Following the recent launch of an appeal by the Malagasy government and the United Nations for international assistance in response to the worsening humanitarian situation in Madagascar, Doctors Without Borders (MSF) is concerned about the risk of a rapid deterioration in the nutritional situation for young children in Ikongo district, in the south-east.
Present in Ikongo since 2022 in support of the Ministry of Public Health, MSF teams are already witnessing growing pressure on health facilities to provide care for growing numbers of sick children. Classified in Phase 2 of the Integrated Food Security Phase Classification (IPC) since October, the district is now entering a critical period marked by the lean season (a period of the year when food stocks from the previous harvest are running low, but the next harvest has not yet arrived) from January to April, which coincides with the cyclone season and a peak in malaria.
Madagascar is also facing acute vulnerability to climate change. Repeated extreme weather events are disrupting health services and further weakening communities’ long-term nutrition resilience.
This combination of factors raises fears of an increase in acute malnutrition in the coming weeks. Communities, already weakened by chronic food insecurity, limited food diversity, recurrent climate shocks and seasonal diseases, have seen their coping capacities further eroded following the malaria outbreak in 2025. The result is an increased risk of nutritional complications among young children.
From January to mid-February, more than 11,000 malaria cases were reported, making it one of the hardest hit areas in the country, according to the Ministry of Public Health. In MSF-supported facilities, malaria is now the leading cause of consultations, with a positivity rate exceeding 50%. This resurgence is placing additional strain on already vulnerable families and increasing the risk of nutritional complications among young children.
Access to healthcare remains a major challenge for many people. Geographic isolation, poor road conditions, lack of transport and climate-related disruptions delay access to treatment, resulting in children with acute malnutrition arriving late for care, sometimes in critical condition.
In response to these warning signs, MSF has been scaling up its activities since late October, in collaboration with local authorities. In addition to the 22 health facilities already supported by MSF, activities have expanded to support nine basic health centres and 22 outpatient therapeutic feeding centres in the southern part of the district. Activities include medical and nutritional care, active community screening, and awareness-raising to encourage timely healthcare seeking.
This expansion comes at a time when partners’ response capacities are weakening. At the national level, the World Food Programme (WFP) has warned of an estimated US$18 million funding gap to cover food security and nutrition response needs over the next six months. In Ikongo, the supply of remote areas with essential commodities and the care of pregnant and breastfeeding women remains insufficiently supported, and there are few organisations in place to respond.
The findings from our teams in Ikongo confirm the concerns expressed by the Malagasy governmentDoctors Without Borders (MSF) Head of Mission in Madagascar.
Since last October, 27072 children have been screened. Among them, 4 077 have been treated for acute malnutrition, including 842 for severe acute malnutrition. These efforts are complemented by support from UNICEF, which assists the district through three intensive nutritional rehabilitation centres and mobile clinics.
“The findings from our teams in Ikongo confirm the concerns expressed by the Malagasy government,” says Narcisse Wega, MSF Head of Mission in Madagascar. “The lean season, the cyclone season and the resurgence of malaria are creating a particularly worrying combination. Without a rapid strengthening of prevention and treatment capacities, we risk seeing more children arriving in severe nutritional condition in the coming weeks.”
For MSF, the national-level mobilisation is essential to support health facilities, ensure continuity of supplies of nutritional and antimalarial medicines, and maintain free access to healthcare for people living in the most isolated areas. In Ikongo, the trend of increased illness and severity indicates that the coming weeks will be decisive in preventing a further deterioration of children’s nutritional and health status.
About Doctors Without Borders (MSF) in Madagascar
Doctors Without Borders (MSF) is an international medical humanitarian organisation providing medical assistance in more than 70 countries worldwide. Present in Madagascar since 1987, MSF responds to epidemics, natural disasters and nutrition crises. MSF has been working in Ikongo district since 2022 and is currently supporting the Ministry of Public Health by providing pediatric care and services for pregnant women.
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