(Anna Fifield/The Washington Post)

The world has become used to terrible stories of brutality from North Korea. The hundreds of thousands who starved during the 1990s famine, the all-encompassing repression, the torture of those who dare to try to escape. 

But this week, North Korea showed itself capable of an entirely new type of brutality, and one that strikes much closer to home for Americans.  

Otto Warmbier — a quintessential American, tall and good-looking, from a close-knit family in a leafy Ohio suburb — had joined a group tour to North Korea at the end of 2015 on his way to study in Hong Kong.  

Instead of graduating with his classmates at the University of Virginia last month and heading to the job on Wall Street he had lined up, the 22-year-old was brought home on a military medical plane and now lies unconscious in a Cincinnati hospital. He suffered extensive loss of brain tissue, a condition usually caused by a lack of blood flow to the brain. 

The case raises many questions. How did Warmbier fall into this coma? Once he did, why did North Korea, a country with so few resources, spend 15 months keeping him alive instead of sending him home and getting the problem off its hands? 

(Reuters)

And why did the North Koreans apparently lie about the cause of the coma — claiming it began with a case of botulism — but tell the truth about the length of it? 

Some answers will come out; some may never be known. 

In the meantime, Warmbier’s horrific treatment has created a new, pressing concern for the U.S. government: freeing the three American citizens still held in North Korea.

There could be progress on the prisoners soon. Diplomats and former U.S. officials are pushing behind the scenes for the release of Kim Dong-chul, a businessman held for 21 months, as well as Kim Hak-song and Kim Sang-dok (or Tony Kim), both affiliated with the Pyongyang University of Science and Technology. 

A visit by an unlikely envoy, pro basketball bad boy Dennis Rodman, has raised hopes that he could bring the trio out with him when he departs Pyongyang, probably Saturday. 

Rodman has been on a kind of redemption tour in North Korea this week, following his disastrous trip in 2014, when he went on a tirade on CNN and suggested that Kenneth Bae, another American who was imprisoned in the country, deserved what he got. 

Former NBA basketball star Dennis Rodman walks through an exhibition hall during his visit to Pyongyang's Central Zoo on Friday, June 16, 2017 in the North Korean capital. (Kim Kwang Hyon/AP)

This time, Rodman has been much more low-key and even diplomatic, releasing a video saying he was “trying to open doors between both countries.” 

“Even if Rodman brings back the remaining three Americans still detained in North Korea, the Otto Warmbier story is not over,” said David Straub, a former State Department official who traveled to North Korea with former president Bill Clinton in 2009 to secure the release of two imprisoned journalists. 

Indeed, the Warmbier case is very different from those of previous American prisoners in North Korea. 

For all of its mistreatment of its own citizens and arbitrary detention of foreigners, North Korea generally has lines it does not cross with foreign inmates widely viewed as hostages. 

While it keeps them in harsh conditions and subjects them to psychological abuse, only 1 of the 18 or so Americans detained in North Korea in the past decade — a Korean American missionary who entered the country illegally from China in 2009 — has said he was beaten. 

A senior U.S. official rejected reports that Warmbier was beaten in custody, and doctors said there are no signs of trauma or fractures on his body. 

Furthermore, the regime does not want a prisoner to die on its watch. It has gone to some lengths to care for sick detainees and released an 85-year-old man relatively quickly.  

Theories abound about what happened to Warmbier after he was sentenced to 15 years in prison with hard labor in March last year, his punishment for trying to steal a propaganda poster from the hotel where his tour group was staying. 

One of the most puzzling aspects is why North Korea held onto Warmbier for 15 months after he fell into a coma. Doing so undoubtedly worsened his condition, and caring for him was probably expensive and difficult for a country with limited medical resources. 

Michael Madden, the editor of the North Korean Leadership Watch website, said that whatever went wrong while Warmbier was in custody, those in charge apparently tried to cover it up. 

“State security concealed whatever it was and have been concealing it for some time,” Madden said, citing North Korean sources. 

Straub agreed. “They were probably scared,” he said. “The brain scan would have told them he was in a serious condition.” 

But security authorities may have been forced to disclose Warmbier’s state after North Korean diplomats met with U.S. officials in Oslo last month and agreed to allow consular access to the four prisoners. 

If North Korea releases the three Americans still in detention, some analysts think the Trump administration would have little choice but to continue on the path already set. 

“I don’t know if there is any reason to change course from what the administration is trying to do, and I don’t think they will,” said Stephan Haggard, professor of Korea-Pacific studies at the University of California at San Diego. 

“They may put some more pressure on the Chinese, but the testimony of [U.S. Defense Secretary Jim] Mattis suggests the administration has made the threat of North Korea its number one priority,” he said. 

President Trump has articulated a policy of putting “maximum pressure” on North Korea to give up its nuclear ambitions, and he has made clear that he expects China, North Korea’s main patron, to help. 

But he also has professed a willingness to meet Kim Jong Un, whom he has called a “smart cookie,” and there have been subtle signals that the man who wrote “The Art of the Deal” is serious about getting North Korea back to the negotiating table. 

“There seems to be a willingness to engage in some exploratory conversations and some pretty substantial ones,” said Evans Revere, another former State Department official who continues to talk to North Korean officials. The release of all four prisoners would remove a hurdle to talks, he said. 

But Straub, the official who traveled to North Korea with Clinton, was not optimistic about making progress if talks do resume. “The issues between North Korea and the United States are not fundamentally about hostages; they’re about huge strategic issues — and the gap between the two sides is still huge,” he said. 

In that regard, the Trump administration’s approach to North Korea is essentially the same as during the last years of President Barack Obama’s presidency: increase the pressure until North Korea is willing to change.