Madagascar: Surviving a ‘triple crisis’

Madagascar: Surviving a ‘triple crisis’

In Madagascar, Médecins Sans Frontières / Doctors Without Borders (MSF) teams are witnessing an alarming rate of malnutrition in the southeast of the country. Here, families are dealing with a triple crisis of food insecurity, malaria, and extreme weather events.

Between January and April this year, more than 1,200 children under five years old were admitted to MSF-supported treatment centres suffering from severe acute malnutrition. Around 75 percent of these children also had malaria.

This comes after Cyclone Freddy – likely to be recorded as the longest-lasting tropical cyclone in history – hit Madagascar on 21 February, killing 17 people. It was the latest in a series of cyclones which have worsened health problems for already vulnerable communities.

Extreme weather

“Life here got really bad,” says Joella, a 19-year-old pregnant woman receiving antenatal care at an MSF clinic in Ambodirian’i, southeast Madagascar. 

“So many things were destroyed [by the recent cyclones], there were many diseases as well. The hospital building was destroyed.”

Joella and many others being cared for at MSF facilities describe the devastating impact that extreme weather events have had on their ability to grow and harvest rice. Rice is the main food crop of Madagascar and vital to the economic security of the population, generating 41 percent of household income nationwide. 

Another young mother, Genevia, explained how cyclones had completely ruined their rice crop: “Our rice plantation was flooded, it was full of sand. The water level was increasing a lot."

Genevia had brought her twins to the MSF-supported clinic to receive treatment for malnutrition.

Many of the pregnant and breastfeeding mothers being treated by MSF spoke of the arduous work that goes into cultivating and harvesting rice, and the heartbreaking reality of that work going to waste when a cyclone or heavy rains arrive.

“I'm afraid to be weak," says Genevia. She fears that the lack of access to food will impact her ability to work long hours in the family's rice field. 

Across southeast Madagascar, 80 percent of crops were destroyed by cyclones in 2022. After Cyclone Freddy in particular, preliminary assessments by the government and humanitarian organisations estimated that 148,000 people needed humanitarian assistance.

The extreme weather has had many other impacts beyond the destruction of crops. When roads and bridges are damaged by wind and rain, people in affected areas find it difficult to access healthcare.

Madagascar has one of the least developed road networks globally. Many people arriving at MSF facilities have faced long dangerous roadways or flooded paths to get there. For some, the treacherous journeys stop them from seeking healthcare altogether.

In response, MSF teams have launched mobile clinics using boats, cars and motorbikes to ensure remote communities are able to safely access care.

Food insecurity 

With the impact of multiple cyclones on crops, food stocks are dwindling. 

The day before Cyclone Freddy hit Madagascar, MSF teams witnessed people in rural communities foraging for fruits and vegetables before the storm could destroy them. 

Now, in the southeast district of Ikongo, an increasing number of parents are bringing malnourished children to the MSF-supported clinic in the town of Ifaneria. 

“People know that MSF is here to take care of malnourished kids under five,” says Olga, an MSF nurse.

“They are very motivated to bring their kids here.”

Of the nearly 2,200 children screened for malnutrition in Ikongo during the first two weeks of April, five percent were suffering from severe acute malnutrition. 

In Nosy-Varika, one of the coastal areas worst hit by Cyclone Freddy, MSF and local health authorities also increased malnutrition screening in response to the worsening food security. Here, between February and March, admissions of children under the age of five with severe acute malnutrition more than doubled. 

MSF teams have now increased malnutrition-related activities and are intensifying support to communities by expanding medical coverage to new locations in even harder-to-reach areas. 

Malaria season

Cyclone season and the so-call ‘lean’ season (the period between harvests when food stocks are low) also coincide with malaria season. 

Malaria is a major health issue in Madagascar and one of the top five causes of mortality for the Malagasy population. 

“Malaria is not the same today as it used to be,” said Masy, an elderly woman in the waiting area of the MSF-supported clinic in Sahavato. The town is situated within the southeast of Nosy Varika. 

“Now, malaria is very severe. It used to only happen to kids... now malaria is happening to everyone.”

Malaria increases in many parts of Madagascar during the rainy season as there is more stagnant water around, which acts as a breeding ground for mosquitos. 

During peak season, MSF teams in the southeast conduct test-and-trace activities for malaria. In some communes, 90 percent of children treated by MSF for malnutrition also test positive for malaria.

In future, heavy rains and flooding in Madagascar are predicted to increase, with climate scientists also warning of a likely rise in the number of category 4-5 tropical cyclones – the two highest levels.

This will increase the risks faced by many, particularly the 80 percent of people living in rural areas and the 80 percent living at the poverty line in places like Nosy-Varika.

“A quarter of children in this area are acutely malnourished,” says Brian Willett, Head of MSF in Madagascar.

“This catastrophic humanitarian crisis will continue through repeated climate shocks and long-term poverty if we don't see consistent political and collective action."