Madagascar Health Cluster activated to respond to increasing hazards related to climate change

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 is responding to the health needs of both the Eastern Region struggling with cyclones and the Great South region suffering from severe drought. For the period from January 2021 to May 2022, it was estimated that 1.59 million people will require humanitarian assistance, including just over 700 000 people for the Health Sector with a US$ 2.6 million required funding for health response (1).

The Great South of Madagascar has suffered severe drought for nearly forty years, which has plunged the population into critical food insecurity (IPC Phase 3 or higher). Ten districts are most affected by this humanitarian crisis, with Ambovombe, Ampanihy, Beloha and Tsihombe districts being the most affected with 55% to 60% of their population in need of urgent of lifesaving interventions. The last 3 years have been among the most severe ever recorded in the country. As of January 2021, 68.6% of the southern territories were affected by drought, resulting in 4 districts being classified as IPC 4 emergencies in early 2022 (2).

Soil conditions and humidity are suboptimal for cultivation, and as groundwater sources have dried up, access to water has deteriorated and the cost of water has risen, especially in rural areas. Consequently, agricultural production has declined significantly and is 60-90% below the average of the last 5 years. Vulnerability of the population to food insecurity increased from 392 000 to 510 000 people in need (PiN) by the end of 2021, and famine increased from 14 000 to 28 000 PiN. The food insecurity has forced population displacement which increased by 67% from 3000 to 5000 by the end of 2021 (3).

In addition, the series of storms and Cyclones, Storm Ana (23 January), cyclones Batsirai (5 February), Dumako (15 February), Emnati (23 February) and Gombe (7 March) have exacerbated the already critical situation, leaving a total of 204 deaths, 945 727 affected and 172 339 displaced with 650 245 estimated to be without health access (4). Many communities currently remain inaccessible. Emergency operations continue to be hampered by excessive damage to road infrastructure, disrupted power and communications networks, and limited availability of aircraft and other transportation. Continued severe weather is also limiting access to those in need.

This food insecurity plus extreme weather events occur in a context of poverty (77.6% of population is living 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 in children, low immunization coverage, low availability of health services and a decline in delivery rates in health facilities have been observed. This crisis also paves the way for the emergence and re-emergence of infectious diseases such as measles, plague, malaria, and tuberculosis plus 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 alleviate the ongoing crisis in the country with the goal to save lives and alleviate suffering in the most affected areas by ensuring the provision of essential health services. In addition, the Health Cluster, along with its 32 operational partners, will respond to other public health emergencies occurring in the country.

Partners are supporting lifesaving interventions in the most affected areas. For example, as part of the cyclone response, from 15 February until 5 March, more than 5000 consultations were carried out by the following Health Cluster partners: Poland-EMT/WHO, MSF France, MSF Switzerland, Médecins du Monde France, Catholic Relief Services, Douleurs sans frontières, Directions Regional de la Santé Publique (DRSP) mobile teams, UNICEF and UNFPA, providing urgent health services, including reproductive health and mental health and psychosocial support services to affected populations.

"Madagascar is an example of how globally climate change is exacerbating the risk of complex emergencies, to which responding is an ever-greater challenge for the humanitarian community", says Jerry-Jonas Mbasha, WHO Incident Manager and Health Cluster Coordinator ad interim. "Health Cluster partners will continue to closely monitor the situation in the coming months".

(1) Grand Sud Flash Appeal

(2) WHO situation report

(3) Public Health Situation Analysis

(4) Health Cluster Bulletin, March 2022