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Photostory: Madagascar's looming famine

18 May 21 | 01 Jun 21

Photostory: Madagascar's looming famine

MSF emergency teams on the ground are appealing for a massive increase in food aid

Photostory: Madagascar's looming famine

An immediate and massive increase in food aid is urgently needed for people in southern Madagascar.

MSF teams in the region are witnessing an exceptionally severe malnutrition crisis which in some places borders on famine.

“We’re seeing totally destitute people who have literally nothing to eat and are teetering on the edge of survival,” says Julie Reversé, MSF coordinator in Madagascar

“Some have had to sell their cooking utensils and don’t even have containers to fetch water.” 

In some villages in Amboasary district of Anôsy region in the south, MSF teams have found that, on average, around 28 percent of children under five are acutely malnourished. 

One-third have severe malnutrition and are at high risk of death.

Malnutrition emergency: mobile clinic in Ranobe Caption
In Ranobe, a child is weighed to check for malnutrition – often an upsetting moment for young children.
Malnutrition emergency: mobile clinic in Ranobe Caption
A child is weighed at an MSF mobile clinic in Amboasary district.

Since late March 2021, MSF teams have been screening and treating people for acute malnutrition and providing basic medical services through mobile clinics in Amboasary district. 

We are also working to improve people’s access to drinking water by distributing jerry cans, repairing hand-operated pumps and treating and transporting water drawn from the river. 

Our teams are currently gearing up to launch food distributions and scale up inpatient treatment for patients with severe acute malnutrition and associated medical complications.

Malnutrition emergency: mobile clinic in Ranobe Caption
The MUAC (Mid-Upper Arm Circumference) measurement is a quick way of identifying children at risk of malnutrition. This child is suffering from severe acute malnutrition and will be integrated into the programme.

According to recent figures released by Madagascar’s authorities, UN agencies and other organisations operating in the region, 74,000 children across southern Madagascar are acutely malnourished, including 12,000 children who have severe malnutrition.

This is an increase of 80 percent compared to the last quarter of 2020. 

Almost 14,000 people in Amboasary, one of the worst affected districts, are now considered to be starving.

“One alarming indicator is that the 2,200 people treated by MSF for acute malnutrition since the end of March include children under five, but also adolescents and adults,” says Reversé.

Malnutrition emergency: mobile clinic in Ranobe Caption
In order to drink, wash and cook, people often rely on surface water from rivers. However, drought and the poor quality of water has had severe medical consequences.

A unique combination of factors has plunged southern Madagascar into this crisis:

The worst drought in 30 years has wreaked havoc on agriculture. Sandstorms caused by deforestation have covered much of the arable land, even destroying food sources such as cactus fruit – normally eaten as a very last resort. And, COVID-19 has had a spill over effect on the island's economy. 

Related to the food shortages driven by these events is a reported rise in attacks, hold-ups and thefts of livestock, property and food. 

Other factors include a surge in malaria infections and a lack of access to healthcare and drinking water, which have exacerbated the health situation still further.

Malnutrition emergency: mobile clinic in Ranobe Caption
The MSF team unload ready-to-use therapeutic food at the mobile clinic.
Malnutrition emergency: mobile clinic in Ranobe Caption
Nutritional assistants distribute two weeks of food treatment, to get people through to the arrival of the next mobile clinic.

Due to a lack of resources, food distributions by the World Food Programme and other aid organisations are limited to half-day rations, while some villages are receiving no food aid at all. 

This is all the more worrying as access to food is likely to be an even bigger issue in the coming months, with little or no harvest expected in June and the onset of the “lean season” in October.

Malnutrition emergency: mobile clinic in Ranobe - Portrait Maraignavy Caption
Maraignavy and his children walked for five hours to reach the MSF mobile clinic in Ranobe. They will return home with bags full of Plumpy’Nut emergency rations.

Getting aid to the people who need it is challenging. 

The island’s geography brings its own specific constraints and the semi-arid southern regions have many remote villages and few paved roads. 

It takes at least three days to drive from the capital Antananarivo to the main town in Amboasary district, and from there it can take many hours along tracks and trails to reach the most remote villages. 

On top of this, in mid-March the authorities introduced restrictions on entering Madagascar and travelling within the country due to the COVID-19 pandemic.

Malnutrition emergency: mobile clinic in Ranobe Caption
People shelter from the sun as they wait to be seen by MSF medical teams at a mobile clinic in Ranobe, Amboasary District.
Malnutrition emergency: mobile clinic in Ranobe - Portrait Vitasoa Caption
42-year old Vitasoa has six children. She’s brought four of them to the MSF mobile clinic. All the children are included in the nutrition programme launched at the end of March to respond to the food and nutrition emergency in southern Madagascar.

“Hundreds of thousands of people in southern Madagascar rely almost entirely on food aid,” says Bérengère Guais, MSF’s head of emergency operations. 

“A substantial effort – not only financial, but also logistical and human – is vital to ensure regular deliveries of food rations in sufficient quantities over a period of several months. Travel must be made easier for aid workers by ensuring regular flights to enter and move around the country. 

“An entire population, spread across vast, remote areas with very little infrastructure, is in desperate need of life support. The clock is ticking.”

MSF and malnutrition

Nine children die every minute because their diet lacks essential nutrients.

According to the World Health Organisation (WHO), malnutrition is the single greatest threat to the world’s public health, with 178 million malnourished children across the globe.

However, MSF estimates that only three percent of the 20 million children suffering from severe acute malnutrition receive the lifesaving treatment they need.

In 2019, we admitted 76,400 severely malnourished children into inpatient feeding programmes.