Madagascar: the country that’s poor but not poor enough for aid

With no terrorism or geo-strategic importance, the island nation slips off lists of global causes despite widespread hunger and harsh impact of climate change

David Smith in Ambovombe

Lahie and Njomasy, with the children – Vorito, Lovasoa, Fanampesoa and Rasoa – who gained notoriety on Facebook because of photos of their malnourished bodies. Photograph: Shiraaz Mohamed

She had never heard of Facebook, so when shocking photos of her emaciated children and grandchildren were posted there, Njomasy could little guess the ripples of anger they would send all the way to the president. The family’s plight brought rare public attention to the “silent killer” of child malnutrition.

Nearly 1.9 million people in southern Madagascar do not have a secure food supply with 450,000 facing severe shortages, according to government and UN figures published recently.. This follows three successive poor harvests hit by drought.

One of the worst affected areas is the Ambovombe district, where few places feel as remote, dry, hot and dustblown as the village of Satrie. There Njomasy and her husband, Lahie – they are known by single names and uncertain of their ages – are among 12 people crammed into a small house fashioned from tree branches and dry grass. Their twin sons, three-year-old Fanampesoa and Vorito, and their grandchildren, Rasoa, five, and two-year-old Lovasoa, achieved notoriety inMadagascar in March when photos showing them severely malnourished were uploaded to Facebook and went viral.

Amid wild rumours that hundreds of children had starved to death, they came to the attention of President Hery Rajaonarimampianina, who then visited the region bearing rice and cash. “I noticed they were very tired and one was unconscious,” Njomasy, wearing a pink t-shirt, floral pattern skirt and no shoes, told the Guardian during a media visit organised by the UN children’s agency Unicef.

“I thought they might die. I took them immediately to the health clinic and they explained it was acute malnutrition.” The children received Plumpy’nut, a peanut-based paste credited with saving thousands of children in similar circumstances. Njomasy said: “They have recovered now but I always fear they will get ill again.”

Rows of cacti cling to the landscape but little else can grow in this sun-baked soil. The family go without breakfast and eat a lunch and dinner that consists of cassava leaves and red cactus fruits. Njomasy reflected: “There was no harvest here so there was no food. I always feel hungry and the children do as well. We are not the only ones in this community. There are other children suffering.”

Lahie, wearing an imitation “US Army Airborne” shirt, has no access to electricity or the internet but is glad that the case provoked emotions on social media. “It was good the photos were shown so we got attention and more food.” The case demonstrated once again that a picture is worth a thousand press releases.

Simeon Nanama, chief of the nutrition section of Unicef in Madagascar, said: “The photos were really shocking. They’re the kind of photos we would have expected from the Horn of Africa crisis way back.” Nanama has a daunting task in a coup-prone country where nine in 10 people live on less than $2 per day, according to the 2012-13 millennium development goal survey, and a quarter of children are out of school and nearly half of rural dwellers practise open defecation.

The former French colony is exposed to cyclones, droughts, floods, locust plagues and the sharp end of climate change, with a long-term uptick in temperature and decline in rainfall. There have even been outbreaks of bubonic plague and polio over the past year. Almost half of children under five suffer chronic malnutrition, the fourth highest rate in the world, yet less than 0.5% of the national budget is spent on the problem. Malnutrition not only stunts their growth and increases their risk of obesity but can also impede brain development, causing irreversible harm to memory, learning ability and IQ.

Stunting reduces school performance, equivalent to two or three lost years of education, and diminishes earning power, Unicef says, while a stunted girl is more likely to give birth to an undernourished baby. But only 12% of malnourished children have access to treatment. Experts warn that raising a damaged generation will have far reaching social and economic consequences. “Most of the damage happens in the brain,” Nanama said.

A swarm of the red locusts in Madagascar, destroying local vegetation. Photograph: AFP/Getty Images

“That damage is not reversible after two years. This form of malnutrition is affecting half of Madagascar’s children under five. If nothing is done it means we are losing an important proportion of human capital in this country.” Over the past quarter of a century, he added, rates of stunting have barely changed. “Probably a lot of adults are now suffering from inadequate brain development.”

