US officials declined to confirm the observations, but Secretary of State Mike Pompeo said in Washington he planned to meet his North Korean negotiating counterpart next week and would speak to him about inspections. The victims know they are only asking for more trouble by reporting abuse to the authorities - possibly the kind of trouble that involves multiple generations of entire families getting permanently sentenced to labor camps as dissident troublemakers.
"This is not a regime-threatening issue, so that is why it is particularly appalling that the government is not doing anything to prevent sexual abuse by officials", said Roth. "Kim Jong-un could stop this, he could enforce the laws North Korea already has on the books".
Away from home, they found that those who were supposed to look after them were instead their predators: police officers, prison guards and inspectors on trains.
Gathering information in North Korea is notoriously hard, and HRW acknowledged its survey was too limited to provide a generalized sample.
One woman interviewed in the report said a police agent penetrated her several times with his fingers while questioning her illegal stay in China.
On any given day, "market guards or police officials could ask me to follow them to an empty room", says another woman who describes being sexually assaulted many times.
"We hope to get them there before too long", he told the Laura Ingraham show.
"Sometimes", she said of the psychological torment from such abuse, "out of nowhere, you cry at night and don't know why".
She said that the climate of sexual abuse was so pervasive that it had been normalized - both by the perpetrators and their victims.
The coerced sex has become so common that the men don't think their actions are wrong, and the women have come to accept such behavior, some said. "But we don't talk about it".
North Korea strongly rejected the report, calling the allegations "trite" and "fictitious".
Also vulnerable are women who enter China illegally to find work or smuggle goods.
Voice of America Newsput the question to South Korea's Unification Ministry on Wednesday and received assurances via email that the Moon administration "places emphasis on human rights in the notion of universal value and ethnicity, and strives to continuously improve the quality of life for North Koreans".
Some said that North Korean women did not even understand that widespread assaults and harassment were abuse. Thirty-three of the defectors said they had been raped there.
North Korea agreed to allow global inspectors to observe a "permanent dismantlement" of key missile facilities, in return for reciprocal measures by the United States, the South's President Moon Jae-in said in September.
Yoon Mi Hwa, a former trader from North Hamgyong province who escaped North Korea in 2014, described to Human Rights Watch how a guard at a holding centre in 2009 would pick a woman to be raped each night.
"Click, click, click was the most terrible sound I ever heard", Yoon was quoted as saying in the report. "It was the sound of the key of the cell of our prison room opening".
Others in the report said police don't consider sexual violence a "serious crime" and that it's "almost inconceivable" to even consider going to the police to report their suffering because of possible repercussions.
Data submitted by Pyongyang to a United Nations panel on gender equality shows five people were convicted of rape in the North in 2015.
Afraid of retaliation or social disgrace, women rarely report abuse and authorities rarely investigate or prosecute such cases, according to HRW, which said it interviewed 54 North Koreans who had fled the country since 2011 and eight former North Korean officials. "While sexual and gender-based violence is of concern everywhere, growing evidence suggests it is endemic in North Korea".