The medical condition of North Korea’s latest escapee reveals worrying insights about health and hygiene in the rogue state.

The individual, who was shot multiple times after running across the demilitarized zone that separates North and South Korea on Monday, is currently recovering at a hospital near Seoul. His chances of survival, however, are complicated by the “enormous number of parasites” found in his body, South Korean doctor Lee Cook-Jong told Agence France-Press on Thursday.

In the man’s small intestine, Lee discovered numerous roundworms, including one that was 27 centimeters, or about 11 inches, long. “I’ve never seen anything like this in my 20 years as a physician,” he told AFP.

Parasites such as roundworms are reportedly widespread in the nuclear-armed nation and can often be the result of consuming vegetables fertilized with human feces. South Korea faced a similar problem until the use of commercial fertilizers became widespread in the 1980s.

Roundworms “thrived in Korea because human excrement was practically the only method used to fertilize the land, possibly due to the relative scarcity of cattle,” said a report published in Cambridge University’s Medical History journal this June.

In recent years, the secretive state has received shipments of fertilizer from Seoul and beyond, but it’s not clear whether that’s being continued in light of the latest international sanctions.

Malnutrition is also a common issue in North Korea, where famines are a regular occurrence.