As a devastating drought continues in southern Madagascar, food insecurity is on the rise. Humanity & Inclusion is providing food assistance to households with the most acute needs.

Year after year of insufficient rainfall in southern Madagascar has caused one of the worst droughts in the country’s history. And communities are facing a food crisis.

“Life is not like it used to be,” says Nahy, 66, who lives in a village classified as severely impacted by the drought. “Things are getting harder. Before, there were abundant rains and we could cultivate crops. Today, there is no more rain and we’re suffering from it.”

Nahy has six children and 10 grandchildren.

“I take care of the entire family of 16 people alone because my husband and other family members have all passed away,” Nahy explains. “The youngest children live with me in my tiny house, and we all eat and sleep together on the floor.”

Critical food assistance

“We need to cook 10 kapoaka of rice (about 7 pounds) per day to feed everyone,” Nahy continues. “We don't have enough food, and we run out of what we can afford after just one week. We have to walk over a half-mile away to get water. My wish is that we can have enough food to last us each month so that we can have a better life.”

During a door-to-door evaluation, Nahy met with Victor, a partner community agent for Humanity & Inclusion living in her region. He learned about Nahy’s situation and connected her with Humanity & Inclusion to receive monthly food provisions for her family.

“During the distributions I receive 66 pounds of rice, 2.5 liters of vegetable oil, and 10 pounds of beans each month,” Nahy says.

Inclusive actions

People living with disabilities, low incomes or facing situations of extreme vulnerability face even more difficulty providing for themselves and their families during times of crisis. As crops fail to grow, food becomes scarce and prices increase. Nahy lives with a disability that affects the use of her hands and prevents her from working.

“Due to my disability, I cannot cook meals by myself and I need help for small tasks like getting dressed in the morning,” she explains. “My children and grandchildren are the ones who cook for us, because it causes me too much pain. I am not able to work, and my children cannot find jobs here, so we cannot afford the little food available.”

Humanity & Inclusion provides monthly food assistance to people with disabilities and their households living in the Atsimo Andrefana region of Madagascar to alleviate the negative impacts of the drought, reaching approximately 7,000 individuals. Teams also offer stimulation therapy to children, a rehabilitation service that helps prevent developmental delays and disabilities associated with a lack of nutrition. 320 children have already received stimulation therapy, and 350 others have been identified for the coming months.

Green Initiative

Humanity & Inclusion is committed to reducing the adverse effects of climate change on populations worldwide. We help communities prepare for and adapt to climate shocks and stresses, and we respond to crises magnified by environmental factors. Applying a disability, gender and age (DGA) inclusion lens across all our actions, we advocate for practitioners and policy-makers to embed DGA in their climate work as well. Humanity & Inclusion is also determined to reduce its own ecological footprint by adapting and implementing environmentally conscious approaches to humanitarian action.

A stroke left Raizy partially paralyzed and stole her independence. Through rehabilitation sessions with Humanity & Inclusion’s local partner, she’s improving her mobility and adapting to daily activities.

Raizy, 54, has four adult children. Originally from the Tulear region of Madagascar, she traveled far and wide with her business. When she was 40, Raizy experienced a stroke, which left the right side of her body paralyzed. Ever since, she has used a wheelchair to get around and says she must depend on others to complete daily activities.

“Since I can’t move anymore, I have to depend on others to do everything for me,” Raizy explains. “I cannot even feed myself. Sometimes I call for help and nobody comes, I feel powerless and it makes me sad. I don’t want to sit anymore.

"My greatest wish is just to walk again. I want to take care of my children, my grandchildren, and return to my business.”

Rehabilitation challenges

Raizy was referred to Humanity & Inclusion’s partner rehabilitation center. Because Raizy did not start rehabilitation care until years after her stroke, the paralysis is more difficult to overcome. Covid-19 precautions presented an additional challenge.

“We had finally started to see some progress, but with the pandemic, Raizy had to stop coming to the center altogether,” says Denis, a physical therapist at the rehabilitation center. “She is now able to come back again, but she has lost her progress and the paralysis is now also affecting her left side.”

At the rehabilitation center in Tulear, Raizy regularly works with Humanity & Inclusion’s rehabilitation partners to help improve her movement. She receives massages to release muscle tension and improve flexibility and participates in one-on-one sessions with Denis to strengthen her arms, legs and core. Raizy also exercises using a stationary bike.

Restoring independence

“Right now, we are working on little movements like lifting her hands and touching her nose,” Denis explains. Later we will help her learn to hold and write with a pen. We also exercise her upper body so that she will be able to sit up on her own one day. I try some exercises without holding her, and I push her gently on one side so that she has to balance herself and it helps her core muscles grow. She will gain stability and upper body muscles.”

Denis says there is still a long way to go before Raizy reaches her dream of walking again, but in the meantime, his focus is on restoring her independence.

