North Korea has been pushed to the brink by Covid-19, an economic meltdown and famine, says a defector.
Timothy Cho, who escaped from North Korea and now works for Open Doors, said there were "multiple causes" behind the crisis, including "catastrophic flooding" and international sanctions.
The North Korean Government continues to claim that the country has no coronavirus cases, but experts believe the true number runs into the tens of thousands.
Brother Simon, Open Doors ministry coordinator for North Korea, said coronavirus was known in the country as "the ghost disease".
"People can be sick without knowing it," he said.
"They are usually malnourished already. Then suddenly they die quickly. Some even just fall dead on the ground."
In a bid to stop the spread of the virus, the government closed the border but this has led to a collapse in the black market economy, causing "chronic food and medical shortages".
"We are hearing that many marketplaces are closed down. Even if they are open, there's little food you can buy. It will cost you two months' salary to buy a kilo of rice," he said.
To make the situation worse, serious flooding has triggered mudslides that have "wiped out" rice fields and farmland.
Cho estimates at least 10 million North Koreans are in urgent need of humanitarian aid.
While the UN has said it is prepared to help, North Korea is "not willing to let UN representatives have free access to the country in exchange for aid – there are too many human rights abuses that would be exposed," Cho said.
"For the same reason, they aren't willing to take any further steps towards nuclear demilitarization to get international sanctions lifted," he added.
Brother Simon said the pandemic had proved too much for the North Korean Government.
"The government doesn't really know what to do," he said. "Kim Jong-Un has even left Pyongyang to decrease the chance of him getting ill."
This hasn't gone down well with North Koreans who are "upset with their leaders who don't take care of them and only think about their own safety", he added.
"Open Doors has aid ready for North Korean Christians. But first God needs to open the door," Brother Simon said.
"Once people can come out of the country, we can give them the means to survive. We're waiting for a window of opportunity."
