SEOUL, South Korea — North Korea has long claimed that it defeated the COVID-19 pandemic without vaccines, losing only 74 lives in what it called “a miracle unprecedented in the world’s public health history.” But a report released Tuesday said the government lied and left many of its people to die without proper health care or access to outside help.

As the pandemic raged, the already woeful economic and public health conditions of ordinary North Koreans rapidly worsened as a result of their government’s efforts, especially in the first two years, to deny that the virus was spreading, according to a report compiled by the Washington-based Center for Strategic and International Studies and the George W. Bush Institute . Pyongyang’s repeated rejections of international help and its draconian crackdown on the movement of people made their suffering worse, the report said.

The authors said their report was based on rare interviews with 100 people inside isolated North Korea — conducted by an outside intermediary that engaged them in “casual, in-person conversations.” Their findings provide a rare glimpse into the scale of human distress inside the country during the pandemic.

“Deaths and suffering due to suspected COVID-19 cases were widespread in North Korea starting in 2020,” well before it reported its first outbreak in May 2022 , the report said.

“The government’s negligence was nothing short of abominable ,” it said.