{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T23:46:03Z","timestamp":1775778363971,"version":"3.50.1"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T00:00:00Z","timestamp":1686182400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"BRAC James P Grant School of Public Health, BRAC University"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>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\u2019s 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\u2019s 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\u2019 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\u2019s 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.<\/jats:p>","DOI":"10.1371\/journal.pgph.0000451","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T17:24:10Z","timestamp":1686245050000},"page":"e0000451","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["\u201cWe are invisible to them\u201d\u2014Identifying the most vulnerable groups in humanitarian crises during the COVID-19 pandemic: The case of Rohingyas and the Host communities of Cox\u2019s Bazar"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2496-7972","authenticated-orcid":true,"given":"Rafia","family":"Sultana","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1653-1856","authenticated-orcid":true,"given":"Ateeb Ahmad","family":"Parray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5584-6201","authenticated-orcid":true,"given":"Muhammad Riaz","family":"Hossain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0242-1792","authenticated-orcid":true,"given":"Bachera","family":"Aktar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0916-2631","authenticated-orcid":true,"given":"Sabina 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and Health"},{"key":"pgph.0000451.ref012","first-page":"1","article-title":"Exploring the impacts of COVID-19 on Rohingya adolescents in Cox\u2019s Bazar: A mixed-methods study","author":"S Guglielmi","year":"2020","journal-title":"Journal of Migration and Health"},{"key":"pgph.0000451.ref013","article-title":"COVID-19 Impact on Refugees and Host Communities.","author":"WFP","year":"2020","journal-title":"Cox\u2019s Bazar"},{"key":"pgph.0000451.ref014","article-title":"Two years into the COVID-19 pandemic, Rohingya refugees and their hosts in Bangladesh remain highly vulnerable.","author":"WFP","year":"2022","journal-title":"In: WFP"},{"key":"pgph.0000451.ref015","article-title":"COVID-19 Situation Analysis.","author":"iMMAP","year":"2021","journal-title":"Cox\u2019s Bazar"},{"key":"pgph.0000451.ref016","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1017\/S0033291721000015","volume":"51","author":"G Prati","year":"2021","journal-title":"Psychol 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Maestripieri","year":"2021","journal-title":"Frontiers in Sociology."},{"key":"pgph.0000451.ref019","article-title":"Centre for Peace and Justice. Perception of Rohingya Refugees: Marriages and Social Justice after Cross-Border Displacement","author":"J Olney","year":"2021","journal-title":"Cox\u2019s Bazar"},{"key":"pgph.0000451.ref020","article-title":"Preventing a silent crisis for Rohingya women and girls during COVID-19 pandemic.","author":"K Jean","year":"2020","journal-title":"In: UNICEF"},{"key":"pgph.0000451.ref021","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13031-020-00274-0","article-title":"Child marriage practices among the Rohingya in Bangladesh.","volume":"14","author":"AJ Melnikas","year":"2020","journal-title":"Conflict and Health"},{"key":"pgph.0000451.ref022","article-title":"COVID-19: Projecting the impact in Rohingya refugee camps and beyond.","author":"S Truelove","year":"2020","journal-title":"Baltimore, Maryland"},{"key":"pgph.0000451.ref023","unstructured":"International Development Research Centre. Bridging Communities in Cox\u2019s Bazar: Mitigating Risks and Promoting Gender, Governance, and Localization of Humanitarian Responses in the COVID-19 Era. In: COVID-19 Responses for Equity (CORE) [Internet]. [cited 30 Sep 2021]. Available: https:\/\/c19re.org\/project\/bridging-communities-in-coxs-bazar-mitigating-risks-and-promoting-gender-governance-and-localization-of-humanitarian-responses-in-the-covid-19-era\/"},{"key":"pgph.0000451.ref024","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1080\/17441692.2020.1812103","article-title":"COVID-19 pandemic and Rohingya refugees in Bangladesh: What are the major concerns?","volume":"15","author":"R Banik","year":"2020","journal-title":"Global Public Health."},{"key":"pgph.0000451.ref025","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1177\/1010539520932707","article-title":"COVID-19 and the Rohingya Refugees in Bangladesh: The Challenges and Recommendations.","volume":"32","author":"MN Islam","year":"2020","journal-title":"Asia-Pacific Journal of Public Health"},{"key":"pgph.0000451.ref026","first-page":"259","article-title":"The outbreak of COVID-19, response, and the vulnerabilities of Rohingya refugees in Bangladesh.","volume":"14","author":"Rabby AlA Alam MdF","year":"2020","journal-title":"International Journal of Innovation, Creativity and Change."