Madagascar: MSF raises alarm over worsening nutrition crisis among children in Ikongo District

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 consultation, with a positivity rate exceeding 50 per cent. 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 healthcare seeking with less delay.

This expansion comes at a time when partners’ response capacities are weakening. At 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 remain insufficiently supported, and there are few organisations in place to respond.

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 malgasy 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.

Mothers make weekly visits to MSF health centers with their children to receive malnutrition care, ensuring continuous monitoring and treatment throughout their recovery. Photographer: Miora Rabearisoa | Date: 20/02/2026| Location: MadagascarLearning to heal through food. In the Ikongo district, medical treatment is only one part of the journey to recovery. This mother, whose son is currently enrolled in MSF’s nutrition program, participates in community-led cooking demonstrations. Photographer: Miora Rabearisoa | Date: 20/02/2026| Location: Madagascar

Poor road infrastructure and extreme weather conditions severely restrict access to health centers. Due to geographic isolation, lack of transportation, and limited access to healthcare, both patients and medical teams struggle to reach facilities. These barriers often delay timely treatment for children, with many families only seeking care once their condition has significantly worsened. Photographer: Miora Rabearisoa | Date: 20/02/2026| Location: Madagascar

Jane Rabothata

Communications Specialist, Doctors Without Borders

• jane.rabothata@joburg.msf.org
• 0712873613

About Doctors Without Borders (MSF)

Doctors Without Borders (MSF) is a global network of principled medical and other professionals who specialise in medical humanitarian work, driven by our common humanity and guided by medical ethics. We strive to bring emergency medical care to people caught in conflicts, crises, and disasters in more than 70 countries worldwide.

In South Africa, we currently run a non-communicable diseases (NCDs) project in Butterworth, Eastern Cape province, where we support the Department of Health (DoH) in improving care for patients with diabetes and hypertension. The project focuses on improving screening, diagnosis, management, and prevention of NCDs through advocacy, research, health promotion, training, and mentorship of Community Healthcare Workers.

MSF is also recognised as one of the pioneers in providing antiretroviral treatment (ART) in the public sector. It started the first HIV programme in South Africa in 1999. The organisation's earlier interventions in the country have primarily been on developing new testing and treatment strategies for HIV/AIDS and Tuberculosis (TB) in Eshowe (Kwa-Zulu Natal) and Khayelitsha (Western Cape). The Eshowe project was handed over to DoH in 2023 after 12 years of operations. The Khayelitsha project was closed in 2020 after 22 years of activities and campaigning for improved HIV and TB treatment.

Other projects we have been involved in include our Migrant Project in the country's capital, Tshwane, which was handed over to authorities and a local Community-Based Organisation after building the capacity to work with undocumented populations. We also previously offered free, high-quality, and confidential medical care to survivors of sexual and gender-based violence in Rustenburg, North West province.

To learn more about our work in South Africa, please visit this page on our website (www.msf.org.za). To support MSF’s work: