Madagascar: A humanitarian emergency driven by the climate crisis - Doctors of the World

Madagascar: A humanitarian emergency driven by the climate crisis

2.2 million

people are highly food insecure and need assistance


children in the Grand South are likely to suffer from acute malnutrition


is the poverty rate for Madagascar, ranking it 3rd in the world

Madagascar is an island lying off the southeastern coast of Africa that is facing the severe ramifications from the climate crisis. Its geographical placement puts it in the path of some of the most extreme weather hazards in the world, including flooding, tropical storms, cyclones and droughts that have devastating impacts on the population and humanitarian needs throughout the island.

The small nation is facing two extremes on the opposing ends of its country. The northern and eastern regions of the country have faced devastating cyclones, flooding and heavy rains, while the south has been experiencing the worst drought in 40 years. The combination of the two spells disaster for the Malagasy people, who are struggling with high rates of food insecurity, poverty and access to clean water and healthcare. 

Madagascar is a historical mission of Doctors of the World. The NGO has been present there since 1986. In addition to its emergency and post-cyclone recovery programs, in particular through the training of medical personnel or the pre-positioning of health inputs, the teams carry out various programs to help populations affected by drought or on projects concerning sexual and reproductive health rights.

How the climate crisis has exacerbated the humanitarian situation in Madagascar

In the south of Madagascar, known as the Grand Sud, the region is facing its most acute drought in 40 years. The drought is  accompanied by sandstorms, due to three consecutive years of failed rains, along with growing expansion of worms and locusts. Between October 2020 and January 2021, less than 50% of the normal rainfall was received in the Grand Sud, causing severe damages to agricultural production during the main harvest that year, with losses of up to 60% in 3 of the most populated districts. 

Meanwhile, in the northern and eastern region, massive cyclones have destroyed homes and livelihoods. Cyclone Freddy struck the coast of Madagascar on February 21, 2023, with waves 8 meters high and wind reaching speeds of 180 km/hr. A year ago, cyclones Batsirai and Emnaty killed more than 100 people and affected 150,000 people. An average of 1.5 cyclones affect Madagascar yearly, the highest number in Africa, and each strong cyclone on average affects 700,000 people. 

The consequences of the climate crisis have compounded the humanitarian needs in Madagascar, and created a vicious cycle. Food insecurity and climate disasters destroy the livelihoods of people, forcing them to sell their assets or pull their children out of school. Rates of early marriage and gender-based violence begin to grow. Restoring damaged infrastructure as resources dwindle adds additional stressors, especially when there is no guarantee that another cyclone won’t sweep through and destroy any advances made. The situation leads to loss of hope, a cycle of devastation that can be debilitating to anyone.

Health needs in Madagascar and DotW response



Epidemics and Infectious Disease 


Madagascar has a fragile health system, which faces recurrent crises. Life expectancy at birth is only 65 years for men and 68 years for women. Fragile health systems combined with poor sanitation (only 1% of the population has access to basic sanitation) can create an environment where infectious disease can thrive. 

Madagascar has been dealing with diseases with high epidemic potential for many years, such as plague and measles, with more than 1,000 measles deaths recorded between 2018 and 2019. When COVID-19 arrived, the country struggled to once again adapt, with its fragile health system and poor screening abilities. At the end of 2021, Madagascar had around 64,000 cases and more than 1,500 deaths. 

Doctors of the World has mobilized its team to support the Malagasy Ministry of Health during the arrival of the COVID-19 epidemic on the territory, as well as other infectious diseases. Our efforts focus on capacity building, providing training to healthcare staff, along with medication and medical equipment needed to respond to COVID-19 and other outbreaks. In September 2021, our medical team aided in the response to the pneumonic plague epidemic that broke out by providing necessary drugs as well as training 283 healthcare personnel in prevention and the protocol for treating plague cases. 


Sexual and Reproductive Health 


On the island of Madagascar, the health indicators are alarming, particularly those concerning sexual and reproductive health (SRH). 

  • Maternal mortality rate of 426/100,000
  • Proportion of births in the presence of qualified nursing staff of 46%
  • Proportion of births in a health facility of 39%
  • The use of prenatal consultations at 56.7%
  • Modern contraceptive use rate of 38% among sexually active young people aged 15-19

To respond to the growing health needs of the region, Doctors of the World launched a SRH program in 2017 which aims to contribute to the reduction of maternal mortality and morbidity associated with the lack of access to quality services in particular among adolescents and young people (10-24 years old).

To improve these health outcomes, DotW reached out to civil society actors and public institutions related to sexual and reproductive health in Antananarivo, the capital of Madagascar, to support and bolster their work. This humanitarian action in Madagascar aims to improve the prevention and management of unwanted pregnancies according to a rights-based approach, through three main components:

  1. A community component in partnership with national associations and NGOs, aimed at strengthening the capacities of adolescents and young people to become actors in their own health,
  2. A medical component aimed at improving the accessibility and quality of the supply of SRH services adapted to the needs of adolescents and young people in seven basic health centers,
  3. An advocacy component aimed at promoting the right to decide for adolescents and young people in SRH.




A major food crisis has unfolded due to the drought and extreme weather hazards that have hit the island the last 4 years. In the South, the rivers have dried up, the fields have turned into vast barren expanses and nothing grows anymore, while there, 90% of the inhabitants live from agriculture or livestock. The result is more than 1 million Malagasy people suffering from hunger. Médecins Sans Frontières reports that nearly 1 in 5 children screened were suffering from moderate or severe malnutrition. Severe acute malnutrition can lead to irreversible damage to their development: growth retardation, insufficient immune defenses and risk of death.

From October 2021, Doctors of the World was able to deploy 2 mobile clinics in the districts of Ambovombe and Amboasary, regions hardest hit by the drought. An additional 2 mobile clinics were deployed in 2022. These mobile units save lives, they allow us to travel to the most isolated and difficult to access areas and provide emergency first aid to the population including: 

  • Screening and management of cases of malnutrition
  • Management of childhood illnesses and vaccination against measles
  • Women’s health, pre and post natal consultations
  • Referral of complicated cases and coverage of medical expenses



International action is still needed


Despite our efforts in Madagascar, there is still more that needs to be done. Widespread poverty and the escalating climate crisis ensures that the humanitarian situation in Madagascar will only get worse. Action is needed to help the nation rebuild and develop infrastructure that is strong enough to endure yearly cyclones and flooding. Mitigating climate risks are also crucial as is restoring Madagascar’s environment. Unfortunately, this cannot be done without the support of the international community. 


Olivier Papegnies

Bruno Fert