For the third year in a row, persecution rose globally, with countries in South and Southeast Asia rising rapidly in danger levels, almost matching the severe persecution Christians face in the Middle East and Sub-Saharan Africa, where Islamic extremism still maintains a strong presence.
North Korea tops the list for the 15th time; in the isolated country, owning a Bible carries harsh penalties, including imprisonment and executions of Christians.
"Worship of the ruling Kim family is mandated for all citizens, and those who don't comply (including Christians) are arrested, imprisoned, tortured or killed," reads the report. "Entire Christian families are imprisoned in hard labor camps, where unknown numbers die each year from torture, beatings, overexertion and starvation. Those who attempt to flee to South Korea through China risk execution or life imprisonment, and those who stay behind often fare no better."
Somalia rises from seventh to second, and is referred to as a "safe haven for Islamic militants" where Christians have "no voice in society".
Nine of the top 10 were among the top 10 on the previous year's list, with Yemen replacing Libya, which now is No. 11. Somalia (2), Afghanistan (3), Pakistan (4), Sudan (5), and Iran (8) each rose in the rankings; Syria (6) and Iraq (7) fell slightly.
In those countries, Christians are a "small and vulnerable minority", and comprise less than 15% of the population in 41 of the top 50 countries.
Like last year, Islamic extremism remains the most common cause of pressure against Christians, and has seen its greatest rise in Africa, where more people are killed for their Christian faith than anywhere else in the world. In those countries, extremists aiming to eradicate Christianity have burned churches, homes, and other places of worship.
India's Hindu-majority nation places at no. 15, due to the rising attacks by Hindu nationalists. Open Doors said that an average of 40 incidents per month against Christians or churches were reported in India during 2016.
"For Christians in the West, the Open Doors World Watch List is a clear indicator that we need to advocate on behalf of those who do not have the same religious freedom privileges we do," said David Curry, president and CEO of Open Doors USA.
"We hope the Trump administration will address religious liberties in the first 100 days in office."
Recently, another persecution watchdog, International Christian Concern, released its own list - the "Hall of Shame" report - of countries where Christians face the most persecution. According to the report, North Korea, Syria, Nigeria and Iraq are the worst countries in the world for Christians, but the United States is also included on the list.
"Throughout the US, current events and shifting perceptions are causing conflicts between Christian beliefs and public sentiment," reads the report. "This cultural shift affects Christian businesses, organizations and individuals through legal action, free speech infringement, public expressions of faith, and employment."