{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:18:44Z","timestamp":1790716724251,"version":"4.1.0"},"reference-count":73,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"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":"\n Background<\/jats:title>\n The health system is required to be safe, equitable, and accessible to all ages, gender, and vulnerable groups, including older persons and persons with disability, and address their specific needs and concerns. However, limited evidence is available on the effectiveness and practicality of gender and protection mainstreaming interventions in health response in humanitarian crises.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The overall objective of the research was to explore practices, gaps, and challenges and generate recommendations regarding gender and protection mainstreaming in health response to the Rohingya refugee crisis in Cox\u2019s Bazar, Bangladesh.<\/jats:p>\n <\/jats:sec>\n \n Methodology<\/jats:title>\n The research employed a qualitative case study design to explore the practice of gender and protection mainstreaming in health response in Cox\u2019s Bazar. Data collection methods include an extensive literature review and in-depth interviews with professionals. The professionals interviewed from the area of health and protection, specifically gender, child protection, emergency health intervention, and primary health activities. Data were analyzed using thematic analysis related to gender and protection mainstreaming. Limitations were assessed as to researcher bias because the researcher did all the coding; however, an open recording process, inter-literature cross-potentiation, and ethical considerations of research helped add to the reliability of the research. Exclusion criteria were defined to ensure data consistency, removing insufficiently detailed responses not pertinent to the research objectives.<\/jats:p>\n <\/jats:sec>\n \n Result<\/jats:title>\n The study found a range of good practices on gender and protection mainstreaming in health response, e.g., placement of a gender action plan, monitoring system for gender and disability inclusion, emergency preparedness and response system, availability of sex-segregated toilets and waiting spaces, availability of gender-based violence service and engagement of female community health workers. The study also revealed some best practices which have the potential to scale up, e,g. psychosocial spaces at health facilities for children, palliative care for terminally ill patients, integrated medical and protection services, and facilitation of community health facility support groups. Critical gaps were found in the areas of women\u2019s leadership, coordination, capacity building, targeted interventions for vulnerable groups, infrastructural adaptation and consultation with the community on their concerns.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n We urge policymakers, sector coordinators, health program management, healthcare workers, and global stakeholders to address the gaps and challenges, learn and scale up the best practices, and take action to implement the study\u2019s recommendations to maximise gender and protection mainstreaming in health response.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0310878","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T13:37:52Z","timestamp":1751377072000},"page":"e0310878","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["The practice of gender and protection mainstreaming in health response in humanitarian crisis - A case study from the refugee camps in Cox\u2019s Bazar, Bangladesh"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4862-7745","authenticated-orcid":true,"given":"Charls Erik","family":"Halder","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9205-7810","authenticated-orcid":true,"given":"Md Abeed","family":"Hasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"pone.0310878.ref001","author":"World Health Organization","year":"2008"},{"key":"pone.0310878.ref002","first-page":"406","volume-title":"The sphere handbook: humanitarian charter and minimum standards in humanitarian response","author":"Sphere Project","year":"2018"},{"key":"pone.0310878.ref003","author":"Global Protection Cluster","year":"2022"},{"key":"pone.0310878.ref004","author":"Inter-Agency Standing Committee","year":"2018"},{"key":"pone.0310878.ref005","author":"United Nations High Commissioner for Refugees","year":"2021"},{"key":"pone.0310878.ref006","author":"ActionAid","year":"2016"},{"key":"pone.0310878.ref007","author":"Aditi Sharma","year":"2021"},{"key":"pone.0310878.ref008","article-title":"The role of gender inequities in women\u2019s access to reproductive health care: a population-level study of Namibia, Kenya, Nepal, and India","volume":"351","author":"A Namasivayam","year":"2012","journal-title":"Int J Womens Health"},{"key":"pone.0310878.ref009","author":"Age and Disability Consortium","year":"2018"},{"key":"pone.0310878.ref010","volume-title":"Gap analysis: the inclusion of people with disability and older people in humanitarian response; Key findings from academic and grey literature reviews","author":"A Robinson","year":"2020"},{"key":"pone.0310878.ref011","year":"2022"},{"issue":"4","key":"pone.0310878.