The largest international aid operation in North Korea cuts off aid to a starving population

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• Operations shut down in provinces
• Surgery without anesthetics
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PYONGYANG, North Korea (CNN) -- The French-based Doctors Without Borders is pulling its aid staff out of North Korea to protest what it calls a discriminatory process in the distribution of aid to a starving population.

The government sharply curtailed the charity's activities, relief workers said, and has distributed aid primarily to North Koreans most loyal to the communist government. Many needy people got nothing, the workers said.

"The aid is used as a political tool, and that is contradictory to the purpose of aid ... that it should be totally impartial," said Dr. Eric Goemaere of Doctors Without Borders.

A team of 13 doctors and experts from the agency had been running the largest international aid operation in North Korea, taking care of some 14,000 children and running 64 feeding centers. Through the centers, the agency was giving food, medicine and other emergency supplies to needy North Koreans.

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A few weeks ago, North Korean officials told the organization that its operations in the nation's provinces would have to close. Charity officials were repeatedly denied access to people, places and information, relief workers said.

"You can go only to the hospital or clinic. You cannot go around. You cannot speak with people. You can't see villages .... cannot find a solution," said aid worker Marie-Rose Pecchio.

The agency said conditions in medical centers are primitive.

Goemaere said surgeons were performing operations such as abortions and appendectomies with no anaesthetic, no sterilization and rusty instruments.

Old beer bottles were being used for intravenous drips, he said.

Relief workers also said malnutrition in North Korea remains acute. In addition, traditional herbs are being used in place of modern medicine, aid workers said.

"There is a real risk of epidemic," said Dominique Lafontaine, one of the agency's doctors in North Korea.

Doctors Without Borders said the situation in North Korea could improve if aid could reach those who need it most.

In announcing its decision to leave, the agency called on all aid agencies and donor nations to demand greater openness and cooperation from the North Korean government.

U.S. officials who toured some of the hardest-hit regions of North Korea this summer said 2 million North Koreans -- nearly 10 percent of the population -- may have died in the 3-year famine.

The communist government had no public comment on the agency's withdrawal.

Correspondent Mike Chinoy and Reuters contributed to this report.