Madagascar, situated off Africa's east coast, is one of earth’s largest islands. Its ecology is diverse, including rainforest and desert regions. However, its location in the Indian Ocean makes Madagascar prone to cyclones and flooding.

Médecins Sans Frontières/Doctors Without Borders (MSF) first worked in Madagascar in 1987. MSF ended operations in Madagascar in 2016, but returned in October 2017 to respond to an outbreak of plague.