Many detainees are tortured into confessing crimes they didn't even commit.
And this is just the tip of the iceberg when it comes to the treatment of inmates inside Kim Jong-un's torture chambers and prison camps.
The brutality of the North Korean regimewas once again cast into the international spotlight following the death of 22-year-old American student Otto Warmbier last week.
While the brutal conditions inside North Korea's prison camps and detention centres are well documented, less is known about how the American came to be in a coma in the first place.
However a 2012 video could provide some clue as to how North Korea treats its detainees and prisoners.
The shocking video provides a glimpse of what takes place inside North Korea's prison system where anyone who is even accused of minor crimes is made to pay for it.
In the horrifying footage, a man can be seen being beaten and tortured, his legs twisted repeatedly while he sits in a chair.
In other scenes a woman is accused of having sex with Chinese and South Korean men and is repeatedly punched and kicked by a state security agent.
Questions remain
Warmbier was on a tourist trip to North Korea when he was detained for allegedly stealing a political poster from a hotel in Pyongyang last year.
He was sentenced to 15 years hard labour but died six days after returning to the US in a coma.
Doctors said the University of Virginia student had suffered severe brain damage, which doctors said was likely due to cardiopulmonary arrest suffered while in North Korean detention.
Warmbier died last Monday of severe brain damage in a Cincinnati hospital and was buried three days later.
Medical tests didn't show what precipitated his injuries but doctors found no evidence of the botulism infection that North Korea claimed caused his coma.
US doctors said given Warmbier's young age his severe brain injury was most likely caused by cardiopulmonary arrest cutting the blood supply to the brain.
Otto Frederick Warmbier was arrested for committing hostile acts against North Korea. Photo/AP
Kim's 'true face'
Human Rights Watch said Mr Warmbier's death and his unexplained injuries showed the true face of the North Korean regime.
Phil Robertson, deputy director of Human Rights Watch's Asia division, said Warmbier was sentenced in a North Korean kangaroo court and his case should never have gone to trial.
"No one anticipated that Warmbier would be abused in a way that more closely resembles the manner in which North Korea treats its own citizens, where those who cross the government or show disloyalty to leader Kim Jong-un face severe consequences, including death," he said.
Robertson said it was clear North Korea is a human rights black hole for both foreigners and citizens and that Warmbier's death should be a wake-up call to governments dealing with Pyongyang.
He also said the family deserved to know the truth about their son's death.
"No one believes Pyongyang's claim that his condition was triggered by botulism and a medically ill-advised sleeping pill," he said.
"How did such a healthy young man suffer such severe brain damage that he remained in a coma since March 2016?"
'Smear campaign'
North Korea last week accused the US of waging a "smear campaign" over the death.
"The smear campaign against (North Korea) staged in the US compels us to make firm determination that ... we should further sharpen the blade of law", the foreign ministry spokesman said according to state media.
"The US should ponder over the consequences to be entailed from its reckless and rash act," he said in an apparent warning over the fate of three other US citizens currently being held in the country.
Supporters stage a memorial rally for the late American student near the US Embassy in Seoul. Photo/AP
US Secretary of State Rex Tillerson warned that Washington holds North Korea "accountable" for Warmbier's fate, and demanded the release of three other Americans held by the reclusive regime.
Secretary of Defence Jim Mattis said that US patience with Pyongyang is running out.
"To see a young man go over there healthy and, (after) a minor act of mischief, come home dead basically ... this goes beyond any kind of understanding of law and order, of humanity, of responsibility towards any human being," Mattis said.
Defector pain
If anyone knows the brutal treatment Warmbier may been subjected to it's fellow American Kenneth Bae.
Bae was working as a tour operator in North Korea he was accused of plotting to overthrow the regime in 2013.
He ended up serving 735 days in a labour camp before authorities managed to secure his freedom.
In an interview with CNN last year, Bae revealed how he worked from 8am until 6pm, six days a week and prisoners were under 24-hour guard.
Kenneth Bae, a Korean-American Christian missionary was detained in North Korea for more than a year. Photo/AP
"(I was) working on the field, doing farming, labour, carrying rocks and shovelling coal," the 47-year-old said.
"All those things that were physically very demanding and were very difficult."
He also revealed the psychological toll of being treated like a political prisoner with one prosecutor telling him: "No one remembers you. You have been forgotten by your people, your government. You're not going home any time soon."
