Madagascar

Since being plunged into economic uncertainty in 2009, MSF had been working in the country to fill in healthcare gaps, responding primarily to food insecurity and malnutrition, as well as disease epidemics.

Responding to outbreaks of plague 

MSF officially ended operations in Madagascar in 2016 but returned in October 2017 to respond to the outbreak of plague in Tamatave (also known as Toamasina).

The island has suffered from outbreaks of bubonic plague almost annually since 1980. The disease returns with each hot rainy season (September to April). On average, between 300 and 600 cases of bubonic plague are recorded every year, mostly in the same rural areas, and authorities are typically equipped to contain and treat it.

In 2017 however, authorities recorded more than 2000 cases, the majority of which has progressed into the more dangerous and transmittable pneumonic plague. Poor sanitation and vector control on Madagascar contribute to the rising number of annual infections. The World Health Organisation predicts that outbreaks may be more common and more severe in the future.

Further complicating vector control is the fact that the fleas that carry the Yersinia pestis bacteria that cause the plague have proven resistant to chemicals and insecticides.