The death toll from a massive earthquake that struck Japan on New Year’s Day rose to 64 on Wednesday as authorities rushed to bring aid to survivors facing freezing temperatures and heavy rain forecast for later in the day.

The quake with a preliminary magnitude of 7.6 struck the Noto peninsula on Monday afternoon, levelling houses and cutting off remote areas from much-needed aid.

Heavy rains were forecast in the quake-hit areas on Wednesday, raising fears of landslides in what could further hinder efforts to free many more trapped under rubble.

Severed roads, damaged infrastructure, and the remote location of the hardest-hit areas have complicated rescue efforts. The full extent of damage and casualties remains unclear two days after the quake.

Authorities have confirmed 64 deaths so far, up from 55 late on Tuesday, making the earthquake the deadliest in Japan since at least 2016.

Over 33,000 people have evacuated their homes and some areas have no access to water or electricity and have spotty signal, according to Ishikawa prefecture.

The mayors of the hardest-hit cities demanded the government clear roads and deliver aid swiftly at a regional emergency disaster meeting held Wednesday morning.

“Even those who narrowly escaped death can’t survive without food and water,” said Masuhiro Izumiya, the mayor of Suzu, a town of about 13,000 near the quake’s epicentre.

“We haven’t received a single loaf of bread,” he added.

Shigeru Sakaguchi, the mayor of hard-hit Wajima city, said he was grateful for the government’s efforts but had received only 2,000 meals for some 10,000 evacuees so far.