SANTA ANA, Calif. — A watchdog organization that releases a report each year on the global persecution of Christians has again named North Korea as the most dangerous place to live as a Christian—for the 16th year in a row.

Open Doors USA released its “World Watch List” on Wednesday, which lists and ranks the 50 countries that are most hostile toward those who follow Jesus. It estimated that 215 million Christians in those nations face significant persecution, with 3,066 of those who professed faith in Christ being murdered during the reporting period.

A tally of 1,252 were abducted, 1,020 were raped or sexually harassed, and 793 houses of worship were attacked. The organization especially expressed concern over what appears to be an increase of attacks against women.

“Open Doors monitors the intensity faced by Christians around the world, and the World Watch List quantifies what we see,” David Curry, president of Open Doors USA, said in a statement. “This year, as incidents of violence related to persecution have increased—especially those related to women, it is imperative we continue to advocate and call leaders to prioritize issues of religious freedom.”

As it has for over a decade, Open Doors USA placed North Korea at the top of its list.

“The primary driver of persecution in North Korea is the state. For three generations, everything in the country focused on idolizing the leading Kim family,” the report states. “Christians are seen as hostile elements in society that have to be eradicated. Due to the constant indoctrination permeating the whole country, neighbors and even family members are highly watchful and report any suspicious religious activity to the authorities.”

An estimated 50,000 people, including Christians, are believed to be in prison or forced work in labor camps.

While North Korea was the worst persecutor on the list, Open Doors USA noted that Afghanistan was not far behind.

“Afghanistan and North Korea nearly tied. Never before have the top two countries been so close in incidents,” Curry said. “Both countries are extreme in intolerance and outright persecution of Christians in every area Open Doors monitors.”

“Afghanistan now meets the same level of persecution as North Korea in five out of the six areas [used as the criteria for ranking]. This is a tragedy considering the efforts being made by the international community to help rebuild Afghanistan are failing to ensure freedom of religion,” he lamented.

The report outlines that because Afghanistan is Islamic by its Constitution, there is no tolerance toward those who convert to Christianity. Those who turn to faith in Christ may lose their property and their livelihood, and may be beaten or even killed.

“Pray for Christian converts from Islam, who face strong pressure from family, friends and neighbors to recant their Christian faith,” the report urges.

The other countries in the top 10 of the “World Watch List” are also either predominantly Muslim or considered to be Islamic nations, with Somalia, Sudan, Pakistan, Eritrea, Libya, Iraq, Yemen and Iran being among the most dangerous places to live as a Christian.

“In Somalia, there are no safe places for Christians to practice their faith,” the report reads. “It is a violent country where believers face horrific challenges, but Christians still choose to follow Jesus knowing these dangers.”

“Libyan believers from Muslim backgrounds face violent and intense persecution, constantly pressured by their families and the community to renounce their faith,” it also explains. “Christ-followers who publicly express their faith face the risk of arrest and violence as well.”

35 of the 50 nations on the list are largely Islamic, prompting Open Doors USA to note that Muslim “extremism” continues to be the “global, dominant driver of persecution” in the world today.

However, Islam is not the only factor that landed a nation on the list. Nepal was added to the top 50 (#25) for the first time due to concerns over its new Constitution, which “clearly specifies conversion to any religion other than Hinduism is not permissible and is in fact a punishable offense.”

Open Doors USA encourages Christians and their churches to pray for these countries, and includes prayer points for each nation on its list. The full list of 50 countries may be viewed here.

Hebrews 13:3 reads, “Remember them that are in bonds, as bound with them; and them which suffer adversity, as being yourselves also in the body.”

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