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The government and QMM must be held accountable to make sure that at least people’s health is taken care of.
Say Louise, female, 38, Ilafitsignana

Although access to modern healthcare provision has improved for some of the communities in recent years, narrators say that in other respects the situation regarding health has deteriorated.

Declining harvests and restrictions on access to fishing grounds and forests mean that many people are no longer ensured a healthy and adequate diet. Appropriation of the forest also represents a significant loss to people’s wellbeing, as they have traditionally made use of a wide range of medicinal plants.

With the loss of access to such plants – and among the younger generation, an increasing lack of knowledge about the plants’ healing properties – reliance on modern medicine has grown. In communities where health centres have been built by QMM, narrators generally express appreciation that they no longer have to walk to a distant hospital, especially in emergencies. Despite the infrastructure, some narrators refer to insufficient personnel and medicines at these health centres. A number of narrators also speak positively about the government’s family planning initiative.

The health hazards linked to air and water pollution from mining activities – particularly dynamiting – are cause for great concern, both for humans and livestock. The incidence of respiratory disease appears to have significantly increased – many narrators refer to people with persistent coughs, for example.

In Ilafitsignana and Ambinanibe, water sources – already scarce – have frequently been polluted by QMM’s quarry blasting. Water standpipes supplied by QMM, in response to the communities’ complaints tend to break down for lack of proper maintenance. According to some narrators, taps were only supplied to those communities whose land had been appropriated by QMM and not to other nearby villages also affected by the pollution.


If people have money, yes, they go [to the hospital] but if not, they remain in the village and wait for a miracle. I wish the hospital was here so that people could pay on credit whenever they get sick. I assume that it would be possible to make such arrangements with doctors here rather than with the doctors in Fort Dauphin. My daughter-in-law [died] because we had to take her to the hospital in the city. The problem was that we did not have the money for her to get emergency treatment. These days, doctors or medical personnel do not want to treat patients without being paid first…
Tsitafandry, male, 75 years, Ilafitsignana

We think that QMM built the health centre in order to divert our attention from the fact that they took our forest. I think our request to the government [for a health centre] was sent to QMM and then QMM built the health centre… It is a huge benefit…What happened in the past was that illnesses that could have been treated instead killed people, because of the lack of a health centre. Pregnant women can now visit a midwife, even at night.
Alter, male, 65 years, St Luce

I want to thank the government for establishing a family planning programme because without this, people would have too many children and live in stricken poverty. With the decrease in fishing production, I don’t know how each family would have lived. When I had my first child, in 1985, the cost of living was still manageable… Now, I have seven children and it is a struggle to feed them. Thankfully, my wife adopted family planning and for the last five years we have not had a pregnancy.
Flemmond, male, 48 years, St Luce

Medicinal plants to heal babies’ diseases and a plant called “healing 150 diseases” are either becoming extinct or are located in the restricted areas [of the forest]… It is the same for a medicinal plant needed for a woman who has just delivered a baby. She should drink it as a tea. These plants are not accessible anymore…
Limbisoa, male, 22 years, Ambinanibe

Drinking water is becoming scarce. Luckily, a foreigner decided to help… He built a well to supply clean water. Despite such efforts and good intentions, many people have complained that the drinking water is polluted by the dust created by the dynamite explosions. They said that many people got sick after drinking the water.
Brinaldine, female, 42 years, Ilafitsignana

[For a time] I gave birth every year…my body could not resist this frequency and as a consequence, I aged quickly and became weak. Our children are now just starting to grow up, so this has given me relief lately from raising kids. In addition, the government has introduced family planning so I decided to follow the programme… Because I was so weak, my husband was almost ready to leave me.
Lala, female, 40 years, St Luce

In terms of health, we need the forest because that is our source of medicine. Most of plants in the forest are useful to our body. Well, I want to emphasise that diseases in the past were not the same as the ones that currently exist, because people travelling from abroad may have brought diseases to our village and all of the diseases may mix up rendering the treatment difficult. In the past, a disease could be treated easily with medicinal plant, using someone’s knowledge of medicinal plants.
Kasambo, male, 70 years, Petriky

People want to have a health centre in our village, because going to Manambaro for a treatment takes 2 hours; sometimes women give birth along the way to the hospital. The road should be rehabilitated as well so that any types of vehicles can come here…and in case there are sick people, they can catch a ride with these vehicles.
Tema Pauline, female, 36 years, Petriky


Health is a key theme of the Pushed to the edge oral testimony project.


Constand: middlemen control everything

Olina: money talks

Fanja: forest is forbidden

Sorahy: education is crucial

Kazy: rains aren’t coming

Zanaboatsy: needing the forest

Sambo: life goes on

Jean-Claude: we are not livestock

Rosette: story of change

Bruno: hotter and hotter

Say Louise: when hardships started

Sirily: working for foreigners

Key themes

Background to the region

The project and partners

Rivers and the sea


Land and compensation

Farming and food security

Environmental change


Economic conditions


Cultural and social change

Communications and power relations

Local development

The future