{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:21:35Z","timestamp":1791282095199,"version":"4.1.0"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,11]],"date-time":"2021-06-11T00:00:00Z","timestamp":1623369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>On August 25 2017, an unprecedented influx of Rohingya refugees began from Rakhine State in Myanmar into Bangladesh\u2019s district of Cox\u2019s Bazar. The scale and acuteness of this humanitarian crisis was unprecedented and unique globally, requiring strong coordination of a multitude of actors. This paper reflects on the health sector coordination from August 2017 to October 2019, focusing on selected achievements and persisting challenges of the health sector strategic advisory group (HSSAG), and the health sector working groups including epidemiology and case management, sexual and reproductive health, community health, mental health and psychosocial support, and emergency preparedness. In the early days of the response, minimum service standards for primary health care were established, a fundamental initial step which enabled the standardization of services based on critical needs. Similarly, establishing standards for community health outreach was the backbone for capitalizing on this important health workforce. Novel approaches were adopted for infectious disease responses for acute watery diarrhoea and varicella, drawing on inter-sectoral collaborations. Sexual and reproductive health services were prioritized from the initial onset of the crisis and improvements in skilled delivery attendance, gender-based violence services, abortion care and family planning were recorded. Mental health service provision was strengthened through community-based approaches although integration of mental health programmes into primary health care has been limited by availability of specialist psychiatrists. Strong, collaborative and legitimate leadership by the health sector strategic advisory group, drawing on inter-sectoral collaborations and the technical expertise of the different technical working groups, were critical in the response and proved effective, despite the remaining challenges to be addressed. Anticipated reductions in funding as the crisis moves into protracted status threatens the achievements of the health sector in provision of health services to the Rohingya refugees.<\/jats:p>","DOI":"10.1371\/journal.pone.0253013","type":"journal-article","created":{"date-parts":[[2021,6,11]],"date-time":"2021-06-11T17:25:28Z","timestamp":1623432328000},"page":"e0253013","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":33,"title":["The health response to the Rohingya refugee crisis post August 2017: Reflections from two years of health sector coordination in Cox\u2019s Bazar, Bangladesh"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2367-2072","authenticated-orcid":true,"given":"Rosanna","family":"Jeffries","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Abdi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abu Toha Md Rezuanul Haque","family":"Bhuiyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"El Shazly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Harlass","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9659-8286","authenticated-orcid":true,"given":"Asm","family":"Ishtiak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9303-6541","authenticated-orcid":true,"given":"Md Khadimul Anam","family":"Mazhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukeshkumar","family":"Prajapati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5840-8461","authenticated-orcid":true,"given":"Qing Yuan","family":"Pang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balwinder","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Tabu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5295-5085","authenticated-orcid":true,"given":"Amrish","family":"Baidjoe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,6,11]]},"reference":[{"key":"pone.0253013.ref001","unstructured":"Inter Sectoral Coordination Group. SITUATION REPORT ROHINGYA REFUGEE CRISIS: JULY 2019. 2019."},{"key":"pone.0253013.ref002","unstructured":"UNHCR. Rohingya emergency [Internet]. [cited 2021 Apr 7]. https:\/\/www.unhcr.org\/uk\/rohingya-emergency.html."},{"key":"pone.0253013.ref003","unstructured":"The Guardian. Where is the world\u2019s densest city? 2017 May 11; https:\/\/www.theguardian.com\/cities\/2017\/may\/11\/where-world-most-densely-populated-city."