},{"key":"pgph.0000451.ref027","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1016\/S0140-6736(20)31036-9","article-title":"The COVID-19 response for vulnerable people in places affected by conflict and humanitarian crises","volume":"395","author":"D. Nott","year":"2020","journal-title":"The Lancet"},{"key":"pgph.0000451.ref028","doi-asserted-by":"crossref","first-page":"e993","DOI":"10.1016\/S2214-109X(20)30282-5","article-title":"Rohingya refugees at high risk of COVID-19 in Bangladesh.","volume":"8","author":"MM Islam","year":"2020","journal-title":"The Lancet Global Health"},{"key":"pgph.0000451.ref029","author":"Strategic Executive Group","year":"2020","journal-title":"2020 COVID-19 Response Plan: Addendum to the Joint Response Plan"},{"key":"pgph.0000451.ref030","article-title":"Covid-19, refugees and the shift to the right: the Rohingya in Myanmar and Bangladesh.","author":"MW Charney","year":"2020","journal-title":"Cox\u2019s Bazar"},{"key":"pgph.0000451.ref031","author":"MSF","year":"2020","journal-title":"Five challenges for the Rohingya in Bangladesh amid COVID-19 pandemic.UNICEF"},{"key":"pgph.0000451.ref032","article-title":"In the world\u2019s largest refugee camp, a female cleric tackles coronavirus myths.","author":"N. Karim","year":"2020","journal-title":"In: Thomson Reuters Foundation"},{"key":"pgph.0000451.ref033","article-title":"Amid COVID-19, Bangladesh turns its back on Rohingya.","author":"I. Islam","year":"2020","journal-title":"In: New Atlanticist"},{"key":"pgph.0000451.ref034","article-title":"Vulnerability of Rohingya refugees to COVID-19","author":"HAEFA","year":"2020","journal-title":"In: Health and Education for all"},{"key":"pgph.0000451.ref035","volume-title":"Live blog: Refugees in the COVID-19 crisis","author":"UNHCR Staff","year":"2020"},{"key":"pgph.0000451.ref036","article-title":"Institutional Review Board.","author":"BRAC JPGSPH","year":"2021","journal-title":"In: BRAC James P Grant School of Public Health, BRAC University"},{"key":"pgph.0000451.ref037","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12905-020-01046-x","article-title":"Challenges and opportunities confronting female-headed households in Iran: A qualitative study.","volume":"20","author":"J Yoosefi Lebni","year":"2020","journal-title":"BMC Women\u2019s Health"},{"key":"pgph.0000451.ref038","article-title":"Gender, Generation and Poverty: Exploring the Feminisation of Poverty In Africa, Asia and Latin America","author":"S Chant","year":"2007","journal-title":"Northampton: Edward Elgar Publishing Inc.;"},{"key":"pgph.0000451.ref039","article-title":"Female Household Headship and the Feminization of Poverty: Facts, Fictions and Forward Strategies.","author":"Chant SylviaH","year":"2003"},{"key":"pgph.0000451.ref040","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijdrr.2022.103246","article-title":"An assessment of gender vulnerability in the humanitarian crisis in Cox\u2019s Bazar, Bangladesh: Developing a gender-based vulnerability index in the Rohingya and Host community contexts.","volume":"81","author":"S. Nasar","year":"2022","journal-title":"International Journal of Disaster Risk Reduction"},{"key":"pgph.0000451.ref041","unstructured":"UNICEF.Female-headed households bear the brunt of Covid-19 as livelihood gaps increase;Available: https:\/\/www.unicef.org\/rosa\/stories\/female-headed-households-bear-brunt-covid-19-livelihood-gaps-increase"},{"key":"pgph.0000451.ref042","unstructured":"Needs Assessment Working Group Bangladesh. COVID-19: Bangladesh-Multi-sectoral Anticipatory Impact and Needs Analysis. Dhaka; 2020 Apr. Available: https:\/\/reliefweb.int\/sites\/reliefweb.int\/files\/resources\/COVID_NAWG%20Anticipatory%20Impacts%20and%20Needs%20Analysis.pdf"},{"key":"pgph.0000451.ref043","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-021-01070-6","article-title":"The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review.","volume":"18","author":"B Kotlar","year":"2021","journal-title":"Reproductive Health"},{"key":"pgph.0000451.ref044","article-title":"Assessing Socioeconomic Vulnerabilities Related to COVID-19 Risk in India: A State-Level Analysis.","author":"PK Pathak","year":"2020","journal-title":"Disaster Med Public Health Prep."},{"key":"pgph.0000451.ref045","doi-asserted-by":"crossref","first-page":"584408","DOI":"10.3389\/fpubh.2020.584408","article-title":"Managing multimorbidity (multiple chronic diseases) amid COVID-19 pandemic: a community based study from Odisha, India.","volume":"8","author":"S Pati","year":"2021","journal-title":"Frontiers in public health."},{"issue":"1","key":"pgph.0000451.ref046","article-title":"Disruption of healthcare amid COVID-19 pandemic in Bangladesh.","volume":"13","author":"HM Reza","year":"2020","journal-title":"The Open Public Health Journal"},{"issue":"12","key":"pgph.0000451.ref047","doi-asserted-by":"crossref","first-page":"e007051","DOI":"10.1136\/bmjgh-2021-007051","article-title":"Difficulties faced by older Rohingya (forcibly displaced Myanmar nationals) adults in accessing medical services amid the COVID-19 pandemic in Bangladesh.","volume":"6","author":"SK Mistry","year":"2021","journal-title":"BMJ global health"},{"key":"pgph.0000451.ref048","unstructured":"Islam MdN. Child Marriage in Bangladesh. [cited 7 Apr 2022]. 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