Following years of severe cyclical droughts, southern Madagascar has been experiencing an exceptionally acute malnutrition crisis. Food supplies have dwindled, leaving people in some areas starving.

In March, we sent mobile clinics to provide care in this hard-to-reach region, where people live in remote, scattered communities and roads are poor. Our teams treated children with acute malnutrition and provided ready-to-use therapeutic food. We also started to support Ambovombe hospital’s paediatric ward and built an inpatient therapeutic feeding centre.

In April and May, we noticed that the children we had been treating through our mobile clinics had gained only a little weight, despite long-term follow-up, demonstrating that medical treatment is not sufficient for recovery when food availability remains unchanged. As food stocks were depleted and the next harvest was not expected until at least March 2022, we resumed food distribution, including rice, beans, salt and oil, to the families of the children in our programme.

Finding access to adequate clean drinking water is challenging in this semi-arid region and the situation has been exacerbated by a third consecutive year of drought: every carer we asked reported that it was their main concern. We carried out various water and sanitation activities to improve supply, such as rehabilitating hand pumps, digging wells and trucking in water alongside mobile clinics, and we continue to seek a more permanent solution, but the area remains water-stressed in the absence of rainfall.

Given the size of the Great South area and the low population density, it is difficult to ascertain whether all villages in need receive enough support. By the end of 2021, an estimated 1.47 million people were still affected by the malnutrition crisis, in spite of the increase in food distribution during the year.