After a period of turbulence, the country now appears to be on the path towards political and economic renewal, although many problems persist. For example, 70 percent of the population still lives in poverty. Despite various attempts at health policy reform, the most impoverished people still have no access to health care.

Today MSF offers medical, nutritional, social and judicial assistance for children and families in severe need in the capital, Antananarivo. Staff seek contact, often at night, with vulnerable civilians living on the streets, in detention centers and in temporary shelters.

Moreover, MSF has provided assistance in the wake of extreme weather hazards including cyclones, hurricanes and floods. During 2003, MSF intensified its medical activity in the Isotry, Andravohangy, and Anosibe health centers in Antananarivo and consolidated the quality of medical care provided.

The team provides outpatient medical consultations, vaccinations, pre- and post-natal care and referrals to Befeltanana Hospital when needed. At present, approximately 3,700 children and pregnant women are being assisted by the program. MSF staff also remain involved in providing health care to patients and training staff in the therapeutic feeding center located in Befeltanana Hospital. MSF also gives social and legal assistance on a case-by-case basis.

In response to the current government policy which seeks to expel homeless people from the downtown area of the capital, MSF staff closely monitor the conditions of the "clean up" actions and resettlement of displaced people into shelters situated on the city's outskirts. In October, a study was done in the south of the island to evaluate nutritional needs in an area that is typically threatened by an unstable food supply. However, the situation was found to be adequate and no new program was launched.

Relief after a cyclone

After a cyclone hit the northeastern region of Antalaha, MSF distributed medicines, helped reconstruct roofs and supplied other materials to the affected population. Malnutrition became a serious problem in the areas surrounding Morondave province, in the southwest part of the island, which were poorly accessible due to flooding.

MSF opened a therapeutic feeding center in Morondave to provide urgently needed food to children in the area. A nutritional survey being conducted in the area will provide more detailed information about the nutritional needs of the affected population. In June 2004, MSF started a medical/nutritional intervention for children and families who have been affected by the cyclone.

The main objective is to reduce mortality linked to malnutrition and to prevent further illness caused by it. This project will continue for three months.