Political tensions and government controls in North Korea are jeopardizing international relief efforts, putting the communist state at risk of a humanitarian disaster, the Red Cross said on Tuesday.

More than one million people have died of famine in isolated North Korea since the mid-1990s and the country relies on outside aid for medicine and food supplies to feed about one quarter of its 22.5 million population.

“If our programs are compromised, the result will be a large loss of life and a large increase in illness and disease in the DPRK,” John Sparrow, a spokesman for the International Federation of Red Cross and Red Crescent Societies in Beijing, said on Tuesday after a five-day trip to North Korea.

DPRK stands for the Democratic People’s Republic of Korea, the North’s official name.

North Korea last September said it wanted to stop humanitarian aid and only receive technical assistance, and tightened control of expatriates meant monitoring relief work had dropped by as much as half, the Red Cross said in a statement.

That endangered the effectiveness, and therefore the backing, of badly needed health, water, sanitation and disaster readiness programs, Sparrow said.

Pyongyang has been embroiled for years in a nuclear standoff with Washington, and recent efforts to restart the stalled six-party talks between the United States, the two Koreas, China, Japan and Russia have been fruitless.

Widespread famine struck North Korea in the 1990s after a series of natural disasters and low harvests followed the collapse of the Soviet Union and Pyongyang’s other eastern European Communist allies.

The World Food Programme, which has provided food aid to North Korea since 1995, said over the weekend it is cutting supplies because it is struggling to find cash and food donors.

The organization earlier said foreign food aid had helped curb malnutrition in North Korea in the last two years, but any gains could be lost if international donations wane.