{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T20:32:11Z","timestamp":1787085131784,"version":"build-2736575974"},"reference-count":50,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Planning &amp; Management"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Humanitarian settings face a growing healthcare workforce crisis marked by staff shortages, unsafe working conditions, and limited professional development. Despite being critical intermediaries in outbreak responses, demands on health workers come at a substantial cost to their health and wellbeing. Research on health workers responding to the Rohingya refugee crisis in Cox's Bazar, Bangladesh, is limited. Focussing on health systems \u201csoftware\u201d (relationships between people and structures), this study explores health workers' interactions with different levels of governance structures, including humanitarian response governance, the health sector coordination leadership team, and their affiliated NGO management structures when responding to disease outbreaks in the camps, particularly during COVID\u201019. Qualitative research consisted of 33 interviews and 4 data validation workshops with frontline health workers, and 13 key informant interviews with humanitarian stakeholders. Health workers' dependence on government camp authorities for their safety and public health enforcement produced complex relationships and sometimes compromised medical practices and professional support. Through the support of the health sector leadership team, infection prevention and control training was perceived as a key strength; however, health workers reported limited inclusion in decision\u2010making and being professionally unprepared during outbreaks. These experiences compounded risks to their mental and physical health, and they reported receiving minimal organisational support. These relational and structural tensions undermined worker resilience and patient\u2010provider trust. The findings underscore the need for outbreak preparedness and strategic reforms in humanitarian decision\u2010making that prioritise health workers' safety, promote inclusiveness in decision\u2010making, and embed sustained professional support in humanitarian health systems for future outbreaks.<\/jats:p>","DOI":"10.1002\/hpm.70088","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T19:44:38Z","timestamp":1778787878000},"page":"740-752","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["How Health Systems \u2018Software\u2019 Factors Affect Frontline Health Workers' Humanitarian Response Efforts During Infectious Disease Outbreaks in the Rohingya Refugee Camps, Cox's Bazar, Bangladesh"],"prefix":"10.1002","volume":"41","author":[{"given":"Georgia","family":"Venner","sequence":"first","affiliation":[{"name":"Department of Global Health and Development Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Palmer","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasmia","family":"Aksi","sequence":"additional","affiliation":[{"name":"Independent Consultant  Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahima Das","family":"Mumu","sequence":"additional","affiliation":[{"name":"Independent Consultant  Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Mirza","family":"Nu","sequence":"additional","affiliation":[{"name":"Independent Consultant Rohingya Refugee Camps  Cox's Bazar Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1510-9212","authenticated-orcid":false,"given":"Gillian","family":"McKay","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine  London UK"},{"name":"ELRHA  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahbub Ur Rahman","family":"Ujjal","sequence":"additional","affiliation":[{"name":"Friendship NGO  Dhaka Bangladesh"},{"name":"Department of Anthropology Jahangirnagar University  Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhargavi","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine  London UK"},{"name":"Mansion Unit MSF  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Hossain","sequence":"additional","affiliation":[{"name":"Department of Public Health North South University  Dhaka Bangladesh"},{"name":"College of Health Sciences University of Sharjah  Sharjah UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2433-3809","authenticated-orcid":false,"given":"Susannah","family":"Mayhew","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.3792"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0003767"},{"key":"e_1_2_11_4_1","volume-title":"Accelerating 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