Madagascar Faces Worsening Nutrition Crisis Among Children

Médecins Sans Frontières (MSF) has raised concerns about a rapidly deteriorating nutritional situation for young children in the Ikongo district, southeastern Madagascar, as the country grapples with a complex humanitarian crisis. The alert comes as the Malagasy government and the United Nations have launched an appeal for international assistance.

Growing Pressure on Health Structures

MSF teams, present in Ikongo since 2022 supporting the Ministry of Public Health, are witnessing increased strain on local health facilities. The district is currently classified in phase 2 of the Integrated Food Security Classification Framework (IPC), indicating a concerning level of food insecurity. The approaching lean season, from January to April, exacerbates the situation as food reserves dwindle before the next harvest. This period also coincides with the hurricane season and a peak in malaria transmission.

Climate Change and Recurring Shocks

Madagascar is highly vulnerable to the impacts of climate change, with frequent extreme weather events disrupting health services and undermining communities’ ability to cope with nutritional crises. These recurring shocks, combined with chronic food insecurity, limited dietary diversity, and seasonal diseases, have eroded the adaptive capacities of local populations. A malaria epidemic in 2025 further weakened these communities.

Malaria Surge Complicates Nutritional Needs

Between January and mid-February, over 11,000 cases of malaria were reported in Ikongo, making it one of the most affected areas in the country, according to the Ministry of Public Health. In MSF-supported facilities, malaria is now the primary reason for consultations, with a positivity rate exceeding 50%. This surge places additional stress on vulnerable families and increases the risk of nutritional complications in young children.

Challenges to Accessing Care

Access to healthcare remains a significant obstacle. Geographical isolation, poor road conditions, a lack of transportation, and climatic hazards all contribute to delays in seeking treatment. Children often arrive at health centers in critical condition due to these delays.

MSF Response and Expansion of Activities

Since the end of October, MSF has strengthened its response in collaboration with local authorities. The organization now supports nine basic health centers and 22 outpatient nutritional treatment centers in the southern part of the district, in addition to the 22 health structures already supported. These activities include medical and nutritional care, active community-based screening, and awareness campaigns to encourage early access to care. MSF teams educate parents on recognizing the early signs of malnutrition in their children, promoting timely diagnosis and treatment.

Funding Gaps and Limited Humanitarian Presence

This expansion of activities occurs amidst decreasing response capacities from other partners. The World Food Programme (WFP) has warned of an estimated $18 million funding gap to cover food security and nutrition needs over the next six months. In Ikongo, the supply of essential medicines to isolated areas, as well as care for pregnant and breastfeeding women, remains under-supported, and the overall humanitarian presence is limited.

Screening and Treatment Efforts

Since the start of the emergency response in October, MSF has screened 27,072 children. Of those screened, 4,077 received treatment for acute malnutrition, including 842 cases of severe acute malnutrition. UNICEF is also contributing to the response through three intensive nutritional recovery centers (CRENI) and mobile clinics.

Urgent Demand for National Mobilization

MSF emphasizes the need for a national mobilization to support health structures, ensure a continuous supply of nutritional inputs and anti-malaria treatments, and maintain free access to care for populations in the most isolated areas. The increasing number of cases and their severity in Ikongo indicate that the coming weeks will be critical in preventing further deterioration of the nutritional and health situation of children.