Babies wail as a nurse tries to reassure mothers who have come to vaccinate their children.
They fear a measles epidemic that has killed more than 1,200 people in this island nation where many are desperately poor.
As Madagascar faces its largest measles outbreak in history and cases soar well beyond 115,000, resistance to vaccinating children is not the driving force.
Measles cases are rising in the United States and other parts of the world, in part the result of misinformation that makes some parents balk at a crucial vaccine.
New York City is now trying to halt a measles outbreak by ordering mandatory vaccinations in one Brooklyn neighbourhood.
In Madagascar, many parents would like to protect their children but face immense challenges including the lack of resources.
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Just 58 per cent percent of people on Madagascar's main island have been vaccinated against measles, a major factor in the outbreak's spread.
With measles one of the most infectious diseases, immunization rates need to be 90 to 95 per cent or higher to prevent outbreaks.
On a recent day the Iarintsena health center's waiting room was full, with mothers sitting on the floor and others waiting outside in the overwhelming heat.
Two volunteer nurses and a midwife tried to respond to the demand.
Nifaliana Razaijafisoa had walked 15 kilometers (9 miles) with her 6-month-old baby in her arms.
"He has a fever," she said.
"I think it's measles because there are these little pimples that have appeared on his face."
"I called the doctor but it was Friday. He had already gone to town. I went to see another doctor who told me that my daughter had an allergy. ... This misdiagnosis was almost fatal."
"I gave my baby the leftover medications from his big brother to bring down the fever."
For a few days she did not worry: "I felt like he was healed."
"She hugged him for a long time and she did not say anything. Then she asked me to be strong. He was gone."
Ravonjisoa said she blames herself, "but I did not imagine for one moment that he was going to die."