North Korea ? North Korea’s health care system is unable to provide sterilized needles, clean water, food and medicine, and patients are forced to undergo agonizing surgery without anesthesia, Amnesty International reported Thursday.

The human rights group, citing World Health Organization statistics, found that North Korea spent under $1 per capita on health care, the lowest in the world. The global average was $716 per capita.

The collapse of the health care system compounds the misery of a population that is chronically malnourished and suffering from digestive problems caused by eating weeds, tree bark, roots, corn husks, cobs and other “substitute” foods.

The poor diet also weakens the immune system, making people susceptible to diseases such as tuberculosis, which afflicts at least 5 percent of the population, according to the report. Meanwhile, about 45 percent of children under the age of 5 suffer stunted growth because of malnutrition.

Amnesty International interviewed 40 people who had escaped North Korea, most of them between 2004 and 2009. They told harrowing stories about their experiences in the medical system.