Over 10 million North Koreans suffered from hunger and malnourishment during the COVID-19 pandemic, according to a new U.N. report.

More than 41% of the North Korean population was undernourished between 2019-2021, according to the annual State of Food Security and Nutrition in the World 2022 report published Wednesday. The figure means the DPRK has the fourth-worst malnutrition rate in the world after Madagascar, Somalia, Central Africa and Haiti, with about 10.7 million North Koreans suffering from hunger.

The report was jointly published by the Food and Agriculture Organization (FAO), International Fund for Agricultural Development (IFAD), U.N. Children’s Fund (UNICEF),