“We are still rehabilitating her muscles, but most importantly we are helping her to adapt to her daily life,” he continues. “If she cannot lift her spoon with her right hand, we help her find another way to use her spoon. If she cannot walk on her feet, we must find another way for her to get around efficiently. This way, she can have her life back, even if it doesn’t look exactly the same.”

Avotavy used to spend all day alone because of her disability. With rehabilitation care from Humanity & Inclusion, she has improved her mobility and gained the confidence to make friends.

Avotavy, 9, lives with her mother, father, and two siblings in a tiny one-room house in Bezaha, Madagascar. Avotavy was born with a disability that affects her legs, so she is not able to walk or stand on her own. Her lack of mobility had a significant impact on Avotavy’s confidence. Though she could easily move her arms and speak, she spent most of her time sitting completely still, alone and silent in a corner.

One day, Avotavy met with Germaine, a community agent trained by Humanity & Inclusion to identify people who could benefit from rehabilitation services. She connected Avotavy’s parents to a Humanity & Inclusion partner physical therapist who helps her perform exercises and massages her leg muscles to relieve tension. They also teach Avotavy’s parents how to continue the exercises at home. After attending only three sessions, her mobility began to improve–and so did her confidence.

Community Agent Germaine with Humanity & Inclusion's physical therapist, Avotavy and Avotavy's mother.

Rehabilitation makes a difference

“She is now able to crawl, which she could never do before,” her mother explains. “She can also move her feet and sit up on her own. Now that she is moving, she has friends. She runs all around the village on her hands and knees playing games with the other children. Some days she is gone all day playing and laughing. It has made a huge difference!”

Avotavy says that her favorite game to play is “kitchen,” where she pretends to prepare meals using dirt, leaves and rocks as her main ingredients. She and her friends also play a Malagasy game called “tantara,” where they tell stories by hitting rocks together. Each rock represents a different character, similar to playing with dolls.

Avotavy’s dream coming true

Avotavy’s older sister teaches her what she learns at school, so Avotavy can write, draw, and even proudly count to 10 in French! She has always dreamed of going to school herself, but has never been able to because of her disability.

Humanity & Inclusion’s staff have helped her enroll for the upcoming school year, and they say that her mobility will have improved even more by the time classes start. Avotavy can’t wait. She says she will grow up to be a midwife one day.

As Humanity & Inclusion’s team leave Avotavy for the afternoon, her mother smiles wide and eagerly asks, “When is her next session?”

A valuable member of Humanity & Inclusion’s team in Madagascar, Deriaz ensures that rehabilitation patients get the support they need.

In Tuléar, Humanity & Inclusion partners with the center for rehabilitation and prosthetic fitting at the regional hospital. Trained community agents identify individuals who could benefit from rehabilitation services, stimulation therapy and artificial limbs., then Humanity & Inclusion links them to the appropriate services, covers associated costs, organizes logistics and follows their progress.

Q: What is your role?

My name is Deriaz Christian, and I work for the Improved Continuum of Inclusive Maternal and Child Health Care and Rehabilitation project in the southwest region of Madagascar. I have been working with Humanity & Inclusion for almost three years now.

When people come to the rehabilitation center, I support them throughout the process. My role is to accompany, supervise and organize their visits. I reserve and cover the finances of their cabs and buses to travel to the center, and I book their accommodation here. I also manage the payments that cover their food costs while they are here receiving services. We oversee the whole process to make sure everyone can access rehabilitation services.

Sometimes the coordination is complicated, because there are different kinds of patients for different services, and sometimes many people come at the same time, so it’s important to know everyone well and to be organized. 

Q: What do you like most about your work?

I love everything about my work! I love taking care of the people we serve because I get to have a relationship with everyone.

In my previous job, I worked with vulnerable populations, too. But here at Humanity & Inclusion, I get to work with people living in vulnerable circumstances and people who have disabilities. As someone with a disability myself, I want to help people in similar situations. (Complications from polio led to a disability that affects Deriaz’s leg.)

The patients that have had the biggest impact on me are people with total paralysis, in both their lower limbs and upper limbs. We see just how far society still has to go to be accessible for these individuals.

Q: Any final thoughts?

My message is to raise awareness in everyone, especially in people with disabilities and parents of children with disabilities. They should not hide. Instead, bring children with disabilities and people with disabilities here to the center for rehabilitation and prosthetic services that so they can be taken care of.

Severe malnutrition has delayed Sosiany’s growth and development. Humanity & Inclusion’s specialists are using stimulation therapy and active play to help her prevent long-term consequences.

“When Sosiany was 3 months old, I noticed that she wasn’t developing normally,” explains her mother, Naliny. “She wasn’t able to hold her head up. Then, at 6 months, she could not sit up on her own.”

