(CNN)North Korean food production in 2018 fell to its lowest level for over a decade, leaving millions without enough to eat, according to the United Nations.
An estimated 11 million people inside the country -- nearly 44% -- are undernourished, the UN's 2019 North Korea Needs and Priorities report found.
Food production fell by more than 9% from 5.45 million metric tons in 2017 to 4.95 million metric tons last year, in part due to "shortages of arable land, lack of access to modern agricultural equipment and fertilizers and recurrent natural disasters," it said.
Outlining the "grim" situation for millions of North Koreans, the UN called for $120 million worth of aid to be sent to the country.
"Widespread under-nutrition threatens an entire generation of children," Tapan Mishra, the UN resident coordinator in North Korea, said in a statement, adding that the UN had been unable last year to reach hundreds of thousands of people it planned to help.
"An estimated 1.4 million people didn't get food assistance. Just under 800,000 people were not able to access essential health services. An estimated 190,000 kindergarten children and 85,000 acutely malnourished children did not get the nutrition support they needed," said Mishra.
"Beyond the numbers, the human cost of our inability to respond is unmeasurable."
North Korea has suffered several famines in recent years.
The worst hit the country in the 1990s, when a series of bad harvests were exacerbated by the faltering economy. Though official figures may never be known, it is believed that about 10% of the country's population died.
North Korean leader Kim Jong Un and his predecessors have faced harsh international criticism for ignoring the needs of their people at the expense of other priorities, notably the nuclear weapons program.
North Korean negotiators, however, have said the country has chosen to engage US President Donald Trump in denuclearization talks in an effort to boost the economy and improve the people's livelihood.
But talks ended abruptly at last week's summit in Hanoi, after Trump said he walked away from the table when North Korea demanded the removal of all sanctions levied against it.
North Korean Foreign Minister Ri Yong Ho said his country asked the Trump administration to remove the "sanctions that hamper the economy and the livelihood of our people."
The measures have left Pyongyang isolated and without trading partners apart from China, which accounts for a large share of its international trade.
Though the sanctions are, in theory, supposed to allow for exemptions for humanitarian aid, there have been delays and other "unintended consequences," Mishra said.