In Madagascar, A Humanitarian Crisis Driven By Drought

Lean Season Madagascar - Action Against Hunger

Vorisoa tending his land. Drought conditions in Madagascar have destroyed consecutive harvests. Photo: Stéphane Rakotomalala for Action Against Hunger

In the southern districts of Madagascar, climate change is increasing the frequency and severity of droughts, posing a serious threat to lives and livelihoods.

Shortages of water, particularly drinking water, are common in the southern districts, but the problem has been exacerbated by historically low rainfall and the depletion of the water table. As a result, waterborne diseases such as diarrhea are increasing sharply, especially among young children, putting them at further risk of severe malnutrition.

The region received virtually no rainfall in 2020. These conditions obliterated the harvest, causing the “hunger season,” or lean season, to arrive early and take an even deadlier toll.

While severe hunger, or “kéré” in Malagasy, occurs every year, the current food crisis is of unprecedented severity. With the region already reeling from back-to-back poor harvests, drought, sandstorms and the COVID-19 pandemic have caused food prices to spiral while limiting opportunities to generate income. The combination of these factors has devastated food security in the region. Households are now depleting the last of their food supplies, with no hope of replenishing them over the summer.

“The little I was able to produce has all been eaten. I don’t know the dates, but it’s been a very long time since I’ve had a harvest. Since there is no rain, the children do not eat normally. I give them whatever I can find, such as cactus leaves. This diet gives them diarrhea and nausea but there is no choice. At least it doesn’t kill them,” says Maliha, a 38-year-old mother of eight in Ampanihy.


The lean season normally begins in October, but will arrive earlier this year as the nutrition security of families continues to deteriorate. To date, 1.14 million people in the Grand Sud are suffering from acute food insecurity, including nearly 14,000 in famine conditions. Among children under five, 135,476 are suffering from acute malnutrition, of which 27,134 are suffering from severe acute malnutrition.

“The lean season comes every year, but now it is particularly severe – it lasts all year. Before, the rain fell during the months of January, February and March and allowed for the cultivation of different varieties of melons and pumpkins,” says Jean Delacroix Tsimanantsiny, deputy program manager for Action Against Hunger in Ambovombe.

The district of Amboasary Atsimo is currently the most severely affected, followed by the districts of Ambovombe, Ampanihy, Beloha and Tsihombe. Some households have virtually exhausted all possibilities of accessing food and income.


Beginning in early 2020, Action Against Hunger has been setting up mobile teams across the Grand Sud, prioritizing areas where the highest levels of child malnutrition (moderate to severe) are identified. There are currently 25 mobile teams crisscrossing the region to ensure that even the most remote communities have access to care.

In coordination with the nearest Basic Health Centre, our mobile teams screen each child under five years of age in the fokontany, or villages, identified as vulnerable. The teams are normally composed of two nurses and an enumerator who is responsible for screening. The teams provide treatment for undernutrition and certain childhood diseases. Moderate cases of malnutrition are treated in Ambulatory Nutritional Recovery Centres, while the most severe cases are transferred to hospital-based Intensive Nutritional Recovery Centres.

“The situation has really deteriorated. Before, there were approximately 80 children in care at the health centre, but now there are nearly 400. That is why we need to provide reinforcement,” explains Hamelo Lahimalio, a nurse and mobile team member in Tulear. “The numbers are increasing at both the Basic Health Centre and village levels.”

This community-based approach, in which our teams intervene directly in the fokontany, allows malnourished children to remain close to home and avoids overburdening the health centres. Upon arrival at each site, our teams begin by explaining the different support steps. The teams then screen and triage the children according to their nutrition status: healthy, moderate acute malnutrition or severe acute malnutrition. The enumerator measures each child’s upper arm circumference and uses a scale and height board to assess weight and height, recording the data on a scorecard. One nurse manages cases of undernutrition while the second manages childhood illnesses.

The next step is to explain the causes of undernutrition to the mothers of the malnourished children. Our teams show the mothers how to use the Ready-to-Use Therapeutic Food (ATPE) by performing an appetite test with their children. Following this step, the medical check and distribution of rations takes place.

“What makes us suffer the most is that we cannot feed our children. There is no rain, so there is no harvest. The land can no longer be cultivated so it has been abandoned. We eat plants; we eat anything we can collect. The care that has been provided has really helped us. My child is now healthy after being treated,” says Donoe, a 40-year-old mother of six in Ampanihy.

Between October 2020 and March 2021, our teams treated 8,727 children under five for severe acute malnutrition, 8,582 for moderate acute malnutrition and 9,611 for other illnesses.

Our teams in Madagascar will continue to monitor and respond to the crisis in the coming months. Even if the rain were to return at the end of the year, the losses are already to great and only urgent support is needed to help the population of southern Madagascar recover from this crisis.

With the support of: ECHO / SIDA / OFDA / CIAA


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