Southern and eastern Madagascar continue to face persistently high levels of acute food insecurity (IPC Phase 3 or above), driven by a combination of factors, including significant climatic shocks and the impacts of the recent socio-political crisis, compounded by a reduction in humanitarian assistance.
In the current period (December 2025–January 2026), more than 1.57 million people are estimated to be experiencing high levels of acute food insecurity, including approximately 84,000 people in IPC Phase 4 (Emergency) and 1.49 million people in IPC Phase 3 (Crisis). This represents a deterioration compared to the situation originally projected in the July 2025 analysis. Populations in the greater south and greater southeast, as well as in the Atsimo Andrefana and Anosy regions, are particularly affected by these conditions.
For the projection period (February–April 2026), the overall trend points towards a further deterioration of the food security situation, with an estimated 1.8 million people likely to face high levels of acute food insecurity (IPC Phase 3 or above). This includes nearly 71,000 people expected to be in IPC Phase 4 and 1.73 million people projected to be in IPC Phase 3. This deterioration is in line with projections for the greater southeast area, where all analysed districts are expected to remain in Phase 3, driven by the combined effects of cyclone and flood risks, access constraints, and sustained health pressures. The most affected districts are projected to include Amboasary Atsimo (Anosy), Ampanihy (Atsimo Andrefana), and Mahanoro, Vatomandry and Maroantsetra.

Between May 2025 and April 2026, the acute malnutrition situation in Grand Sud and Ikongo (located in the Fitovinany Region of Grand Sud-Est) is projected to worsen significantly. An estimated 558,000 children under five are either currently suffering or at risk of suffering from acute malnutrition. Of these, approximately 155,600 are expected to face Severe Acute Malnutrition (SAM), while 402,400 are likely to experience Moderate Acute Malnutrition (MAM). In addition, around 38,500 pregnant and breastfeeding women (PBW) are expected to be affected during the same period.
Amboasary and Ikongo districts are already classified as IPC AMN Phase 3 (Severe) between May and September 2025. This severity is expected to intensify, with five additional districts projected to enter Phase 3 between October 2025 and January 2026. Notably, Ikongo could escalate to IPC AMN Phase 4 (Critical) during this period. By February to April 2026, Amboasary is also projected to reach Phase 4. The residual effects of harvests may temporarily obscure the full extent of the crisis between May and September, but underlying vulnerabilities persist.
Key drivers of acute malnutrition include very low food consumption, soaring food prices, limited market access, high child morbidity (notably from diarrhea and malaria), inadequate healthcare practices, and a fragile health system. These factors are compounded by climatic and socioeconomic shocks, deepening household vulnerability. Without urgent intervention, child survival is at serious risk across several districts.

Significant scale-up needed in southern Madagascar to meet large-scale needs through early 2022