For the twentieth year in a row, North Korea tops the list of countries where Christians face oppression, according to a group that reports on global Christian persecution.

The advocacy group Open Doors released its annual World Watch List on Tuesday, documenting the countries where Christians face the most threats for their faith. North Korea again tops the list, and Nigeria has worsened to the point of entering the top 10 countries for persecution of Christians.

Overall, 340 million Christians worldwide face persecution, according to Open Doors, an increase of 30 million from last year.

The worst country, North Korea, lacks religious freedom, the report said. Here, “being discovered to be a Christian is a death sentence.”

Of the estimated 400,000 Christians in North Korea, around 50-75,000 of them are imprisoned in labor camps; for those Christians not killed by the state upon their discovery, they and their families face “horrendous” conditions in the labor camps, Open Doors said.

The COVID-19 pandemic has exacerbated the suffering of Christians in camps, the group says, as “North Koreans call it [the virus] the ‘ghost disease’ – because people are so malnourished already that they die very quickly.”

The World Watch List covers persecution during the time period from Nov. 1, 2019 through Oct. 31, 2020, and examines restriction on the practice of the Christian faith in a number of areas: private life, family life, community life, national life, church life, and violence.

Afghanistan and Somalia rank closely behind North Korea on the worst countries for Christians, according to Open Doors.

As in North Korea, Christians in Afghanistan and Somalia must keep their faith a secret as their lives are in danger if they convert from Islam to Christianity—and they even suffer at the hands of Muslim family members. In Somalia, there are only a few hundred Christians in a population of 16 million, Open Doors states.

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The list of the 10 worst countries is similar to last year’s, with Sudan being removed and Nigeria added to this year’s list.

Violence in Nigeria against Christians has reached the level of genocide, according to some Christian leaders, as Christians are threatened by Fulani militants, the militant group Boko Haram, and the Islamic State West Africa Province (ISWAP). An average of 10 Christians per day are killed in Nigeria, and attacks on villages and atrocities committed against women and children are often committed with impunity.

Iraq and Syria are both listed as having “extreme” levels of Christian persecution, and are numbers 11 and 12 on the list, respectively.

The pandemic has only worsened a tightening grip on Christian religious practice worldwide, Open Doors noted, and for the first time in the 29-year history of the report, all of the 50 worst countries for Christians had “very high” or “extreme” levels of persecution.

“The COVID-19 pandemic has turned a bad situation into an unbearable one,” David Curry, president and CEO of Open Doors USA, stated. “This public health crisis created an opportunity to expand faith-based discrimination and violence in regions where religious persecution had already reached alarming rates.”

In addition to Nigeria’s rise to the top 10 list, China re-entered the top 20 worst countries for Christians for the first time in a decade, Open Doors noted, with government surveillance of Christians a problem--even documenting their phone messages.