While there isn’t really good place to have a disaster, in recent years Pakistan’s political climate has made it worst than most.

Concerns about terrorism and government mismanagement of aid hampered recovery from debilitating flooding in 2010. Successive annual floods since then have seen a similar lack of response, according to OxFam International. Now, insurgents are keeping rescuers from assisting victims of a 7.7 magnitude quake that struck the Awaran region last week.

“The truth is we are scared and won’t be going in,” the head of an unidentified Karachi NGO told IRIN News. “This is bad for affected people.”

Aid workers have reason to be fearful. The area most affected is a stronghold for Baloch nationalists, an ethnic group that has been fighting for independence from Pakistan for years, according to IRIN. While the nationalists have mainly focused attacks on Pakistani military helicopters attempting to deliver aid, at least one group of doctors and paramedics were fired on, according to a September 25 Islamic Relief update. Experts say any non-Baloch individuals can be at risk.

“The security situation is always unpredictable anywhere in Pakistan,” Haseeb Khalid, of Islamic Relief’s office in Pakistan, told IRIN. “In Awaran, there may be some security threats for relief and aid workers, especially for those who are non-Baloch.”

Adding to the immediate threat of nationalist attack is the lack of infrastructure in the area, some of which has resulted from the years of insurgent occupation. There are no medical facilities, roads are pitted and perilous, and many of the homes in the district were made of unbaked mud bricks—about 90 percent of which were destroyed, according to IRIN. Rugged terrain was also an issue.

The cumulative effect has kept survivors waiting for days in the heat without shelter or medical care. As of September 28, the official number killed by the earthquake and a 6.8 magnitude aftershock had reached 515, but could grow to more than a 1,000 according to Reuters.

“For the first 24 hours no one could reach the [worst affected] areas. Even now most of the aid is stuck in Quetta [the capital city of the province], because security is a concern,” Siddiq Baloch, editor of Balochistan Express, told the Christian Science Monitor. “If the government had paid any attention to these areas from before and built health and medical facilities there, which are currently nonexistent, things would have not been so bad. Many of the critically injured continue to die since they are receiving no help.”

The factors hindering aid to the area have had little effect on novelty seekers traveling to see a newly formed island that was created by the earthquake. The mud and rock formation, which is about 250 miles from Awaran, is spewing flammable gas but has drawn crowds of locals and scientists undaunted by the prospect of a walk on its hellish surface.