North Korea’s “draconian” measures to keep COVID-19 at bay by sealing its borders and further limiting freedoms had “devastating consequences” for the average citizen, according to a leading international human rights organization.

In a wide-ranging report published Thursday, Human Rights Watch (HRW) also highlighted the adverse impacts of international sanctions over the past five years, drawing on analysis of satellite imagery, trade data and interviews with North Korean escapees, former traders and officials, journalists and activists.

The combination of Pyongyang’s extreme restrictions on freedom, pandemic responses, nuclear development and U.N. sanctions have effectively turned the “country-wide prison … into an