Mobile clinics respond to nutritional emergency in the south and southeast

The south and southeast of Madagascar are experiencing an ongoing humanitarian crisis, with serious consequences for food security and public health.

In this emergency situation, Action Against Hunger teams are providing a rapid, coordinated, and multisectoral response, particularly in the areas of health and nutrition, to save lives and limit long-term impacts.

Increase in cases of acute malnutrition in the region

In southern Madagascar, more than 1.2 million people are food insecure (phases 3 and 4 according to the IPC AFI, July 2025). In the districts of Ambovombe, Amboasary, and Ampanihy, up to 40% of the population is affected by this crisis, and this situation is expected to persist until early 2026.

In the southeast, successive cyclones in 2022 and 2023 have worsened the situation in districts such as Nosy Varika and Ikongo. In the south, the passage of tropical cyclone Honde at the end of February 2025 off the coast of Androy and Atsimo Andrefana, particularly in Ampanihy and Beloha, caused severe flooding and seriously damaged roads and supply routes, exacerbating difficulties in accessing markets and causing prices to soar.

These consecutive cyclones have hampered access to healthcare, increased food insecurity in isolated communities, and led to an increase in cases of diarrhea due to the use of untreated surface water.

In addition to these climatic hazards, the Trump administration’s decision in January to reduce or even permanently halt humanitarian funding in the region has further exacerbated the situation.  “Five mobile clinics were able to continue thanks to ECHO funding. However, we still had to stop our support for the CRENI (Intensive Nutritional Recovery Centers) in Tsivory and prioritize our actions where the needs were greatest,” adds Haingo Nirina Ranaivoarivony, head of the health and nutrition department at ACF Madagascar.

“In addition, in the southeast, in May 2025, an outbreak of malaria may have contributed to an increase in cases of acute malnutrition among children. ACF was able to participate in the response by providing logistical support in the delivery of supplies and treating malaria cases through mobile clinics.

However, in Manakara and Ikongo, due to a lack of funding, we are in the process of withdrawing. Unfortunately, we no longer have any partners on the ground, which is a cause of great concern for us regarding the future of the populations in this region.”

Getting closer to isolated populations

In collaboration with its partners, the Malagasy association ASOS (Action Socio Sanitaire Organisation Secours) and Médecins du Monde, and with financial support from the European Union (ECHO), Action Against Hunger has set up mobile clinics that travel to isolated Fokontany communities in the south and southeast to bring healthcare closer to the people.

In order to provide healthcare, nine mobile clinics were deployed in the two regions from October to December 2024, and 15 mobile clinics from January to June 2025. Each team is made up of a doctor, nurse, midwife, healthcare provider, and psychosocial worker. The mobile clinics provide screening for malnutrition in children under 5, treatment for acute malnutrition, PECIME care, prenatal consultations for pregnant women, family planning services, and outpatient consultations.

In the south (Androy, Anosy, and Atsimo Andrefana regions), mobile clinics are operated directly by the NGO ASOS. “Our role is to support ASOS in project management, planning, budget monitoring, and technical support for the supervision of mobile clinics.”

“When malnourished children develop complications, our teams refer them to the CRENIs, where the project also provides support for their care. This support takes the form of reimbursement for care, psychosocial support for caregivers, a daily ration for caregivers, and the provision of human resources (nurses and psychosocial workers) in each supported CRENI. 4,310 children under the age of 5 have received treatment for acute malnutrition, whether severe or moderate,” comments Haingo.

Rhodia’s history

Rhodia, aged 35, lives in Ambodiampaly, a working-class neighborhood, with her husband and their six children. As a housewife, she devotes all her energy to her family in their simple but functional tin-roofed house.

The water they use every day for cooking, washing, and bathing comes from a well located about 50 meters away. Like many in her community, she and her family live on very little. Income is uncertain, and health is often not a priority due to lack of resources. Her husband manages the financial decisions, and making ends meet is often difficult.

When their youngest child, Stanchevah, aged 6 months, fell seriously ill, Rhodia and her husband did not recognize the signs of danger. They tried to treat her themselves, as they usually did for minor ailments. But this time, nothing seemed to work. The little girl was getting worse and worse.

One day, the project’s mobile clinic arrived in their neighborhood. Rhodia went there with her baby, not really knowing what to expect. The child’s condition was enough to convince the medical team to refer her immediately to the CRENI services. As soon as she arrived, she felt relieved. The welcome was warm, respectful, and humane. In this period of fear and uncertainty, she found people who were willing to listen to her and help her. The care was free of charge. Stanchevah received comprehensive medical care: medication, tests, regular follow-ups, and surgery. Rhodia received three meals a day and hygiene kits for herself and her baby. But this support was not limited to healthcare. Rhodia also received psychological support. She participated in activities such as group discussions, learned essential hygiene practices, received nutritional advice, and was even able to share a gentle bath with her baby. These simple moments had a profound impact on Rhodia. They restored her confidence, strength, and dignity. The only difficulty she encountered at the center, she says, was the frequent power outages, which sometimes complicate care. But for her, this is a minor detail compared to everything she has received. Today, Stanchevah is doing better. Rhodia is gradually regaining her smile. She now dreams of starting a small sales business to contribute to the family’s income.

The importance of addressing gender-based violence

Furthermore, gender-based violence (GBV) remains a concern in a context where social norms marginalize survivors, despite the gradual emergence of state support services.

The project has incorporated specific actions to address cases of violence, in particular through community capacity building. In partnership with Médecins du Monde, which is leading this component, ASOS medical staff have been trained to provide medical care for cases of sexual violence. “Mobile clinics are trained to treat and refer people to the appropriate facilities, particularly in the Ambovombe district.”

It is also within this framework that teacher training activities are carried out, in line with one of the program’s key objectives: to equip local actors, including schools, to improve the identification, referral, and management of cases of GBV. This initiative also helps to strengthen synergies between international NGOs and local civil society. A series of training sessions for secondary school teachers were held in January and March 2025, in close collaboration with the Ministry of Technical Education and Vocational Training, the Ministry of National Education, and local education authorities.

Thanks to the project, 2,216 people were informed about their rights, including the prevention of gender-based violence (GBV), and 12 victims of violence received a response tailored to their situation.