The district of Ikongo, located in south-east Madagascar, is facing a particularly worrying nutrition crisis. Classified as Phase 2 (Stressed) of the Integrated Food Security Phase Classification (IPC) since October, the district could see a significant deterioration in the coming weeks as it enters the lean season (January–April), which coincides with the cyclone season and a peak in malaria transmission.
The particular concern in Ikongo lies in the combination of an already fragile nutritional situation and a sharp increase in malaria cases. More than 5,000 malaria cases have been reported since the beginning of the year, placing Ikongo among the hardest hit districts in the country, according to the Ministry of Public Health. In MSF-supported facilities, malaria is now the leading cause of consultation, with a positivity rate exceeding 50 per cent. This surge is placing additional pressure on already vulnerable families and increasing the risk of nutritional complications among young children.
The situation is severely weakening communities and undermining their resilience, exacerbating chronic food insecurity already driven by extreme weather events, low dietary diversity and seasonal diseases. Access to healthcare in the district remains a major challenge: long distances, lack of transportation and frequent stock-outs of medical supplies delay treatment. Many children arrive late, in critical condition.
Médecins Sans Frontières (MSF) has been present in Ikongo district since 2022. In support of the Ministry of Public Health, our teams provide care for children under 15 and pregnant women through primary, paediatric and reproductive health services, including the treatment of malnutrition, across six communes. In response to the alarming evolution of the situation, MSF has stepped up its emergency response, progressively expanding nutritional activities to prevent avoidable deaths and stabilise the situation ahead of the lean season (January–April), identified as a particularly critical period.
Madagascar is currently among the ten countries most affected by malnutrition worldwide. Nearly 40 per cent of children under five suffer from chronic malnutrition nationwide, while 7.7 per cent are affected by acute malnutrition. In late January, the Malagasy government, in partnership with the United Nations system and the humanitarian community, launched an international appeal to respond to the food and nutrition crisis in the Grand South and South-East of the country.
This communication aims to alert authorities, humanitarian partners and the public to the scale of the crisis to mobilize the necessary resources and support a coordinated emergency response. It also seeks to inform local communities about available services and encourage early access to care. Without a rapid scale-up of intervention, thousands of children risk slipping into severe forms of malnutrition, with potentially irreversible consequences.