November 30, 2023
Dr Paul Mushombe Nibhumba: Testimonial from Doctors of the World Medical Coordinator in Mali
These events regularly cripple the country’s infrastructure, leaving Madagascar’s healthcare system fragile and outdated. In addition, the climate crisis will further exacerbate these natural hazards. The average life expectancy of a Madagascan is just 64 years.
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.
Despite Madagascar’s exposure to natural disasters, many homes throughout the country are not disaster-proof, which in turn leads to an increase in casualties, displacement, and the spread of infectious disease during natural disasters.
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.
Since 2008, Doctors of the World has been actively involved in disaster risk-reduction and mitigation plans for local communities, specifically around the city of Vatomandry.
As well as creating emergency plans, we have established a network of over 100 individuals who are trained in first aid and basic healthcare in the event of a disaster. This network has been essential to responding to recent disasters. 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.
In addition, we have trained local staff in surveillance protocol designed to prevent the outbreak of epidemics following an emergency. We have also assisted in the renovation of healthcare centers to ensure that they are cyclone-proof in preparation for future storms.
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.
In Madagascar, modern contraceptive methods are difficult to obtain, resulting in high rates of unwanted pregnancies and terminations. The maternal mortality rate in Madagascar is also one of the highest in the world – with over 353 women dying during childbirth for every 100,000 births – due to the inaccessibility of birthing and healthcare centers.
Doctors of the World is currently working to improve emergency obstetric and neonatal care. We’ve performed over 18,000 antenatal consultations and assisted with over 10,000 births. Since 2014, our team has also led the NGO consortium on mother and child health in Madagascar with the aim of ensuring that SRH health becomes a priority at healthcare centers across the country. Furthermore, in 2017 Doctors of the World launched a SRH program 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.
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: