Care Providers Before the Operating Room: How Nutrition Makes Cleft Surgery Possible Malnutrition can stand between children in need of care and safe surgery. In Madagascar, Operation Smile’s Eli Zakariasy is working to make sure it doesn’t. March 19, 2026 Globally, Operation Smile estimates that more than 118,000 infants and children under the age of 5 with cleft conditions may also be living with malnutrition. For every child enrolled in an Operation Smile nutrition program, at least five more may still be waiting to be identified. In Madagascar , where many families travel long distances for care, feeding challenges can begin at birth. Children with cleft conditions often struggle to eat, placing them at greater risk of malnutrition. Without proper nourishment, they may not be strong enough to safely undergo surgery, making nutrition support a critical part of comprehensive cleft care. For Eli Zakariasy, this work is deeply personal.…