BackgroundChildren born to North Korean defectors in China are effectively stateless and legally invisible, creating severe structural barriers to healthcare. This policy-driven public health crisis, marked by poor physical and mental health outcomes, remains critically underexamined from a healthcare perspective. This study aims to analyze the policy discourse to identify these structural barriers and understand how the health of this vulnerable pediatric population is framed and contested over time.MethodsA longitudinal qualitative content analysis was conducted on official documents from the UN Committee on the Rights of the Child (CRC) treaty-reporting cycles. The analysis covers the period from 2005 to 2022, systematically comparing the evolving positions of the Chinese government, the CRC, and civil society organizations on health-related issues.ResultsThe analysis reveals a persistent discursive stalemate. China consistently employs a strategy of deflection and denial, framing North Koreans as “illegal economic migrants” and a security threat, a position that has not changed over the 17-year period. In contrast, the CRC’s critique evolved from general concerns about “irrepar
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