USA TODAY - Almost a week after Hurricane Maria pounded its way across Puerto Rico as a Category 4 storm with sustained winds of 155 mph, the outlook for anything but a long and arduous recovery is bleak.

FEMA reported Tuesday that only 11 of 69 hospitals had power, and Gov. Ricardo Rosselló said only about 5% of the island's power grid was operational. Less than half the population had potable water. Cell service was out in 95% of the territory, FEMA said. More than 11,000 people remained in shelters.

President Trump will wait until next week to visit, saying he didn't want to disrupt the efforts of first-responders still saving lives on the storm-battered island.

"The island was hit as hard as you could hit," Trump said. "The island is devastated."

Several factors are slowing the recovery effort. Here are some of them:

Getting help to an island

When natural disasters hit the U.S. mainland, trucks full of food, water and other necessities begin rolling to the area before the sun can come back out. Power companies send trucks with hundreds or thousand of utility workers to start the process of returning power to the affected area. 

That's more difficult in Puerto Rico.

"It's an island," FEMA administrator Brock Long said Tuesday. "We don't just drive trucks and resources onto an island."

Everything must be sent by boat or plane. Ports have only recently reopened, and airports are struggling to regain full operations. Long said that damage to air traffic control equipment added to the issues. He said no one should go to Puerto Rico now unless they are on a "life-sustaining" mission.

"Everybody who is trying to get in who is not supporting that is only getting in the way," he said

The infrastructure was tenuous

The Puerto Rico Electric Power Authority, the government-owned agency that provides electricity to the island, struggles in good times. The agency filed for a form of bankruptcy this summer after a federal oversight board rejected a $9 billion restructuring deal.

Then, earlier this month, Hurricane Irma roared past, its glancing blow enough to wreak havoc on the island's power grid. Maria then dealt the system a death blow. 

Rosselló said the power grid has been "devastated." Transmission lines were destroyed and towers and poles toppled to the ground.

Amy Bach, executive director of the non-profit advocacy group United Policyholders, said Puerto Rico's water, roads and communications systems were similarly fragile before the storms. That adds to the workload before the needs of individuals can be fully addressed.

"Those kinds of efforts can absolutely hinder recovery," she said.

FEMA was stretched to begin with

FEMA had already dealt with a series of historic storms this summer before Maria even began quietly forming in the Atlantic. First Hurricane Harvey slammed into the Gulf Coast of Texas and Louisiana. Then came Irma, bringing unprecedented damage to Florida and serious flooding to Georgia, South Carolina and beyond. 

After Hurricane Sandy tore through much of the East Coast in 2012, about 120,000 households registered for federal aid, Bach said. The count from Harvey alone was about 800,000, she said.

Long said FEMA is not running out of money. Earlier this year, however, the Trump administration proposed cutting FEMA state and local grants by about $600 million. 

"FEMA was under-resourced and under attack," Bach said. "Right now the nation's attention is somewhat focused on aid packages, but there is a finite amount of money."

Insurance is not pervasive

Bach says home insurance isn't nearly as common in Puerto Rico as on the mainland. 

"I assume it's because State Farm's NOT there," she said, referring to the insurance giant's jingle,  "Like a good neighbor, State Farm is there."

Of the estimated 1.6 million housing units on the island, only 1% have flood insurance and about half have wind insurance, Bach said. Many homes are passed down from generation to generation, and there are only an estimated 500,000 mortgages.

With more than half the 3.4 million people living below the poverty line, insurance may not make the list of bills locals want to pay.

"Insurance ads don't saturate the airwaves as they do in the U.S." Bach said. "People often don't think about it — or buy it."

Puerto Rico's financial troubles

The island's government is in no position to provide strong financial support to the recovery effort, which Trump acknowledged in a tweet Monday.

"Much of the Island was destroyed, with billions of dollars ... owed to Wall Street and the banks which, sadly, must be dealt with," Trump tweeted.

Puerto Rico has been in recession for almost a decade. Facing more than $70 billion in debts, the island defaulted on its bonds and filed for the equivalent of bankruptcy in May. That has essentially locked Puerto Rico out of the bond market, leaving little room to borrow money for the rebuild.

"None of that is going to help," Bach says. "Households impacted by Maria have a long road ahead, and the elected officials have their work cut out for them."

Gregory Acevedo, an associate professor at Fordham University whose work has focused on Puerto Rico, said the federal government's poor management of Puerto Rico's financial crisis exposed the true nature of the island's "second-class" status.

"The devastation from a natural disaster like Maria will be amplified by the devastation that U.S. neo-colonialism (has) already wrought," Acevedo said.