of programs at the Center for Strategic & International Studies Pacific Forum.

"That's really where we're headed if we continue down this harsher sanctions path."

He is not surprised to hear that organizations such as First Steps are now struggling to get goods to North Korea. "Aid groups are the ones that are starting to feel it first," he said.

Indeed, international organizations have raised warnings about the potential for unintended consequences from sanctions.

A crackdown on financial institutions doing business with North Korea has made it difficult to transfer money, the United Nations lamented earlier this year in a report, which said one of the most serious problems has been a "radical decline" in donations. The report called for $114-million (U.S.) in funding to meet local needs.

"In the current climate of heightened tensions, it is crucial that we do not lose sight of why we are here: to serve the needy and vulnerable populations who need assistance," Tapan Mishra, the Pyongyang-based UN resident co-ordinator, wrote in a note to diplomatic missions and international organizations this week.

Humanitarian assistance to North Korea is controversial, with critics arguing it enables the country's leadership to divert resources toward its nuclear program.

At the same time, North Korea has veered between devastating natural disasters. Last month, the Food and Agriculture Organization of the United Nations warned that the driest spring since 2001 had diminished early season crops by 30 per cent. Greater rains since then have "substantially" minimized the effects of the drought, the FAO said, but crop yields are still expected to fall. The organization has warned that "cereal import requirements are likely to increase."

But those sending goods to North Korea have, in recent years, experienced a steady increase in irritations. "It has been quite a hassle for some time," said Daniel Gerster, a former aid worker who spent nearly a decade living in North Korea. Officials in Germany once demanded an explanation for some as innocuous as aprons, which were intended for use in a North Korea milk-processing operation but may also have raised concern for their potential use in a laboratory, Mr. Gerster said.

Anything containing aluminum is off-limits, he said. "If you have something that has aluminum in it, even a handle, it's pretty impossible," he said. Cars, too, are "very tricky," he said. For international organizations in North Korea, "cars are just a tool you need to do proper work. If you can't get them in, you can't do a proper job."

Now, the refusal by private shippers to touch North Korea-bound cargoes constitutes a serious new hurdle.

YangMing Marine Transport, a Taiwanese shipping line, has in the past delivered goods bound for North Korea. It has now stopped "because of the intense situation with North Korea recently," said Benson Chou, a company manager in Dalian.

"Almost all of the shipping companies have stopped recently, because they aren't willing to take the risk," he said. Most had stopped by June, he said.

A company that carries cargo bound for North Korea runs the danger of looking like it supports a country that is the object of U.S. ire – and any shipper that falls afoul of Washington risks jeopardizing lucrative business to the United States.

Even if humanitarian goods can still legally move to North Korea, shipping companies have to place their trust that what their clients declare is what is actually in a container. "We are not actually certain what exactly is inside," Mr. Chou said.

It's easier to simply cut off all shipments to North Korea.

"Almost all of the shipping companies want to avoid unexpected situations, because our biggest market is the U.S.," he said.

Overall U.S. trade with North Korea fell from $4.8-million in 2015 to roughly $100,000 last year.

South Korea's Unification Ministry, which has a humanitarian division, said it is "aware that international organizations are having a hard time in shipping goods into North Korea," a spokesperson said.

The new logistical obstacles have renewed calls for aid organizations to think differently about North Korea. Tim Peters, a Christian activist in Seoul who founded mission agency Helping Hands Korea, said he routinely urges others to send in goods "by alternative and informal, unofficial means."

In other words: smuggling.

One of Helping Hands Korea's operations is to "smuggle things like vegetable seeds or medicine into North Korea in order to reach some of the more vulnerable sectors," Mr. Peters said. There are risks in such an approach, but also obvious advantages, in that it allows the delivery of aid "not subject to the North Korean regime's loyalty-based distribution system."

Aid groups can also help by directing their attention to other priorities, such as vulnerable women who escape the country, he said.

Ms. Ritchie, meanwhile, succeeded in getting her soybean containers through with what she called "relentless" calling. "All hours of the day and night. A lot," she said. The 137 tonnes of soybeans on those seven containers is enough to produce more than five million glasses of soy milk.

She hopes similar persistence will help her keep moving goods into North Korea, a dedication emphasized by her frequent visits to the country, where she has seen urgent need. More than 40 per cent of the population is undernourished, according to the UN.

"Vulnerable children and pregnant women need timely help," Ms. Ritchie said. "There's a point beyond which the effects of stunting and malnutrition are irreversible."

With reporting by Yu Mei