Beatings, rape, starvation and sick public executions are a daily reality for thousands of North Koreans, according to years of witness testimony.
Now, the death of Otto Warmbier has brought fresh scrutiny to the regime's brutal torture camps under leader Kim Jong Un.
The 22-year-old student passed away from mysterious brain damage he suffered while a prisoner in the isolated state.
He succumbed to his horrifying injuries just six days after he was released from North Korea back to his parents in a vegetative state following 17 months in custody.
Its believed he spent some of that time in one of Kim's prison camps, where thousands of his citizens are believed to have died.
Warmbier's doctors in Cincinnati said that the student had suffered 'extensive loss of brain tissue in all regions of his brain' consistent with oxygen deprivation for a prolonged period.
The isolated North Korean regime is believed to have as many 120,000 political prisoners in its harsh labor camps.
Grotesque stories of torture offer among the few clues to Warmbier's fate.
In a 2014 report, the United Nations Human Rights Commission called North Korea 'a state that does not have any parallel in the contemporary world' due to the country's 'systematic, widespread and gross human rights violations'.
Beatings are widespread in the camps, in which guards are given near-absolute authority to abuse and kill prisoners, according to survivors who have survived to speak out.
Escapees have said that the sounds of beatings were so extreme each night that it was impossible to sleep.
Yet Warmbier's doctors have said that extensive scans have revealed no evidence of broken or fractured bones, including to his skull. They also found no damage to his neck tissue that could indicate strangulation.
One woman interviewed for the UN report, who had been imprisoned for practicing Christianity, told of a torture room with a water tank in which suspects could be immersed to simulate drowning.
'She indicated that she was fully immersed in cold water for hours,' the report said. 'Only when she stood on her tip-toes would her nose be barely above the water level. She could hardly breathe. She was gripped by panic, fearing that she might drown.'
Could drowning explain the oxygen deprivation event that damaged Warmbier's brain so severely? Possibly, but doctors have not said they've found any evidence indicating that's the case.
Other baroque torture methods of the North Korean regime have come to light as well.
One Ministry of People's Security official who defected revealed that the agency made use of small metal cages in the Pyongyang offices of its pre-trial investigative bureau.
'Victims would be crammed into the cage for several hours so that the circulation of blood to extremities becomes interrupted and other parts of the body swell up,' according to the UN report.
'The victim turns into a rusty brown color. After removal from the cage, the victim is abruptly "unfolded" causing further excruciating pain,' the report said.
The same witness recalled receiving formal training on torture techniques, including 'how to cut off a suspect's blood circulation using straps, while simultaneously placing the suspect in physical stress positions in order to inflict the maximum level of pain.'
Notably, most foreign prisoners of the North Korean regime report significantly more gentle treatment, presumably because they are considered geopolitical bargaining chips.
Matthew Todd Miller, a California man who was sentenced to six years in a North Korean labor camp in 2014, was released six months later and said that he was treated relatively well.
'I was prepared for the torture. But instead of that, I was killed with kindness,' he said in an interview with NK News.
Miller's case is unique though, in that he entered North Korea with the intention to defect, and he was detained after he was asked to leave the country and refused.
In 2013, Merrill E. Newman, an 85-year-old former US Army officer who served in the Korean War, was accused of war crimes and held by North Korea for 42 days.
Most of that time he spent confined in a hotel in Pyongyang, were Swedish consular officials who had access to him said he was well cared for and had even received needed medical attention for a heart condition.
In Warmbier's case, the official story from Pyongyang is that the student contracted botulism shortly after he was sentenced last spring in a show trial for allegedly stealing a propaganda poster from his hotel.
The North Koreans claim a sleeping pill put Warmbier into a coma from which he never awoke.
The astonishing claim is almost certainly false - doctors found no evidence of botulism, and a sleeping pill would not be indicated in the case of that rare illness, which is treatable with an antitoxin.
The true cause of Warmbier's tragic death may never be known, but the brutality of the regime responsible for his death remains grimly clear.