© UnicefStaff at at Black Death treatment centre wear gloves and masks to protect themselves from catching the killer bug. And health officials have warned things will get worse before they get better.
More than 100 have been killed and 1,300 infected with the pneumonic plague since August - leading UK authorities to warn Brits off visiting the African wildlife paradise.
And now health officials are warning things will get even worse before they get better.
Olivier Le Guillou of Action Again Hunger said: "We have not yet reached the peak."
Health officials say the disease has now become much more contagious because it is now being transmitted from person-to-person through the air as well as from animals to humans through infected flea bites.
The disease, which contributed to the deaths of more than 50 million people in Europe during the Middle Ages, has spread from rural areas into urban areas which are not usually affected.
Comment: ...And it likely was not spread by fleas. Mike Baillie theorizes that it was caused by cometary debris.
While cases of bubonic plague occur in Madagascar nearly every year, this years epidemic is "much more dangerous", said Elhadj As Sy, secretary general of the International Federation of Red Cross and Red Crescent Societies (IFRC), from Madagascar.
This year, plague arrived earlier than expected, and the infection is also spreading in urban centres and in areas that until now had not been affected, the World Health Organisation (WHO) said this week.
Health officials say the medieval illness is spreading at an "alarming rate".
Dr Manitra Rakotoarivony, Madagascar's director of health promotion, said: "Normally, people who catch the plague live in poor areas, but people in every place in society are catching the disease."
The country reports between 300 and 600 cases of bubonic plague each year - equal to 80 per cent of the world's total cases.
But experts say the deadlier version of the disease, pneumonic plague, is spreading rapidly into towns.
Madagascar, off the south- east coast of Africa, is a popular destination with travellers and has a British and American expat community among its 25million population.
Around 8,000 adventurous Brits visit each year.
Jimmy Whitworth, professor of International Public Health at the London School of Hygiene and Tropical Medicine, said: "It has been a long time since we have seen the plague in an urban environment.
"The risk of it spreading internationally is low. But the risk of this continuing to spread within Madagascar is still quite high."
Someone testing new biological weapons on that continent or what?