Madagascar: almost two years after the cyclones, the situation remains critical in the southeast

Enormous accessibility challenges

10 km is the distance separating the village of Ambodiharamy from the nearest Basic Health Center. It’s also the distance covered by Action contre la Faim’s mobile Health and Nutrition teams, crossing waist-high rivers and carrying at arm’s length the equipment needed to care for the region’s malnourished children. They criss-cross winding roads to reach remote areas completely inaccessible to motorized vehicles.

“Lack of access to basic services is the major challenge facing the people living in this region,” Tom Meunier, field coordinator for Action contre la Faim in Manakara. “Only 34% of health centers are accessible by car, and 19% are accessible only on foot. The long distances to health centers often discourage families from seeking care or continuing their treatment”.

Many rural communes can only be reached by pirogue, launch or on foot, resulting in limited coverage and an excessively long response time. In this context, humanitarian aid can prove complicated during the rainy season.

Populations impacted by climate change

“After the passage of cyclones Batsirai and Emnati last year, the Fitovinany region experienced a deterioration in the nutritional situation. The mass screening carried out by Action contre la Faim teams in December revealed that the Manakara district is classified as an alert situation”, explains Jean Pierre Randrianarivo, head of Action contre la Faim’s Health Nutrition program in Manakara.

To alleviate this critical situation, Action contre la Faim is deploying mobile Health Nutrition teams to get as close as possible to populations, in order to identify and monitor the state of health of malnourished children. In the Manakara district, 5 mobile teams have been mobilized to intervene in 20 sites spread over 8 communes.

“A mobile team is made up of a nurse in charge of integrated disease management for children aged 0 to 9 months, and a nurse in charge of patient care. The team also includes a measurer, who takes anthropometric measurements, and a psychosocial worker, who provides psychological support to mothers,” explains Jean Pierre.

On this day, Marie-Clarisse, 28, a farmer and mother of 5, took her place in the mobile activities queue, accompanied by her 4-year-old son Bienvenu, so that he could be seen by the Action contre la Faim nurse. “My son suffers from malnutrition; he was really very small.

“We were really hit by the cyclone and it hit here, it destroyed the houses, the crops and that’s what led to malnutrition for the children. All our means of subsistence were destroyed, so we had to eat foods that were not part of our normal diet, such as pikopiko, hofika and veoveo. (poisonous Malagasy wild plants)”, says Marie-Clarisse.

Treatment of severe acute malnutrition with complications in district hospitals (CRENI – Centre de Récupération d’Education Nutritionnelle Intensif) was not available before the emergency, due to a lack of trained personnel. Today, Action contre la Faim is helping to improve the quality of care by training health workers, building their capacity and providing medical equipment and supplies. In addition, Action contre la Faim’s mobile teams help refer and transport malnourished children with complications to the Manakara hospital. Action contre la Faim also covers the costs of admitting children to the CRENI and carrying out medical tests, as well as the costs of accompanying persons (food, hygiene kits, etc.).

Cash transfers for emergency situations

Today, Action contre la Faim teams are setting up in a shelter in the commune of Sahanambohitra to begin registering cash transfer beneficiaries. “We’re expecting 300 households for the census,” explains Sergino Andriamitantsoa, head of the Food Security and Livelihoods program.

“We distribute cash to households in critical situations. In the selection criteria, we prioritize people who depend on agriculture for their livelihoods and households with malnourished children”.

In this region, where nearly 900,000 people suffer from acute food insecurity, Action contre la Faim, in response to the emergency, is providing unconditional food assistance to around 80,000 people until September 2023, and supporting agricultural recovery for 3,000 households over the 2023-2024 farming season.

Torice and Maroline, a couple with 3 dependent children answer questions from Action contre la Faim’s interviewer. “We don’t grow rice. We grow manioc, but we don’t harvest much. So we work for other people to make a living. Sometimes we earn 1,000 ariary, sometimes 1,500 ariary a day (about 30 euro cents). Sometimes we earn nothing, and sleep without food. With sickness and lack of food, we’re getting skinny”.

“Our 3-room house was destroyed by the cyclone. The land slid over our rice fields, and the trees were also ravaged. Today, we have a small, basic house made of tree leaves, while we wait to rebuild our house. We’ll be able to use this money to buy land to cultivate and also to build a house ».

As a result of the cyclones, production losses from the two successive harvests, particularly on food crops, cash crops and fruit trees, are very high. The next agricultural season, due to start in November, is likely to be a difficult one for families in the region. According to a survey carried out by Action contre le Faim teams, 36% of households have expressed a lack of access to seeds and inputs, and are worried about missing the agricultural season again.

Six months after the passage of cyclone Freddy, the region already weakened by the various cyclones in 2022 finds itself in a dramatic situation. In the Southeast, the prevalence of acute malnutrition is almost as high as it was during the drought in the Grand Sud.

According to the results of a mass screening for malnutrition in children under 5 carried out in October 2023 in two of the three districts of the Fitovinany region, the global malnutrition rate is 8% (6.3% for the Manakara district and 12.1% for the Ikongo district). 15 communes in the region have global malnutrition rates of over 10%, including 6 with rates of over 15%.