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With scrawny arms and bellies swollen by malnutrition, a dozen children waited for a meal at a World Food Programme centre in southern Madagascar, a region still scarred by famine and now bracing for the looming El Niño weather pattern.
Flour porridge simmered on a stove at the centre in the small town of Ifotaka, which was opened the year after a devastating 2021-2022 famine that the United Nations described at the time as the world’s first famine caused by climate change.
But even before the full impact of El Niño is felt in the coming months, people in Madagascar’s far south are already struggling to find enough food.
At the centre, a staff member had to step away after learning that a malnourished two-year-old child had died.
The World Meteorological Organization has warned of an increased risk of drought in southern Africa as the months-long weather phenomenon begins in October, with countries as far away as Brazil and India also vulnerable to its effects.
In Madagascar, meanwhile, international aid cuts and rising inflation linked to the Middle East conflict are adding to the threat of severe hunger.
Ifotaka, an inland town of wooden shacks and corrugated iron huts, was at the epicentre of the 2021-2022 “kere”, the local term for periods of severe hunger.
Around 30,000 people in the surrounding region, characterised by sandy soil and bristling cacti, suffered from a life-threatening shortage of food during the crisis. Some survived by boiling pieces of cactus and scraps of animal hide.
“There has been a dramatic increase in climate-related events in Madagascar,” WFP country director Tania Goosens told AFP.
“In 20 years, there have been 35 cyclones, eight floods and five severe droughts,” she said, describing the number of climate-related events as three times higher than during the previous two decades.
“So we’re really in a very, very fragile context,” Goosens said.
In the nearby coastal village of Manindra, where the ocean stretches beyond farmland struggling under dry conditions, rainfall would normally be expected from late September, said 46-year-old farmer James Tsirimalaza.
“Unfortunately, there’s no rain,” he said.
Anticipating another crisis, Save the Children has doubled its normal budget for Madagascar, the organisation’s country representative Tatiana Dasy told media.
The situation is expected to deteriorate sharply in the coming months.
By April next year, 39 percent of children under the age of five in Madagascar’s “Grand South” are projected to suffer from acute malnutrition, according to forecasts by the UN-backed Integrated Food Security Phase Classification (IPC).
That would amount to nearly 270,000 children.
The conflict involving the United States, Israel and Iran, which has driven up the prices of oil and fertiliser, is expected to further increase pressure on vulnerable communities, the IPC warned in July.
Higher prices would “directly affect the costs of transport, pumping, fertilisers, fuel for fishing, agricultural inputs and food prices”, it said.
Annual food inflation in the Indian Ocean island nation reached 10.4 percent in July, up from 6.8 percent in January.
About an hour away by 4×4 vehicle — a mode of transport no local resident owns — the hospital in Amboasary-Atsimo has recorded six deaths this year among malnourished children suffering from medical complications.
In 2022, when the famine continued until the harvests in early May, 15 children died at the hospital.
A logo of USAID, the US foreign aid agency dismantled in 2025, remains displayed on a hospital wall, serving as a reminder of how international humanitarian assistance has also declined.
US funding previously covered patient transportation and health training through the humanitarian organisation Medecins du Monde, but the support ended two months earlier, according to an official who spoke to AFP.
The WFP estimates that around 3.7 million people in Madagascar will experience “crisis-level food insecurity”, Goosens said.
“We haven’t seen that in the country before, so it’s even worse than in 2021-2022,” she said.
The WFP had planned to support 720,000 people in Madagascar this year, but funding had reached barely half of the amount required, she added.
At the WFP centre, Eva Razafindrazaka held her grandson, who was receiving treatment for malnutrition. She said she was unable to water her crops because they were located too far from the communal water point.
“But those who have solar pumps can,” the 51-year-old said.
The growing importance of access to water was also evident elsewhere in the region.
As cattle were returned to their enclosure for the night, farmer Manjomaro Andrianantenaina struggled to transport solar panels on a wheelbarrow, whose wooden wheels sank into the sand.
“If I leave them, I won’t find them again,” said the 25-year-old, who had received the panels only the previous day.
He had spent more than two million ariary, or about $450, to drill a well and install a solar-powered pump — an amount beyond the means of most people in the region.
More than 90 percent of the population live below the World Bank’s poverty line of $2.15 a day, according to 2023 data cited in the report.
“I used to worry about the lack of rain when it was hot,” Andrianantenaina said. “Now I wait for the sun so I can pump water from underground.”
For communities in Madagascar’s drought-prone south, the combination of worsening climate shocks, high food prices and shrinking humanitarian support is leaving little room to absorb another severe weather-driven food crisis.
And with El Niño expected to intensify drought risks in the region, families already struggling to secure food and water are entering the coming months with increasingly limited resources.