No mother would ever want to be told her child has "severe acute malnutrition", but in parched southwestern Madagascar, 27-year old Donasine, mother of nine and four months pregnant, welcomes the nurse's diagnosis with a smile - the child will receive free life-saving treatment.
Hundreds of desperate mothers and children have gathered at the government health centre in Androka, a town in the rain-starved Ampanihy district of the huge Indian Ocean island. It is Saturday, which is when the health staff – one nurse and an assistant – examine the nutritional status of children.
The figures on the wall chart indicate that 2010 is going to be a very bad year: by mid-May admissions to the malnutrition rehabilitation centre had topped the combined totals for 2008 and '09, and at 117 seemed set to breach the '07 level – a notoriously bad year.
Donasine had just arrived from Mahatsandry village - a two day journey by foot - to seek help for her emaciated youngest son, Ekavitse. "We are farmers, but without rain we were not able to grow anything. Every year I have another baby, and I am worried - I don't have anything to feed them," she told IRIN.
Celestine Zafimanomjy, the nurse on duty, feared the numbers seeking treatment would rise in the coming months. "It's difficult to see such cases, but we will have more," he said. Ekavitse would be given Plumpy'nut, a ready-to-use therapeutic food for treating malnutrition.
Yes, it could get worse
At the end of April 2010 the Malagasy government's Early Warning System (SAP) projected that a record number of communes in the south would face hunger in the coming months - bad news in a region already hit hard.
Having experienced conditions on the ground, most aid workers knew the projections would be alarming but were desperate for statistical evidence to strengthen their pleas for help.
Pierre Bry, Senior Humanitarian Affairs Officer at the UN Office for the Coordination of Humanitarian Affairs in Madagascar, said a persistent problem like hunger in southern Madagascar was a hard sell to donors, particularly in a country without an internationally recognised government, but "at least now we have something to show them," he told IRIN.
Current President Andry Rajoelina and part of the army took power from former President Marc Ravalomanana in March 2009, and international development aid rapidly ran dry.
Many aid workers and recipients fear that the rising food insecurity is a deadly spin-off from Madagascar's ongoing political deadlock, because the only foot in the donor door is now humanitarian aid, and only if justifiable.
"Major donors continue to try to help with emergency funding for the south. However, raising awareness does present a challenge, given the slow-onset nature of the recurrent crises, as well as clear signs that this is becoming a situation of structural food insecurity," John Uniack Davis, Madagascar country director of CARE International, which works to reduce poverty, told IRIN.
"People ... are directly affected by the combined consequences of political instability, economic decline, insecurity, recurrent droughts and suspension of major development projects," said Krystyna Bednarska, head of the UN World Food Programme (WFP) in Madagascar.
"Insufficient and erratic rainfall, plant pests and infestations between October and February deeply affected main crops, since 85 percent of the maize crop was lost," she pointed out.
|It is very clear that we need to plan to prevent a famine|
Bruno Maes, Madagascar representative for the UN Children's Fund (UNICEF) stressed the need "In the coming weeks to have a mission to do an assessment with the [donors], particularly related to the crop assessment, because if we know that most of the crops were jeopardized, and this is confirmed in the south, it is very clear that we need to plan to prevent a famine."
Crunching the numbers
The SAP system started keeping tabs on food insecurity in the arid south in 1996, but had never recorded such human vulnerability: a record 65 communes fell into the "Food Insecure" category, meaning that around 866,000 Malagasy are expected to need assistance by June 2010. The organisation's forecasts have usually been accurate.
Food insecurity might be a perennial problem in the region, but the figures also show a gradual decline: the previous record was set in 2009, when 45 communes were in trouble.
"WFP is already targeting 115,000 beneficiaries with roughly 1,500mt of food assistance until early June. [We] will then run out of resources and we will have to cease assistance in the drought-affected south," Bednarska said.
"An additional 7,650 tons [valued at some US$6.4 million] is needed immediately to provide the minimum recommended response to the food insecurity situation from May to December 2010. If WFP's pipeline is not resourced in quantity and in time, this will have a disastrous impact on the most vulnerable of our beneficiaries," she warned.
Poor rainfall is clearly to blame for the meagre harvests, but this year "even the traditional bread baskets in the south" - the districts of Betroka and Bekily, which usually cushion the region in bad years - "also had a lack of rainfall", said Dominic Stolarow, an Emergency Officer at UNICEF.
Photo: Tomas de Mul/IRIN
|A mother at the Androka health center feeds her child red raketa - a "dangerous" cactus fruit|
Nearly 70 percent of Malagasy live below the poverty line, according to UNICEF, and the number tends to rise the further south you go, where most people depend on subsistence farming. Stolarow said vulnerability had compounded over the years and meagre coping mechanisms were now completely depleted.
The year-on-year shocks had also "undermined farmers' livelihoods", said WFP's Bednarska, and failing to act now would have long-term consequences. "The greatest concern is that negative coping strategies - such as de-capitalization, consumption of seeds as food - will have detrimental impacts on development activities that aim at mitigating the effects of drought."
Moreover, consecutive dry years meant even wild "emergency foods", like a local cactus fruit known as "raketa", were hard to find. Aro Rajoelina, Regional Medical Inspector of Ampanihy district, said the red variety of raketa was "unfit for human consumption - it's dangerous and leads to digestive problems".
At the Androka health centre Donasine and the other mothers were eating it and feeding it to their children because there was nothing else. "We have not had a single drop of rain in some places in the last for months," said Rajoelina. "We are really tightening our belts."