While Chinese youth joined the summer camp at the Songdowon International Children’s Camp this year—expanding the previous DPRK-Russia solidarity initiated in 2024 into a trilateral DPRK-China-Russia alliance—construction at the DPRK-Russia Friendship Hospital remains unusually stagnant. Despite a high-profile groundbreaking ceremony in April attended by two Russian cabinet ministers, work has been carried out since April using a massive workforce completely devoid of heavy machinery. Because operations rely entirely on manual labor, the overall construction progress remains exceptionally sluggish. While the division of labor for the friendship hospital project was likely structured with North Korea providing construction personnel and Russia supplying the architectural design, medical equipment, and engineering expertise, actual construction delays appear to stem from a lack of concrete cooperation on these technical deliverables. This breakdown in coordination explains why Kim Jong Un omitted the site from his June visit. If this stagnation persists, it is anticipated to exacerbate friction and foster deep mutual distrust between the two nations.