Madagascar: Climate factors contribute to malnutrition spikes

MSF teams are treating thousands of children and expecting cases to rise

Ifanirea, Ikongo district, Madagascar

Madagascar 2023 © MSF

An alarming situation is unfolding in southeast Madagascar, where teams with the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) are seeing a rise in severe acute malnutrition in rural communities that were impacted by last year’s cyclones.

MSF is currently supporting 24 health facilities in hard-to-reach places in southeast Madagascar, as well as treating patients for malnutrition in five health centers in the Ikongo district of the Fitovinany region. As of early January, 2,072 children under the age of five were being treated for severe acute malnutrition. Nearly half of these children were admitted to MSF nutritional programs. This number is expected to rise over the coming months due to a lack of food and the upcoming peak of the malaria season—a disease that can exacerbate malnutrition.

The two consecutive cyclones that hit the southeast region of Madagascar nearly a year ago—Batsirai on February 5 and Emnati on February 22—destroyed harvests and left a trail of destruction. Most people in the area survive off crops like cloves, coffee, vanilla, and bananas for both food and income. The cyclones affected almost the entire agricultural area in the southeastern Vatovavy, Fitovinany, Atsimo, and Atsinanana regions, including more than half of people’s food crops.

“While communities in these areas already have very high rates of chronic malnutrition, the cyclones have tipped them over into an acute situation,” said Brian Willett, MSF head of mission in Madagascar. “Repeated climate shocks aggravate hardship for communities that have to build back every time.”

More than a quarter of the population in Madagascar’s Vatovavy, Fitovinany, Atsimo, and Atsinanana regions are currently experiencing acute food insecurity, according to a recent Integrated Food Security Phase Classification (IPC) analysis. In fact, during nutritional screenings in November, MSF found that nearly one in five children screened had moderate or severe malnutrition at the onset of the lean season, which typically lasts from September to April.

Food insecurity is not new in Madagascar, but several factors have further impacted health problems among the most vulnerable. In addition to climate factors like cyclones, intermittent rains, and persistent crop failures, limited access to health care and COVID-19 have fueled existing food insecurity and malnutrition. Madagascar is one of the countries most vulnerable to the impacts of climate change and regularly faces extreme weather events.

“Few humanitarian organizations work in the southeast and we are looking at scaling up our activities,” Willett said. “Many households tell us that despite careful rationing, their staple food stocks will be completely empty by February. This is worrying as the crop production from this year’s season is expected to be low due to little rain in the beginning of the season. If yet another cyclone was to hit this season, it would transform this already dire situation into a catastrophe of significant scale.”

MSF first worked in Madagascar in 1987 and most recently returned in 2021 to tackle the malnutrition crisis in the south of the country. Today, MSF supports 29 local health facilities in Ikongo district with nutritional care, providing therapeutic foods and training health staff to diagnose and treat malnutrition. MSF teams also provide primary health care to communities in the coastal area of Nosy Varika in the Vatovavy region and sanitation and water infrastructure in the Androy region.