March 2022 – Madagascar is one of the ten most disaster-prone countries in the world and faces increasing hazards related to climate change. The recently activated Health Cluster responds to the health needs of the Eastern region struggling with cyclones and the Great South region suffering from a severe drought. For the period from January 2021 to May 2022, it has been estimated that 1.59 million people will need humanitarian assistance, including just over 700,000 people for the health sector with funding of 2.6 million US dollars required for the health response (1).
The Great South of Madagascar has been suffering from a severe drought for nearly forty years, which has plunged the population into critical food insecurity (IPC Phase 3 or higher). Ten districts are the most affected by this humanitarian crisis, with the districts of Ambovombe, Ampanihy, Beloha and Tsihombe being the most affected with 55% to 60% of their population requiring urgent or life-saving interventions. The past 3 years have been some of the worst ever recorded in the country. In January 2021, 68.6% of the southern territories were affected by drought, which led 4 districts to be classified as IPC 4 emergency in early 2022 (2).
Soil conditions and moisture are not optimal for cultivation, and as groundwater sources have dried up, access to water has deteriorated and the cost of water has increased, particularly in rural areas. Consequently, agricultural production has decreased considerably and is 60-90% lower than the average of the last 5 years. The population’s vulnerability to food insecurity has increased from 392,000 to 510,000 people in need (PiN) at the end of 2021, and famine has increased from 14,000 to 28,000 PiN. Food insecurity forced the displacement of the population which increased by 67% from 3,000 to 5,000 at the end of 2021 (3).
In addition, the series of storms and cyclones, storm Ana (January 23), cyclones Batsirai (February 5), Dumako (February 15), Emnati (February 23) and Gombe (March 7) aggravated the already critical situation, leaving a total of 204 deaths, 945,727 affected and 172,339 displaced including 650,245 estimated without access to health (4). Many communities currently remain inaccessible. Emergency operations continue to be hampered by excessive damage to road infrastructure, disrupted power and communication networks, and limited availability of aircraft and other transportation. The persistence of extreme weather conditions also limits access to people in need.
This food insecurity and extreme weather events occur in a context of poverty (77.6% of the population lives in poverty). This weakens the health of the population and seriously affects their access to basic health services, compromising universal health coverage. A significant increase in cases of acute (severe) malnutrition, malaria and water-borne diseases among children, low vaccination coverage, low availability of health services and a drop in delivery rates in health facilities were observed. This crisis is also paving the way for the emergence and re-emergence of infectious diseases such as measles, plague, malaria and tuberculosis, as well as the ongoing COVID-19 pandemic.
After the activation of the Nutrition, Food Security and WASH Clusters in December 2021, the Madagascar Health Cluster was activated in January 2022 as part of a joint intervention with the Nutrition Cluster to mitigate the ongoing crisis in the country in the goal of saving lives and alleviating suffering in the most affected areas by ensuring the provision of essential health services. In addition, the Health Cluster, with its 32 operational partners, will respond to other public health emergencies occurring in the country.
Partners are supporting life-saving interventions in the most affected areas. For example, as part of the cyclone response, from February 15 to March 5, more than 5,000 consultations were carried out by the following Health Cluster partners: Poland-EMT/WHO, MSF France, MSF Switzerland, Médecins du Monde France , Catholic Relief Services, Pain Without Borders, the mobile teams of the Directions Régionales de la Santé Publique (DRSP), UNICEF and UNFPA, providing urgent health services, including reproductive health and mental health services and psychosocial support to affected populations.
“Madagascar is an example of how global climate change is exacerbating the risk of complex emergencies, which to respond to is an increasing challenge for the humanitarian community,” says WHO Incident Manager Jerry-Jonas Mbasha. and Acting Health Cluster Coordinator. “Health Cluster partners will continue to closely monitor the situation in the coming months.”
(1) Great South Flash Appeal
(2) WHO situation report
(3) Analysis of the public health situation
(4) Health Cluster Bulletin, March 2022