North Koreans are starving due to drastic restrictions taken by the state to contain coronavirus, a United Nations investigator says.
Strict measures in North Korea have exacerbated human rights abuses and economic hardship for its people, the report adds.
The country claims not to have any Covid cases despite sharing a border with China.
Officials have imposed border closings, banned most international travel and severely restricted domestic travel in the past year.
It comes after a group of Russian diplomats and their families using a hand-pushed trolley to leave the hermit state.
The group of eight, which included a three-year-old child, were forced to travel 32 hours by train and two hours by bus from Pyongyang to reach the Russian border.
Tomas Ojea Quintana, UN special rapporteur on human rights in the country, revealed fresh concerns in a report seen by Reuters on Wednesday.
In the report, he said: "The further isolation of the Democratic People's Republic of Korea with the outside world during the COVID-19 pandemic appears to exacerbate entrenched human rights violations."
Mr Ojea Quintana urged North Korean authorities to ensure that the "negative consequences of prevention measures do not become disproportionately greater than the impact of the pandemic itself".
The number of foreign diplomats in North Korea has dwindled in the last year, with many Western embassies closing, citing the bans on rotating staff.
There was no immediate reply to a Reuters query to North Korea's mission to the United Nations in Geneva.
Pyongyang does not recognise the UN investigator's mandate and has previously rejected UN allegations of crimes against humanity committed by the state.
Reduced trade with China has led to a significant drop in market activities, lowering earnings for many families reliant on small-scale market activities, Mr Ojea Quintana said.
He added: "There have been shortages of essential goods, medicines, agricultural inputs for farming and raw materials for state-owned factories."
The investigator also voiced concerns that typhoons and floods last year could lead to a "serious food crisis".
He added: "Deaths by starvation have been reported, as has an increase in the number of children and elderly people who have resorted to begging as families are unable to support them."
Humanitarian operations have nearly ground to a halt and only three international aid workers remain in North Korea.
Meanwhile relief goods have been stuck at the Chinese border for months due to import restrictions.
North Korea is to receive 1.7 million doses of the AstraZeneca vaccine via the COVAX facility by the end of May, allocation figures from the GAVI vaccine alliance and World Health Organization (WHO) showed on Tuesday.
Mr Ojea Quintana urged Pyongyang to grant full access for medical and aid workers involved in COVID-19 vaccinations.
In February, North Korea was accused of trying to 'steal Pfizer Covid vaccine technology through hacking.'
Sources inside South Korea's National Intelligence Service reportedly found evidence that the hermit state had tried to steal the technology.
Last year suspected North Korean hackers tried to break into at least nine health organisations, including Johnson & Johnson, Novavax Inc, and AstraZeneca.
South Korea's intelligence agency said it had foiled North Korean attempts to hack into South Korean companies developing coronavirus vaccines.
