Families in North Korea are reportedly paying more than 100 times the country’s average monthly salary to procure fake medical diagnoses to stop young men from being sent to assist Russia in its war with Ukraine.

According to Radio Free Asia’s sources, people have been trying to secure fake tuberculosis certificates to avoid being sent to Eastern Europe to fight. Since last year, the prices of these fraudulent medical certificates have jumped fivefold to around $500. This is in a country whose average monthly salary for a government worker is around 5,000 to 10,000 won, equivalent to just $1 to $3.

“Until last year, most medical certificates for military exemption cost around US $100,” a resident of North Korea told RFA Korean on condition of anonymity.

While neither Moscow nor Pyongyang have acknowledged their presence in the war, the United States and South Korea estimate that up to 12,000 North Korean troops have deployed to Russia.

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The hermit kingdom possesses one of the largest militaries in the world. The isolated nation boasts a massive army of 1.3 million soldiers, the fourth highest globally. The country also possesses another 7.6 million reservists, nearly a third of North Korea’s population.

All North Korean women must serve at least five years in the armed forces, while all men must complete at least 10 years.

“There is an underlying fear that if their sons join the military and are sent to Russia, the parents will never see them again alive,” one anonymous woman in North Korea’s Ryanggang province told RFA.

Another anonymous North Korean, a resident of the northwestern province of North Pyongan, told RFA that people are selling their homes and borrowing money to afford the costly medical notes. However, he said that because the price keeps rising, some people give up.

To help crack down on fraudulent diagnoses, authorities in part of the country have mandated quarterly tuberculosis tests every three months for military-eligible citizens. This marks a change from the previous requirement of testing once per year.

Earlier in January, Ukrainian President Volodymyr Zelensky said that there had been 3,800 North Korean casualties in the war so far.