Difficulties faced by older Rohingya (forcibly displaced Myanmar nationals) adults in accessing medical services amid the COVID-19 pandemic in Bangladesh

Promotion of livelihood opportunities to address food insecurity in Rohingya refugee camps of Bangladesh

The world is facing a tremendous problem in the form of food insecurity that is posing a great challenge to achieving sustainable development goal 2 of creating a hunger-free world. Refugees and displaced populations are particularly vulnerable to food insecurity and malnutrition, who lack any productive assets and depend on aid. Rohingya refugees, displaced from Myanmar and took refuge in Cox's Bazar, Bangladesh, live in a crowded unhealthy environment and are severely vulnerable to food insecurity and malnutrition. In our recent study, we found that only 21.6% of the households in Rohingya refugee camps had acceptable food security status. Interestingly, this study further revealed that acceptable food security status was significantly higher among the households that had some additional income aside from aid, compared to those relying on aid alone. This shows the importance of promoting livelihood opportunities to improve food security status among the camp dwellers. In this paper, we presented our views on promoting livelihood opportunities to address the overwhelming food insecurity crisis among the Rohingya refugees in Bangladesh.

Anxiety and Stress Related to COVID-19 Among the Community Dwelling Older Adults Residing in the Largest Refugee Camp of the World

The current cross-sectional study was conducted among 864 older adults aged ≥ 60 years residing in Rohingya refugee camp through face-to-face interviews during November-December 2021. COVID-19-related anxiety was measured using the five-point Coronavirus Anxiety Scale (CAS) and perceived stress using the 10-point Perceived Stress Scale (PSS). The linear regression model identified the factors associated with COVID-19-related anxiety and perceived stress. The prevalence of COVID-19-related anxiety and perceived stress was 68% and 93%, respectively. The average COVID-19-related anxiety score expected to be significantly higher among those who were physically inactive, concerned about COVID-19, had a close friend/family member diagnosed with COVID-19, and had some difficulty in getting food and routine medical care during the COVID-19 pandemic. Meanwhile, the average perceived stress score was expected to be significantly higher among those without partners, who were feeling overwhelmed by COVID-19, and who experienced COVID-19-related anxiety during the pandemic. The findings suggest providing immediate psychosocial support to older Rohingya adults.

Factors contributing to the high prevalence of intimate partner violence among south Sudanese refugee women in Ethiopia

BACKGROUND

Intimate partner violence is a universally occurring form of violence against women which is perpetrated by a husband or other intimate partner. It is a common public health problem during humanitarian crisis. Despite this, little is known about the problem among South Sudanese refugee women in Ethiopia.

OBJECTIVE

This study aimed to determine the prevalence of intimate partner violence and identify its contributing factors among married refugee women in Pinyudo refugee camp, Gambella, Ethiopia in 2021.

METHODS

A community-based cross-sectional study was conducted from March to June 2021. A random sample of 406 refugee women was included in the study. A structured, pretested, and interviewer-administered questionnaire was used to collect the data. Data were entered into epi-data version 3.1 and exported to SPSS version 22 for analysis. Multivariable logistic regression was run to identify factors associated with intimate partner violence. Statistical significance was affirmed using Adjusted Odds Ratio with its 95% Confidence Interval at a p-value ≤ 0.05.

RESULTS

A total of 406 married refugee women participated in the study making a response rate of 96.2%. The overall prevalence of intimate partner violence in the past 12 months was 48.3% 95% CI= (43.6-53.2). Low-income contribution [AOR = 2.4, 95% CI: 1.2-5.5], and attitudinal acceptance [AOR = 2.1, 95%CI: 1.2-3.8] were significantly associated with the problem.

CONCLUSION

The prevalence of intimate partner violence is alarmingly high as half of participating women reported facing the problem in the year preceding the study. Low-income contribution and attitudinal acceptance were associated with a higher probability of experiencing violence. The government, humanitarian organizations, and other stakeholders should enable refugee women to generate income. There should be continuous women empowerment and behavioral interventions to improve refugee women's attitudes towards intimate partner violence.

"We are invisible to them"-Identifying the most vulnerable groups in humanitarian crises during the COVID-19 pandemic: The case of Rohingyas and the Host communities of Cox's Bazar

The COVID-19 pandemic has had an adverse impact on the Rohingya and the Bangladeshi host communities, which have been well documented in the literature. However, the specific groups of people rendered most vulnerable and marginalized during the pandemic have not been studied comprehensively. This paper draws on data to identify the most vulnerable groups of people within the Rohingya and the host communities of Cox's Bazar, Bangladesh, during the COVID-19 pandemic. This study employed a systematic sequential method to identify the most vulnerable groups in the context of Rohingya and Host communities of Cox's Bazar. We conducted a rapid literature review (n = 14 articles) to list down Most vulnerable groups (MVGs) in the studied contexts during the COVID-19 pandemic and conducted four (04) group sessions with humanitarian providers and relevant stakeholders in a research design workshop to refine the list. We also conducted field visits to both communities and interviewed community people using In-depth interviews (n = 16), Key-informant Interviews (n = 8), and several informal discussions to identify the most vulnerable groups within them and their social drivers of vulnerabilities. Based on the feedback received from the community, we finalized our MVGs criteria. The data collection commenced from November 2020 to March 2021. Informed consent was sought from all participants, and ethical clearance for this study was obtained from the IRB of BRAC JPGSPH. The most vulnerable groups identified in this study were: single female household heads, pregnant and lactating mothers, persons with disability, older adults, and adolescents. Our analysis also found some factors that may determine the different levels of vulnerabilities and risks faced by some groups more than others in the Rohingya and host communities during the pandemic. Some of these factors include economic constraints, gender norms, food security, social safety-security, psychosocial well-being, access to healthcare services, mobility, dependency, and a sudden halt in education. One of the most significant impacts of COVID-19 was the loss of earning sources, especially for the already economically vulnerable; this had far-reaching consequences on individuals' food security and food consumption. Across the communities, it was found that the economically most affected group was single female household heads. The elderly and pregnant and lactating mothers face challenges seeking health services due to their restricted mobility and dependency on other family members. Persons living with disabilities from both contexts reported feelings of inadequacy in their families, exacerbated during the pandemic. Additionally, the shutdown in the formal education, and informal learning centres in both communities had the most significant impact on the adolescents during the COVID-19 lockdown. This study identifies the most vulnerable groups and their vulnerabilities amid the COVID-19 pandemic in the Rohingya and Host communities of Cox's Bazar. The reasons behind their vulnerabilities are intersectional and represent deeply embedded patriarchal norms that exist in both communities. The findings are essential for the humanitarian aid agencies and policymakers for evidence-based decision-making and service provisions for addressing the vulnerabilities of the most vulnerable groups.

Prevalence and determinants of self-reported functional status among older adults residing in the largest refugee camp of the world

BACKGROUND

The older adults of refugee camps might be vulnerable to exhibiting limited functional abilities because of the limited resources available to create a supportive environment for older population in the camps. This study aims to explore the prevalence and determinants of self-reported functional status among the older adults residing in the Rohingya refugee camp in Bangladesh.

METHODS

This cross-sectional study was conducted on 864 older adults aged 60 years and above living in five selected sub-camps of Rohingya refugee camp in Cox's Bazar, Bangladesh. Data were collected through face-to-face interviews of the participants between November-December 2021. Functional status was measured using the Barthel Index. Information on participants' sociodemographic characteristics, self-reported chronic diseases and lifestyle characteristics were also collected. A multiple logistic regression model was used to assess the factors associated with self-reported functional abilities among the participants.

RESULTS

The overall percentage of people having limited self-reported functional ability was 26.5% (male: 22.6% and female: 31.5%) with inability most found in grooming (33.2%), bathing (31.8%), stair using (13.2%) and mobility (10.7%). In the final adjusted model, having age of 80 years or more (aOR = 2.01,95% CI: 1.08,3.75), being female (aOR = 1.44, 95% CI: 1.04,2.0), having low memory or concentration (aOR = 1.83, 95% CI: 1.30,2.56), loneliness (aOR = 2.89, 95% CI:1.74,4.80) and living with aid alone (aOR = 2.89, 95% CI: 1.74,4.80) were found to be associated with self-reported limited functional ability.

CONCLUSION

The findings of this study highlight the need for attention from policymakers and public health practitioners on addressing functional limitations among older adults residing in the Rohingya refugee camp. Our findings emphasize the need for the development of comprehensive interventions that can address the wider unmet needs (e.g., ensuring family/caregiver support, engaging in social and physical activities, providing nutritional support packages, etc.) to improve the health and well-being of older Rohingya adults.

Climate Risks and Truncated Opportunities: How Do Environmental Challenges Intersect with Economic and Social Disadvantages for Rohingya Adolescents in Bangladesh?

Integration of environmental, economic, and social approaches to development is crucial to achieve the United Nations Sustainable Development Goals. Global evidence reflects that this integration is often imbalanced, with development policies and programs in many low- and middle-income countries placing greater emphasis on economic needs than environmental vulnerabilities. Drawing on qualitative research undertaken in mid-2021, this article explores how limited integration of environmental, economic, and social aspects has affected the development of Rohingya refugee adolescents who were forcibly displaced from Myanmar to the Cox’s Bazar district of Bangladesh. Cox’s Bazar is one of the most climate-vulnerable areas in Bangladesh and is subject to extreme rainfall, landslides, and flash floods. The article highlights the ways in which Rohingya adolescents are highly vulnerable to both the direct and indirect consequences of these environmental conditions due to poverty, and inadequate housing infrastructure and water, sanitation, and hygiene facilities. It discusses the ways in which these environmental challenges intersect with socioeconomic disadvantage, especially limited education, skills development, and livelihood opportunities for young people, which are in turn compounded by limited voice and agency, and a dearth of security and protection measures. For some Rohingya adolescent girls and boys, the findings suggests that these multi-dimensional vulnerabilities place them at risk of exploitation by traffickers, smugglers, extremist groups, and criminals. The article concludes by highlighting the importance of explicitly integrating environmental aspects into policy and programs that support Rohingya adolescents to develop their full capabilities, and encouraging their meaningful participation in policy dialogues and accountability processes.

"Younger women had more access to COVID-19 information": An intersectional analysis of factors influencing women and girls' access to COVID-19 information in Rohingya and host communities in Bangladesh

The Rohingya and Bangladeshi host communities live at a heightened risk of COVID-19 impact due to their pre-existing vulnerabilities, religious beliefs, and strict socio-cultural and gender norms that render primarily women and girls vulnerable. However, the extent of this vulnerability varies within and across population groups in the host and Rohingya communities. The intersectionality lens helps identify, recognize, and understand these factors that create inequities within populations. This study explored the factors that influenced the women and girls' access to information during the COVID-19 pandemic through an intersectional lens. This paper presents partial findings from the exploratory qualitative part of mixed-method research conducted in ten Rohingya camps and four wards of the adjacent host communities in Cox's Bazar, Bangladesh. Data were extracted from 24 in-depth interviews (12 in each community) conducted from November 2020 to March 2021 with diverse participants, including adolescent girls, younger women, adult women, pregnant and lactating mothers, persons with disabilities, older adults, and single female-household heads. All participants provided verbal informed consent before the interviews. In the case of the adolescents, assent was taken from the participants, and verbal informed consent was taken from their parents/guardians. The ethical clearance of this study was sought from the institutional review board of BRAC James P Grant School of Public Health, BRAC University. We find that the women and girls living in Rohingya communities exhibit a more profound structural interplay of factors within their socio-ecological ecosystem depending on their age, power, and position in the society, physical (dis)abilities, and pre-existing vulnerabilities stemming from their exodus, making them more vulnerable to COVID-19 impact by hindering their access to information. Unlike Rohingya, the host women and girls explain the impact of the COVID-19 pandemic on their access to information through the lens of intergenerational poverty and continuous strain on existing resources, thereby highlighting shrinking opportunities due to the influx, COVID-19 infodemic and misinformation, access to digital devices amongst the adolescents, and restricted mobility mainly due to transport, school closures, and distance-related issues. Moreover, the socio-cultural beliefs and the gender norms imposed on women and adolescent girls played an essential role in accessing information regarding the COVID-19 pandemic and consequently influenced their perception of and response to the disease and its safety protocols. Socio-cultural gender norms led to mobility restrictions, which compounded by lockdowns influenced their access to information resulting in dependency on secondary sources, usually from male members of their families, which can easily mislead/provide mis/partial information. The younger age groups had more access to primary sources of information and a broader support network. In comparison, the older age groups were more dependent on secondary sources, and their social networks were limited to their family members due to their movement difficulty because of age/aging-related physical conditions. This study explored and analyzed the intersectional factors that influenced the women and girls' access to information during the COVID-19 pandemic from two contexts with varying degrees of pre-existing vulnerability and its extent. These include gender, age, state of vulnerability, power and privilege, socio-economic status, and physical (dis)ability. It is imperative that services geared towards the most vulnerable are contextualized and consider the intersectional factors that determine the communities' access to information.