National Highway 13 has not been repaired for many years. The drought has wiped out the past two harvests, and no more rain is expected before November.
People are walking 10-20 km on a daily basis for the chance to sell some charcoal or a few pieces of sugarcane or cactus fruit. The cassava does not grow as it should. It grows just a few inches high on dusty, small patches of earth surrounded by crooked leaf cactus with big white spines. The corn has dried out and is as sparse as pine trees in a forest clearing.
About half a million people live in the area where the food crisis is worst. Nevertheless it is a sparsely inhabited area. The villages are small and inaccessible. Highway 13 runs through one of the world's forgotten corners. In this case the corner happens to lie in southern Madagascar, but the road might as well run through any of numerous other poor areas around the globe.
The people here are hardened. They are accustomed to chronic malnutrition. Poverty is widespread and the living conditions offer no consolation. An empty stomach is nothing unusual here.
An MSF team member measures a child'd mid upper arm circumference (MUAC), an indicator of malnutrition. ©Jorge Nyari
Malnutrition hits hardest those who are most in need – always the smallest children. They do not grow as they should. They become weakened and vulnerable to infections. Because the roads are so bad and the capital, Antananarivo, is so far away, the food here costs five times more than in the capital. In the past few weeks, the most desperate have begun to eat cactus fruits to get in a little sugar.
What is happening here is not a natural disaster. It is not war or an infectious epidemic. Malnutrition is a personal disaster that gets played out over and over again, in family after family. The slow drama captures no interest among the mass media.
It is not the first time that a child has followed his mother along the sandy paths, when the sun is highest in the sky, on spindly legs, with a pair of emaciated arms which no longer have the energy to scratch his sparse, flea-infested hairline. It is not the first time a child has tried to relieve a hunger-gripped distended stomach by chewing one piece of sugarcane for hours at a time. But, nevertheless, it is a disaster for this child and for his mother and father.
The room where I sit and write these first lines are filled with a sound that I recognise. It is the sound of raindrops hitting the windowpanes in the hospital where I work at home in Sweden. But no rain falls here. The sound I hear is my fingers hitting the keyboard. I've decided that these lines, and all the rest that follow, will be the voice of the children in Madagascar who do not have enough to eat and do not have a voice strong enough to shout so that the rest of us can hear.