},{"key":"pone.0253013.ref004","unstructured":"Nutrition Sector. Emergency Nutrition and Health Assessment Round 3 [Internet]. Cox\u2019s Bazar; 2018. https:\/\/www.humanitarianresponse.info\/sites\/www.humanitarianresponse.info\/files\/2018\/12\/181223-ENA-R3-MS-%26-NYP-Prelim-Results_NUT_SECTOR_DEC2_2018.pdf."},{"key":"pone.0253013.ref005","unstructured":"European Commission, IASC. INFORM Country Profile Map [Internet]. [cited 2019 Oct 21]. https:\/\/drmkc.jrc.ec.europa.eu\/inform-index\/Countries\/Country-Profile-Map."},{"key":"pone.0253013.ref006","doi-asserted-by":"crossref","unstructured":"Sphere. The Sphere Handbook 2018 [Internet]. 2018 [cited 2019 Oct 21]. https:\/\/www.spherestandards.org\/handbook-2018\/.","DOI":"10.3362\/9781908176707"},{"key":"pone.0253013.ref007","unstructured":"Ministry of Health and Family Welfare. BANGLADESH ESSENTIAL HEALTH SERVICE PACKAGE (ESP). Dhaka; 2016."},{"key":"pone.0253013.ref008","unstructured":"UNFPA. Minimum Initial Service Package (MISP) for SRH in Crisis Situations | UNFPA\u2014United Nations Population Fund [Internet]. [cited 2021 Apr 7]. https:\/\/www.unfpa.org\/resources\/minimum-initial-service-package-misp-srh-crisis-situations."},{"key":"pone.0253013.ref009","article-title":"Climate change and its impact on health in Bangladesh","volume":"Vol. 12","author":"A Rahman","year":"2008","journal-title":"Regional Health Forum"},{"key":"pone.0253013.ref010","article-title":"World health organization early warning, alert and response system in the Rohingya crisis, Bangladesh, 2017\u20132018","author":"B Karo","year":"2018","journal-title":"Emerg Infect Dis"},{"key":"pone.0253013.ref011","unstructured":"WHO. EWARS: Epidemiological Highlights Week 43 (21\u201327 Oct), 2019. Cox\u2019s Bazar; 2019."},{"key":"pone.0253013.ref012","unstructured":"Health Sector, WASH Sector, Risk Communications Taskforce. Multi-Sectoral Acute Watery Diarrhoea Response Plan [Internet]. Cox\u2019s Bazar; 2019. https:\/\/drive.google.com\/drive\/folders\/1lTM6pJRpUElKsX5GgdoQ7SZXqiXqta2G."},{"key":"pone.0253013.ref013","unstructured":"UNHCR. Population Factsheet: UNHCR, Bangladesh, Cox\u2019s Bazar- as of 30 September 2019 [Internet]. 2019 [cited 2019 Oct 21]. https:\/\/data2.unhcr.org\/en\/documents\/details\/71790."},{"key":"pone.0253013.ref014","unstructured":"Chowdhury MAK, Billah SM, Karim F, Khan ANS, Islam S, Arifeen S El. Report on Demographic profiling and needs assessment of maternal and child health (MCH) care for the Rohingya refugee population in Cox\u2019s Bazar, Bangladesh. 2018 [cited 2019 Oct 21]; http:\/\/dspace.icddrb.org\/jspui\/bitstream\/123456789\/9067\/2\/Special Report 153.pdf."},{"key":"pone.0253013.ref015","unstructured":"UNFPA. Minimum Initial Service Package (MISP) Calculators [Internet]. 2019 [cited 2020 Oct 29]. https:\/\/iawg.net\/resources\/misp-calculator."},{"issue":"31","key":"pone.0253013.ref016","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/S0968-8080(08)31351-2","article-title":"Reproductive Health: A Right for Refugees and Internally Displaced Persons","volume":"16","author":"J Austin","year":"2008","journal-title":"Reprod Health Matters"},{"key":"pone.0253013.ref017","unstructured":"Handzel E, Couture A, Meehan K, Doraiswamy S, Biswas A, Abdi H, et al. Summary Report: Reproductive Age Mortality Study (RAMOS) [Internet]. Cox\u2019s Bazar; 2019 [cited 2019 Oct 21]. https:\/\/bangladesh.unfpa.org\/en\/publications\/summary-report-reproductive-age-mortality-study-ramos?page=1."},{"key":"pone.0253013.ref018","unstructured":"WHO. Maternal mortality in 2000\u20132017 [Internet]. [cited 2020 Oct 4]. https:\/\/www.who.int\/gho\/maternal_health\/countries\/bgd.pdf?ua=1."},{"key":"pone.0253013.ref019","first-page":"347","article-title":"Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?","volume":"Vol. 384","author":"ZA Bhutta","year":"2014","journal-title":"The Lancet. Lancet Publishing Group"},{"key":"pone.0253013.ref020","unstructured":"Inter Sectoral Coordination Group. 2018 JOINT RESPONSE PLAN FOR ROHINGYA HUMANITARIAN CRISIS [Internet]. 2018 [cited 2019 Oct 21]. www.humanitarianresponse.info\/en\/operations\/bangladesh."},{"key":"pone.0253013.ref021","unstructured":"Inter Sectoral Coordination Group. Joint Response Plan for Rohingya: 2019 Mid Term Review [Internet]. Cox\u2019s Bazar; 2019. https:\/\/www.humanitarianresponse.info\/sites\/www.humanitarianresponse.info\/files\/documents\/files\/2019_jrp_mid_term_review_final_for_circulation1_compressed.pdf."},{"key":"pone.0253013.ref022","unstructured":"The New Humanitarian. Why Rohingya women risk dangerous home births in Bangladesh\u2019s refugee camps [Internet]. 2019 [cited 2019 Oct 21]. https:\/\/www.thenewhumanitarian.org\/news\/2019\/06\/03\/why-rohingya-women-risk-dangerous-home-births-bangladesh-s-refugee-camps."},{"key":"pone.0253013.ref023","unstructured":"ipa, UNICEF. Current Level of Knowledge, Attitudes, Practices, and Behaviours (KAPB) of the Rohingya Refugees and Host Community in Cox\u2019s Bazar: A Report on Findings from the Baseline Survey [Internet]. 2018 [cited 2019 Oct 21]. https:\/\/reliefweb.int\/report\/bangladesh\/current-level-knowledge-attitudes-practices-and-behaviours-kapb-rohingya-refugees."},{"issue":"1","key":"pone.0253013.ref024","doi-asserted-by":"crossref","first-page":"20","DOI":"10.9745\/GHSP-D-19-00092","article-title":"Saving Mothers, Giving Life: It Takes a System to Save a Mother (Republication)","volume":"7","author":"CM Conlon","year":"2019","journal-title":"Glob Heal Sci Pract"},{"issue":"2","key":"pone.0253013.ref025","first-page":"1610275","article-title":"Mortality in Rohingya refugee camps in Bangladesh: historical, social, and political context","volume":"27","author":"PK Parmar","year":"2019","journal-title":"Sex Reprod Heal Matters"},{"issue":"2","key":"pone.0253013.ref026","article-title":"Unsafe abortion: unnecessary maternal mortality","volume":"2","author":"LB Haddad","year":"2009","journal-title":"Rev Obstet Gynecol"},{"key":"pone.0253013.ref027","doi-asserted-by":"crossref","DOI":"10.1363\/46e0820","article-title":"Expanding access to comprehensive abortion care in humanitarian contexts: Case study from the rohingya refugee camps in bangladesh","volume":"46","author":"S Sultana","year":"2020","journal-title":"Int Perspect Sex Reprod Health"},{"issue":"1","key":"pone.0253013.ref028","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s13031-020-00298-6","article-title":"Navigating the crisis landscape: Engaging the ministry of health and United Nations agencies to make abortion care available to Rohingya refugees","volume":"14","author":"T Fetters","year":"2020","journal-title":"Confl Health"},{"key":"pone.0253013.ref029","unstructured":"Women\u2019s Refugee Commission. A Clear Case for Need and Demand: Accessing Contraceptive Services for Rohingya Women and Girls in Cox\u2019s Bazar [Internet]. 2019 [cited 2019 Oct 21]. https:\/\/www.womensrefugeecommission.org\/srh-2016\/resources\/1802-contraceptive-service-delivery-in-the-refugee-camps-of-cox-s-bazar-bangladesh."},{"key":"pone.0253013.ref030","unstructured":"Rahman M. Report on Demographic Profiling and Needs Assessment of Maternal and Child Health (MCH) Care for the Rohingya Refugee Population in Cox\u2019s Bazar, Bangladesh. 2018."},{"key":"pone.0253013.ref031","unstructured":"Schnabel L, Huang C. IMPROVING SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS FOR ROHINGYA Removing Barriers and Closing Gaps: Improving Sexual and Reproductive Health and Rights for Rohingya Refugees and Host Communities EXECUTIVE SUMMARY [Internet]. [cited 2021 Apr 7]. http:\/\/www.un.org\/womenwatch\/daw\/beijing\/official.htm."},{"key":"pone.0253013.ref032","unstructured":"Internews. Chatgaya vs. Rohingya [Internet]. [cited 2021 Apr 7]. https:\/\/internews.org\/news\/chatgaya-vs-rohingya."},{"key":"pone.0253013.ref033","unstructured":"Kobo Tool Box [Internet]. [cited 2020 Oct 28]. https:\/\/www.kobotoolbox.org\/."},{"key":"pone.0253013.ref034","unstructured":"Inter-Agency Standing Committee (IASC). Iasc Guidelines on Mental Health and Psychosocial support in Emergency settings [Internet]. 2007 [cited 2019 Oct 21]. http:\/\/www.humanitarianinfo.org\/iasc\/content\/products."},{"key":"pone.0253013.ref035","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/978-3-319-72914-5_6","volume-title":"An Uncertain Safety","author":"I Weissbecker","year":"2019"},{"issue":"2","key":"pone.0253013.ref036","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1002\/wps.20438","article-title":"The contemporary refugee crisis: an overview of mental health challenges","volume":"16","author":"D Silove","year":"2017","journal-title":"World Psychiatry"},{"issue":"10194","key":"pone.0253013.ref037","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/S0140-6736(19)30934-1","article-title":"New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis","volume":"394","author":"F Charlson","year":"2019","journal-title":"Lancet"},{"issue":"3","key":"pone.0253013.ref038","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1177\/1363461517705571","article-title":"Daily stressors, trauma exposure, and mental health among stateless Rohingya refugees in Bangladesh","volume":"54","author":"A Riley","year":"2017","journal-title":"Transcult Psychiatry"},{"key":"pone.0253013.ref039","unstructured":"Translators without Borders. A Translators without Borders rapid assessment of language barriers in the Cox\u2019s Bazar refugee response [Internet]. 2017 [cited 2019 Oct 21]. https:\/\/translatorswithoutborders.org\/rohingya-zuban\/."},{"issue":"5","key":"pone.0253013.ref040","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1017\/S2045796019000192","article-title":"The culture, mental health and psychosocial wellbeing of Rohingya refugees: a systematic review","volume":"28","author":"AK Tay","year":"2019","journal-title":"Epidemiol Psychiatr Sci"},{"key":"pone.0253013.ref041","unstructured":"World Health Organization, World Organization of Family Doctors (Wonca). Integrating mental health into primary care A global perspective. 2008."},{"issue":"1","key":"pone.0253013.ref042","first-page":"5","article-title":"Integrating mental health into primary healthcare","volume":"5","author":"M Funk","year":"2008","journal-title":"Ment Health Fam Med"},{"key":"pone.0253013.ref043","first-page":"691","article-title":"Effectiveness and value of integrating behavioral health into primary care","volume":"Vol. 176","author":"SJ Reed","year":"2016","journal-title":"JAMA Internal Medicine. American Medical Association"},{"key":"pone.0253013.ref044","unstructured":"Inter Sectoral Coordination Group. Bangladesh National Cyclone Contingency Plan 2018 [Internet]. 2018 [cited 2019 Oct 21]. https:\/\/www.humanitarianresponse.info\/sites\/www.humanitarianresponse.info\/files\/2019\/07\/HCTT_Bangladesh-Cyclone-Contingency-Plan.pdf."},{"key":"pone.0253013.ref045","unstructured":"International Federation of Red Cross and Red Crescent. Bangladesh: Cyclone Early Action Protocol summary [Internet]. 2018 [cited 2019 Oct 21]. https:\/\/reliefweb.int\/report\/bangladesh\/bangladesh-cyclone-early-action-protocol-summary."},{"key":"pone.0253013.ref046","unstructured":"Natural Hazards Risk Analysis Taskforce. Summary report: Natural Hazards Risk Analysis Taskforce, Cox\u2019s Bazar [Internet]. Cox\u2019s Bazar; 2019 [cited 2019 Oct 21]. https:\/\/reliefweb.int\/report\/bangladesh\/summary-report-natural-hazards-risk-analysis-taskforce-coxs-bazar-i-status-1062019."},{"key":"pone.0253013.ref047","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.scitotenv.2019.07.132","article-title":"Tropical cyclone risk assessment using geospatial techniques for the eastern coastal region of Bangladesh","volume":"692","author":"MA-A Hoque","year":"2019","journal-title":"Sci Total Environ"},{"issue":"1","key":"pone.0253013.ref048","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/BF00162096","article-title":"Cyclones and storm surges in Bangladesh: Some mitigative measures","volume":"6","author":"GM Khalil","year":"1992","journal-title":"Nat Hazards"},{"key":"pone.0253013.ref049","unstructured":"Khan SR. CYCLONE HAZARD IN BANGLADESH [Internet]. [cited 2019 Oct 21]. http:\/\/www.adpc.net\/casita\/Case_studies\/Coastal hazard assessment\/Modelling cyclone hazard in Bangladesh\/Background_information_on_the_storm_surge_modelling.pdf."},{"key":"pone.0253013.ref050","unstructured":"NPM-ACAPS Analysis Hub. Cyclones background Rohingya crisis [Internet]. 2018 [cited 2019 Oct 21]. https:\/\/reliefweb.int\/sites\/reliefweb.int\/files\/resources\/20180326_npm-acaps_analysis_hub_thematic_report_cyclones_background_rohingya_crisis.pdf."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253013","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,1]],"date-time":"2024-09-01T17:42:13Z","timestamp":1725212533000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253013"}},"subtitle":[],"editor":[{"given":"Hannah","family":"Tappis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,6,11]]},"references-count":50,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0253013","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,11]]}}}