Open Doors has released its World Watch List 2024 detailing the 50 countries where Christians suffer the most for their faith, and North Korea ranks number one for the 22nd time in 23 years.
Open Doors was especially critical of China's new policy of returning escapees back to North Korea.
It said that while the world's attention was focused on Israel and Gaza, China repatriated around 600 North Koreans back to the hermit communist country on 9 October 2023.
Most of them are thought to be women and all are likely to face a "living hell" upon their return.
"On return they face torture, sexual abuse and hard labour in the nation's infamous prison camps," said Open Doors.
However, other parts of the world are also causing Open Doors serious concern, including sub-Saharan Africa where it warns that a "double blow of violent instability and authoritarian control" could wipe out the Christian presence altogether.
It reports that at least 4,606 Christians were killed in the region last year because of their faith but it expects that the real figure is much higher.
"Christian minorities across east and west Africa face twin existential threats: violent disorder exploited by radical jihadists and autocratic governments backed by larger powers outside the region," said Open Doors.
Countries from the region on this year's World Watch List are Burkina Faso at number 20, Mali at 14, Mozambique at 39, Nigeria at number 6 and Somalia at number 2.
Open Doors blames the violence on "fractures in governance and security" that have "opened the door" for jihadist activities.
"Islamist militants are exploiting unstable political conditions across Sub-Saharan Africa," it said.
"Their aim is to sow disorder and ultimately seize power, turning regions or even nations into Islamic caliphates run under Islamic Sharia laws.
"The fractures in governance and security have opened the door for the jihadist activities seen."
Open Doors said it was most concerned about Nigeria, which accounts for over 82 per cent of Christians killed for their faith worldwide.
Christians have fallen victim to countless attacks by Islamist militants belonging to terrorist groups like Boko Haram and the Islamic State West Africa Province (ISWAP). Other perpetrators are radicalised Fulani herdsmen.
Christian communities have suffered successive raids with widespread killing, raping, maiming, destruction of property, and kidnapping for ransom.
"Attacks by Islamic extremists against Christians in sub–Saharan Africa have intensified as chaos and collapse besets the region," said Henrietta Blyth, Chief Executive of Open Doors UK and Ireland.
"Even in the IDP camps Christians feel fearful and unsafe since the very people who attacked them may be grazing their herds or robbing their crops just outside the camp.
"Governments in the region need to take meaningful action. Without this, once thriving Christian communities will disappear."
Open Doors reports an overall increase in the amount and intensity of persecution taking place worldwide, with 365 million Christians facing "high levels" of persecution and discrimination for their faith - up from 360 million last year.
In India, which ranks 11th again, there has been a nine-fold increase in Christian fatalities in the last year, rising from 17 to 160, after months of violence in the north-eastern state of Manipur.
Open Doors also noted an "extreme rise" in attacks on churches and Christian schools from 67 in the previous report to 2,228.
The violence in Manipur left 160 Christians dead, and displaced 62,000 people, many of whom remain in camps "with no hope of returning home safely".
"We discovered that many of the houses destroyed in the rioting had been marked with a red circle and cross a few months earlier by Meitei Extremists. This had been planned months before," said Chung Mang, a Christian leader from Manipur.
In other parts of India, Christians have been harassed and attacked for their faith. Much of the hostility has been attributed to anti-conversion laws which are in place across 12 states in the country.
