Climate shocks, food insecurity, and malaria in Madagascar

As one of the countries most at risk of climate change, Madagascar has seen worsening health problems in vulnerable communities.

Bruanette works at the MSF clinic

Madagascar 2023 © MSF/Kathryn Dalziel

In Madagascar, teams from Doctors Without Borders/Médecins Sans Frontières (MSF) are witnessing an alarming rate of malnutrition in southeastern districts. Families there are dealing with a triple crisis of food insecurity, malaria, and extreme weather events like Cyclone Freddy, which hit the country earlier this year and killed 17 people. In response, MSF has increased malnutrition activities, consultations, and support to communities by expanding medical coverage to new locations in some of the hardest-to-reach areas.

Madagascar remains one of the countries most at risk of climate change and has experienced a series of cyclones—including Cyclone Freddy, which was the longest-lasting cyclone in history—that have worsened health problems for many vulnerable communities.

Between January and April, as flooding has ruined swaths of agricultural fields, over 1,200 children under five years old suffering from severe acute malnutrition were admitted to MSF-supported treatment centers. Around 75 percent of these children also had malaria. Children who are malnourished and have weakened immune systems are more susceptible to contracting other illnesses like malaria.

Ambodirian'i village, Madagascar
Residents in the town of Ambodirian'i, southeastern Madagascar, prepare to hibernate from Cyclone Freddy. Madagascar 2023 © MSF/Kathryn Dalziel

Extreme weather leads to food insecurity 

"Life here got really bad [following the recent cyclones]," said Joella, a 19-year-old pregnant woman receiving prenatal care at an MSF clinic in Ambodirian’i, southeastern Madagascar. "So many things were destroyed, there were many diseases as well. The hospital building was destroyed."

Joella and many others receiving care at MSF facilities described 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 throughout the country.

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." She arrived at the MSF-supported clinic with her twins, who received treatment for malnutrition.

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Extreme weather has 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 health care. 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 health care altogether. To address these challenges, MSF teams have launched mobile clinics using boats, cars, and motor bikes to ensure remote communities are able to safely access care.

Newborn in Ambodirian clinic, Madagascar 2
First-time mother Soa (left) delivered her baby boy with the help of MSF nurse activity manager Titi at the clinic. Soa stayed with her family and newborn in an adjacent room to the team until the cyclone passed. Madagascar 2023 © MSF/Kathryn Dalziel

Treating children for malnutrition

The multiple cyclones have impacted crops, depleting existing food stocks. On 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.

In the southeastern 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,” Nurse Manager Olga said. “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 increased malnutrition screening in response to worsening food security. Between February and March, admissions of children under the age of five with severe acute malnutrition more than doubled.

Midwife Mamitiana and Nurse Olga
Midwife Mamitiana (left) and Olga (right) work at the MSF supported clinic in Ifaneria. They support the community with pre-natal consultations, malnutrition care and other primary care health concerns. Madagascar 2023 © MSF/Kathryn Dalziel

The increasing risk of malaria

Malaria is a major health problem 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 southeastern district of Nosy Varika. "Now, malaria is very severe. It used to only happen to kids, but now it is happening to everyone."

Ambodirian'i clinic, Madagascar
MSF maternal health consultation at our Ambodirian'i clinic in southeastern district of Nosy Varika. Madagascar 2023 © MSF/Kathryn Dalziel

Malaria spreads through many parts of Madagascar during the rainy season because stagnant water is a breeding ground for the mosquitos that carry the disease. During peak season, MSF teams in southeastern districts conduct test-and-trace activities for malaria. In some areas 90 percent of the children MSF treats for acute malnutrition also test positive for malaria.

Heavy rains and flooding in Madagascar are predicted to increase, with climate scientists warning of a likely rise in category four and five tropical cyclones. This will leave many people vulnerable, particularly the 80 percent of the population 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” said Brian Willett, MSF’s head of mission 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."