Concerned, Naliny brought Sosiany to see a doctor who determined that she was severely undernourished, and it was interfering with her growth and development. At 17 months old, Sosiany’s mental and motor development are more similar to those of a 6-month-old baby. These developmental delays can worsen over time and lead to irreversible disabilities if left untreated.

The doctor prescribed the child a nutritional supplement and referred her to the rehabilitation center at the regional hospital in Tuléar to see if Sosiany could benefit from Humanity & Inclusion’s stimulation therapy.

Early childhood stimulation therapy for undernourished babies and young children is a form of strategic active play that stimulates motor skills and cognitive development by engaging the child with toys and providing individual attention. Humanity & Inclusion’s rehabilitation specialists have trained physical therapists in Tuléar, Madagascar, to use the technique alongside emergency nutrition initiatives to give children the best chance of survival, improve quality of life and prevent the long-term consequences of undernourishment.

Rehabilitation disguised as play

Recently, Sosiany attended her second session with Denis, a physical therapist at the rehabilitation center who was trained in stimulation therapy by Humanity & Inclusion in October 2021.

“In the beginning, we let the child play with whatever they are drawn to,” Denis says. “The first goal is to get them comfortable. Then, you choose activities depending on the specific objective of each child. For example, Sosiany is not able to sit on her own, so we play in positions that train her leg muscles and get her used to sitting for longer periods of time.”

Each activity plays a specific role in Sosiany’s development. Holding a toy above her head will help her practice reaching. Drawing will start to improve her grasp. Simple actions like kicking a ball or pushing a toy car help develop her movement, interactions and reflexes.

Throughout each session, Denis also explains to Naliny how to continue the exercises with her daughter at home.

“Sosiany doesn’t have any toys of her own, but her mother says she likes to drum on a basin they have for washing clothes,” Denis explains. “To encourage her to crawl, she can simply move the basin further away. Then, Sosiany will have to crawl over to it before she can play on it. We can adapt any activity to stimulate the child, you just need to know what she likes to do.”

After about five sessions of stimulation therapy, children generally start to show improvements, but the length of therapy is adapted to the needs of each child based on their progress.

Inspired by the care her daughter is receiving, Naliny says she hopes Sosiany will grow up to be a doctor so that one day she can heal others.

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Odile faces challenges in affording enough food for her son, Nasolo. Humanity & Inclusion provides stimulation therapy to help children like Nasolo overcome the consequences of undernourishment.

“My 16-month-old son, Nasolo, is underweight for his age,” Odile explains. “He struggles to hold things in his hands and he cannot walk yet. A community agent came to our home and found that Nasolo was malnourished.”

In Madagascar, Humanity & Inclusion trains community agents to recognize signs of malnutrition and other vulnerabilities in developing children. They then visit communities in the areas surrounding Tuléar, where malnutrition is common due to high poverty rates and dwindling food supply in an ongoing drought. The community agents identify children who may be in need of stimulation therapy and support from Humanity & Inclusion. If left untreated, malnutrition can cause developmental delays in young children which may lead to long-term disabilities or neurological disorders.

After meeting with the community agent, Odile was encouraged to enroll Nasolo in early childhood stimulation therapy at the Tuléar hospital rehabilitation center, where Humanity & Inclusion uses strategic play-based rehabilitation to encourage physical and cognitive development in undernourished children.

Families face food insecurity

Nasolo’s mother, Odile, is only 18 and is raising her son as a single parent. She has not been able to find work, which makes it difficult for her to provide sufficient food for her only child. At the moment, she is dependent on her mother to care for both her and Nasolo.

Odile lives more than 30 miles from the rehabilitation center and has to travel for an hour and a half to bring Nasolo to his stimulation therapy sessions. To support her and other families with children in stimulation therapy, Humanity & Inclusion covers food, transportation and hotel costs, in case families need to stay overnight, as well as the cost of the rehabilitation services.

Nasolo recently attended his third stimulation therapy session with the physical therapists and continues some exercises when he is at home with his mother. He is already starting to see some results.

“He can’t walk yet, but he is now able to hold things in his hand,” Odile says. “He loves toys and he likes to come here where he can play. I am very happy now that he has started to show progress.”

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After consecutive cyclones devastated Madagascar early this year, communities were left with nothing. For months, Humanity & Inclusion has been providing essentials to people in need.

As increasing exposure to weather-related hazards creates significant needs in Madagascar, Humanity & Inclusion supports development of adapted solutions.

Madagascar is one of the most prone countries to extreme weather hazards in the world, and the third most vulnerable to the effects of climate change. Frequent flooding, tropical storms, cyclones and droughts have devastating impacts on the population and humanitarian needs throughout the island. Climate change is expected to further increase both the frequency and strength of extreme weather events over time.