Tatasoa Mosa, the mayor of Ambovombe, puts it less delicately. “The children will be underdeveloped: we know medically they will be stunted and almost like imbeciles, and lazy. I’d be interested in seeing how those children in the photos are in 20 years. Maybe people who were malnourished as children are not here any more; maybe they’re dead.”

There is an air of impotence in Mosa’s scuffed, tired-looking office in the face of a drought cycle going back decades and little support from central government. “We have spent money on different solutions,” he admitted. “I still cannot see what the solution would be. I’m a father and I feel sympathy for these children but I have no means and there is nothing I can do except sympathise. “Next time there’s a drought with no rain, those kids in the photos will probably be in the same situation.”

In Bevala, a village of 1,580 people in the Anosy region, a child died from hunger earlier this year. Dust blows in eyes and swirls in clouds beyond the cacti. Small houses of concrete or bamboo crouch in the hot sun. There is no electricity and the nearest water source requires a half-hour round trip on foot. A woman pounds corn in a hollowed out tree trunk. The modest marketplace sells beans, cassava, corn, peas, rice, spring onions and sweet potatoes but Sevasoa Maho, a single mother of seven, by different fathers, struggles to afford any of them. Her seven-year-old son Tsiraiky and twins Maharavo and Maharaly, aged one, have spent four to six weeks receiving treatment for severe acute malnutrition. One has relapsed and needs to go back.

Sitting outside her modest wooden shed, Maho, 31, who earns 30,000 ariary (£6.26) a month for weeding at a sisal plantation, said: “The kids cry from hunger. I don’t find anything to eat. I just rush to get them fruit – at least it’s something.” The children, whose T-shirts are torn and dirty, stopped going to school this year because Maho cannot afford the annual fee of 22,000 ariary (£4.59) each. “The kids are not going to learn anything anyway. All they think about is to eat. At school, nothing goes in.”

Edwige Rasoa, 52, the community’s nutrition worker, said the food insecurity situation began in January because of lack of rain and high winds. “Most people are working in the sisal field but for the past eight months they have not worked and not been paid,” she explained. “Those who have money eat cassava or maize for lunch and dinner but now, because of the drought, people are just surviving on cactus fruits.

“Children are tired and very prone to contracting diseases. It may impact on the school performance of the kids. Instead of focusing on learning, they are too worried about what they’re going to eat in the evening. If it doesn’t rain, I’m worried about the health and survival of the kids.”

At the nearest clinic in Amboasary, a tape measure was wound around the arm of nine-month-old Jimmy Lambo, who was then dropped into a blue sling hanging from a scale on a bare wood frame. The results were worrying. His mid-upper-arm circumference was found to be 114mm (4.5in), his weight 6.2kg (13.6lbs) and his height 65cm (2ft 1in).

A woman sits with her sheep along the Andriantany waste water channel in Antananarivo. Photograph: Thomas Mukoya/Reuters

Medical worker Beatrice Razanamazava, wearing white coat and rubber gloves, said: “All the parameters have stabilised since last week. It’s not good news because they should have increased. There’s been a small loss in the arm circumference. He’s severely malnourished.”

Jimmy was believed to have lost weight because of complications including a respiratory infection. His mother, Julia Vaha, 19, a single mother whose other son is also receiving treatment for malnutrition, said: “I saw he was ill about a month ago. He was getting weaker and his arms were getting thinner. He had bad diarrhoea and vomiting so I was frightened. We don’t have enough to eat at home and I don’t have enough milk.”

The clinic has treated 209 malnourished children in the past year, up from 120 the year before, and is supported by Unicef, which last year screened more than a million children for acute malnutrition in Madagascar and referred 6,000 cases for treatment. Razanamazava said: “It’s very tough work. I need a lot of patience to do the job.”