Pastor Douglas Shin has learned the cost of good intentions-especially in North Korea. Every time the Seoul-based Protestant missionary goes in with another shipment of food for the hungry, the regime’s officials grab much if not all of it for themselves, he says. Once, when he tried to negotiate a visit to the capital, Pyongyang, they demanded that he bring a whole rail car loaded with 60 tons of flour and supplies. He finally bargained them down to a 10-ton food shipment, delivered just inside the border by truck from China. At least they let him hand out some of it to people on the streets.

Shin says every relief group encounters the same problem in North Korea. Regime officials demand more and more kickbacks from humanitarian agencies-and South Korea’s church groups are particularly easy marks. “Northerners know how to take advantage of zealous southerners,” Shin says. “But in some way both sides use each other.”

That willingness to cut deals is making North Korea increasingly dependent on Christians from the peninsula’s southern end. While nongovernmental agencies like World Vision and Save the Children, fed up with the North’s rampant corruption and lack of transparency, have closed down or sharply reduced their activities there, South Koreans are racing into the void. Lighthouse Foundation, a Seoul-based Presbyterian group that works with handicapped children, is working with the North to build a center for disabled kids in Pyongyang. The Rev. Kim Jin Gyung, a Korean-American protestant, will soon open a $30 million science and technology university in Pyongyang financed by donations from South Korean Christians.

North Korea’s few churches-Potemkin temples to give the illusion of religious freedom, critics say-are getting costly makeovers courtesy of religious groups on the far side of the DMZ. Seoul’s Presbyterians are spending nearly $3 million to rebuild Bongsu Church in Pyongyang, while Baptist groups are planning to invest a similar sum in nearby Chilgol Church, which was once attended by the mother of North Korean founder Kim Il Sung.

The southerners aren’t competing for converts; proselytizing remains strictly forbidden in the atheist North. The real prizes (for now, at least) are trophy assets-the kind that look good on church Web sites and help fill the collection plates.

By that measure it’s tough to beat the Rev. Yonggi Cho of Seoul’s Full Gospel Church, the world’s largest single house of worship, with 780,000 congregants. Early last month Cho and 250 fellow South Koreans attended the groundbreaking ceremony for the Full Gospel’s $22 million cardiac center on the banks of Pyongyang’s Daedong River. A month earlier the church had sent 23 trucks loaded with heavy equipment, such as cranes and cement mixers, across the DMZ. Construction of the seven-story, 260-bed heart clinic will be financed with individual donations and Cho’s own retirement pay, which he says he’ll transfer after stepping down next year.

There was one snag: the facility’s name. Cho’s first choice-Pyongyang Gospel Heart Hospital-sounded a bit too liturgical for the regime’s tastes, so the preacher backed down. The Rev. Cho Yonggi Heart Hospital is scheduled to open in 2010.

Anything is an improvement on North Korea’s present health-care system. Even in privileged Pyongyang hospitals lack electricity and running water as well as basic equipment and supplies. And the facilities outside the capital are far worse. At the People’s Hospital in Kusong, some 30 miles north of Pyongyang, patients are X-rayed by a 40-year-old Hungarian-built fluoroscopy machine that emits dangerous levels of radiation. Orderlies fashion bandages from cotton grown on the hospital grounds, and intravenous drugs are administered with upended soda bottles. Conditions at Kusong would be even more desperate without donor groups like the Maryland-based Eugene Bell Foundation, which insists on delivering aid directly its final destination. If North Korean officials refuse, the foundation warehouses its aid until permission is given.

Regular site visits by donor representatives are basic to responsible NGO work, not only in North Korea but everywhere else, says Eugene Bell director Stephen Linton. “People who think otherwise are kidding themselves.”

Lack of oversight, however, hasn’t stopped some South Korean religious groups from planting their flags-both spiritual and humanitarian-throughout the north. In 2005 a South Korean Christian denomination authorized construction of a church with $1 million in donations. But the building doesn’t even have a cross, say defectors interviewed in Seoul, and there’s nothing the group can do about it.

The South’s Jogye Buddhist denomination recently spent $8 million to rebuild a temple on Mount Kumkang that was bombed during the Korean War. After the new temple was dedicated in October, however, the southern monks’ northern partners seized control of it, prompting a public expression of regret from the Jogye leader who oversaw the three-and-a-half-year project.

Two years ago representatives of Seoul’s Youngnak Presbyterian Church were in advanced negotiations to build a children’s health center in the North Korean city of Sinuiju, which is on the Chinese border. Blueprints were drawn up and approved, and delegations from the church met with senior officials in Sinuiju’s North Pyongan province. But negotiations came to a halt when the North Koreans demanded that the facility be built in the capital instead. Youngnak says it’s holding firm.

The South Korean government is discouraging such ambitious projects, at least by example, because of the difficulties in supplying such facilities once they’ve been completed. The health ministry in Seoul, smarting from unsuccessful attempts in the past to stock North Korean hospitals directly, now provides a modest $1 million worth of medical materials to the north annually. Two years ago it began supporting a hospital on Mount Kumkang, a popular destination for South Korean tourists. Doctors from the South regularly visit the hospital to treat patients alongside local physicians, who can then benefit from their southern counterparts’ expertise. “We focus on treating patients, not building hospitals,” says an official involved in the Mount Kumkang program.

What the north really needs, say officials in Seoul, is small-scale clinics and medicine for needy people, both in and outside Pyongyang, rather than big hospitals that can benefit only the elites. The average surgery at the Rev. Cho’s hospital, they point out, will cost $3,000 in a country with a per capita income of $760. But given how hard it is to operate outside Pyongyang, South Korean aid groups seem quite content to busy themselves in the big city.