Five storms, two months

Madagascar’s annual cyclone season spans from November to March. During this time, at least one or two cyclones are expected to cause heavy rains, winds, flooding and rising sea levels. In early 2022 alone, the country experienced five tropical storms, including two intense cyclones that occurred only two weeks apart and followed similar paths of destruction.

Between January and March, over 200 people died from these storms. Around 420,000 have been affected, and more than 169,000 people had their homes damaged or destroyed. Families were left without access to food, drinking water, electricity, shelter, or basic hygiene supplies following each storm. Hospitals, schools and farmland were largely demolished, leaving populations without medical care, children without education and entire agricultural-dependent communities without food production or livelihoods, all of which will have long-term consequences. Around 150,000 acres of rice fields were flooded twice by the back-to-back cyclones and some areas lost as much as 90% of food production sources.

The worst drought in 40 years

While the northern and eastern regions of the country have faced flooding and heavy rains, the south has been experiencing the worst drought in 40 years. Following several years of below-average rainfall, approximately 1.5 million people in the region are now alarmingly food insecure.

“The population relies heavily on subsistence agriculture and rain-fed crops,” explains Lili Bazin, Humanity & Inclusion’s Disaster Risk Reduction technical referent. “So the drought has dramatic impacts on their food security and livelihoods.”

Between 2018 and 2021, the price of water increased by 300%. Some families have reported eating dirt or boiling strips of leather just to get by. The alarming lack of food puts pregnant people and children under the age of 5 at heightened risk of malnutrition, which could result in developmental complications.

Compounding vulnerability

Such dramatic meteorological events feed into a vicious cycle: natural disasters create humanitarian need by causing destruction, while pre-existing sources of vulnerability magnify the consequences of those disasters.

Madagascar is one of the poorest countries in the world, making the population that much more vulnerable in times of crisis. When faced with the stresses of food insecurity or disaster, many are forced to sell their assets or pull children out of school. Education dropout rates have increased since the drought began, as have rates of gender-based violence and early marriage. With resources and infrastructure frequently threatened, rebuilding becomes increasingly difficult, and needs continue to grow.

Populations with the greatest needs are often left behind in at-risk regions, as many cannot afford to relocate from isolated regions or lack the resources to do so, such as information or transportation. Impacts are even greater on older populations, pregnant people, people with disabilities, and people from minority groups who may face discrimination or physical barriers to accessing aid.

Reducing the impact

“200 deaths this year is of course 200 more than we want,” says Olivier Benquet, Humanity & Inclusion’s geographic director for Madagascar. “But there is some good news: This is a relatively low number considering the scale of these disasters. That is the result of improving disaster risk reduction.”

Humanity & Inclusion has implemented disaster risk reduction projects throughout the world, and in Madagascar specifically, for years. To better prepare communities faced with climate shocks and events, the organization strengthens local structures, supports education services, raises awareness of risks, implements monitoring and early warning systems, and assists individuals in making their livelihoods more sustainable, among other initiatives.

“We can’t prevent the wind, and we can’t prevent the rains,” Bazin adds. “But we can keep natural events from becoming natural disasters by predicting where they may strike, anticipating their impacts on lives and livelihoods, and by acting accordingly ahead of time to prepare communities.”

Inclusive proactive planning

In January, Humanity & Inclusion launched a three-year disaster risk reduction project to put inclusive anticipatory action in three countries prone to natural disasters: Madagascar, Haiti and the Philippines. The initiative uses the science of weather and climate to anticipate possible impacts in risk-prone areas and mobilizes teams, materials and practices to enact early action protocol and mitigate potential impacts before they can be felt. Through the initiative, Humanity & Inclusion will conduct studies to better understand associated risks on vulnerable populations, locate affected communities, reinforce community capacities to respond, run simulation exercises and ensure the inclusion of marginalized groups in these efforts.

“With today’s technology and meteorological forecasts, we can see a cyclone coming in advance,” Benquet explains. “When we see that, we can start to move our teams to the targeted areas, stock supplies, warn communities, evacuate people, and reinforce structures. We know these events are going to happen more often, so it is critical that we adapt and further develop our risk reduction efforts in the face of environmental changes.”

In Madagascar alone, the project targets nearly 330,000 people. In Haiti, it aims to benefit over 200,000 and another 200,000 in the Philippines.

“We will always support communities recovering from disaster,” Bazin says. “But at the end of the day, if we can prepare ahead of time and prevent the disaster from occurring, that’s the real goal."

Green Initiative

Humanity & Inclusion is committed to reducing the adverse effects of climate change on populations worldwide. We help communities prepare for and adapt to climate shocks and stresses, and we respond to crises magnified by environmental factors. Applying a disability, gender and age (DGA) inclusion lens across all our actions, we advocate for practitioners and policy-makers to embed DGA in their climate work as well. Humanity & Inclusion is also determined to reduce its own ecological footprint by adapting and implementing environmentally conscious approaches to humanitarian action.

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