A mas­sive earth­quake that rocked Myan­mar could ex­ac­er­bate hunger and dis­ease out­breaks in a coun­try al­ready wracked by food short­ages, mass dis­place­ment and civ­il war, aid groups and the Unit­ed Na­tions warned Mon­day. The of­fi­cial death toll climbed past 1,700, but the true fig­ure is feared to be much high­er.

The 7.7 mag­ni­tude quake hit Fri­day, with an epi­cen­ter near Myan­mar’s sec­ond-largest city of Man­dalay, dam­ag­ing the city’s air­port, buck­ling roads and down­ing hun­dreds of build­ings along a wide swath of ter­ri­to­ry down the mid­dle of the coun­try.

Some 270 monks were tak­ing an ex­am in Man­dalay’s U Hla Thein monastery, which crum­pled to the ground when the quake struck.

Sev­en­ty were able to es­cape, but res­cue work­ers at the scene Mon­day said 50 were found dead and that they were still search­ing for 150 more in the rub­ble.

Some 700 Mus­lim wor­ship­pers at­tend­ing Fri­day prayers dur­ing the holy month of Ra­madan were al­so killed when mosques col­lapsed, said Tun Kyi, a mem­ber of the steer­ing com­mit­tee of the Spring Rev­o­lu­tion Myan­mar Mus­lim Net­work.

It was not clear whether they or the monks were al­ready in­clud­ed in the of­fi­cial count. Tun Kyi said some 60 mosques were dam­aged or de­stroyed, and videos post­ed on The Ir­rawad­dy on­line news site showed sev­er­al mosques top­pling dur­ing the quake, and peo­ple flee­ing from the ar­eas.

With an on­go­ing civ­il war and poor in­fra­struc­ture, Myan­mar was al­ready one of the most chal­leng­ing places in the world for aid or­ga­ni­za­tions to op­er­ate, and re­lief ef­forts have been fur­ther ham­pered by se­vere dam­age to roads, bridges and hos­pi­tals, pow­er out­ages, fu­el short­ages and spot­ty com­mu­ni­ca­tions.

A lack of heavy ma­chin­ery has slowed search-and-res­cue op­er­a­tions, forc­ing many to search for sur­vivors by hand, with dai­ly tem­per­a­tures above 40 de­grees Cel­sius (104 Fahren­heit).

Gov­ern­ment spokesman Maj. Gen. Zaw Min Tun told state-run MRTV that more than 1,700 peo­ple had been found dead and that an­oth­er 3,400 have been in­jured and more than 300 were miss­ing.

“This lat­est tragedy com­pounds an al­ready dire cri­sis and risks fur­ther erod­ing the re­silience of com­mu­ni­ties al­ready bat­tered by con­flict, dis­place­ment, and past dis­as­ters,” the Unit­ed Na­tions’ Myan­mar coun­try team said Mon­day, call­ing for unim­ped­ed ac­cess for aid con­voys, med­ical per­son­nel and as­sess­ment teams.

“Even be­fore this earth­quake, near­ly 20 mil­lion peo­ple in Myan­mar were in need of hu­man­i­tar­i­an as­sis­tance,” said Mar­colui­gi Cor­si, the U.N. res­i­dent and hu­man­i­tar­i­an co­or­di­na­tor for Myan­mar.