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003587","article-title":"Epidemiological, clinical, and public health response characteristics of a large outbreak of diphtheria among the Rohingya population in Cox\u2019s Bazar, Bangladesh, 2017 to 2019: a retrospective study","volume":"18","author":"JA Polonsky","year":"2021","journal-title":"PLoS Med"},{"issue":"8","key":"pone.0310878.ref013","article-title":"Diarrhea treatment center (DTC) based diarrheal disease surveillance in settlements in the wake of the mass influx of forcibly displaced Myanmar national (FDMN) in Cox\u2019s Bazar, Bangladesh, 2018","volume":"16","author":"ASG Faruque","year":"2021","journal-title":"PLOS ONE"},{"issue":"1","key":"pone.0310878.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0282558","article-title":"COVID-19 preventive measures in Rohingya refugee camps: an assessment of knowledge, attitude and practice","volume":"19","author":"CE Halder","year":"2024","journal-title":"PLoS One"},{"key":"pone.0310878.ref015","volume-title":"Health sector Strategic Plan (2023 \u2013 2024)","author":"Health Sector, Cox\u2019s Bazar","year":"2022"},{"key":"pone.0310878.ref016","author":"OXFAM","year":"2022"},{"key":"pone.0310878.ref017","author":"REACH","year":"2021"},{"key":"pone.0310878.ref018","author":"Global Protection Cluster","year":"2014"},{"key":"pone.0310878.ref019","author":"Pakistan Protection Cluster","year":"2012"},{"key":"pone.0310878.ref020","author":"Somalia Protection Cluster","year":"2019"},{"key":"pone.0310878.ref021","author":"UNICEF","year":"2018"},{"key":"pone.0310878.ref022","author":"Inter-Agency Standing Committee","year":"2019"},{"issue":"1","key":"pone.0310878.ref023","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s13031-020-00330-9","article-title":"\u201cHaving more women humanitarian leaders will help transform the humanitarian system\u201d: challenges and opportunities for women leaders in conflict and humanitarian health","volume":"14","author":"P Patel","year":"2020","journal-title":"Confl Health"},{"issue":"9","key":"pone.0310878.ref024","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-003760","article-title":"The role of gender inclusive leadership during the COVID-19 pandemic to support vulnerable populations in conflict settings","volume":"5","author":"K Meagher","year":"2020","journal-title":"BMJ Glob Health"},{"key":"pone.0310878.ref025","doi-asserted-by":"crossref","DOI":"10.1093\/heapol\/czx102","article-title":"The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts","volume":"32","author":"S Witter","year":"2017","journal-title":"Health Policy Plan"},{"key":"pone.0310878.ref026","author":"S Scheewe"},{"key":"pone.0310878.ref027","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s13031-018-0170-0","article-title":"Facilitators and barriers in implementing the Minimum Initial Services Package (MISP) for reproductive health in Nepal post-earthquake","volume":"12","author":"A Myers","year":"2018","journal-title":"Confl Health"},{"issue":"1","key":"pone.0310878.ref028","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1186\/s12978-021-01236-2","article-title":"Preparing for and responding to sexual and reproductive health in disaster settings: evidence from Fiji and Tonga","volume":"18","author":"K Beek","year":"2021","journal-title":"Reprod Health"},{"issue":"12","key":"pone.0310878.ref029","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-008226","article-title":"Systematic review of the evidence on the effectiveness of sexual and reproductive health interventions in humanitarian crises","volume":"5","author":"E Warren","year":"2015","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0310878.ref030","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1186\/s12889-020-08818-y","article-title":"A systematic review of sexual and reproductive health interventions for young people in humanitarian and lower-and-middle-income country settings","volume":"20","author":"A Desrosiers","year":"2020","journal-title":"BMC Public Health"},{"key":"pone.0310878.ref031","doi-asserted-by":"crossref","DOI":"10.1186\/1752-1505-9-S1-S3","article-title":"Progress and gaps in reproductive health services in three humanitarian settings: mixed-methods case studies","volume":"9","author":"SE Casey","year":"2015","journal-title":"Confl Health"},{"key":"pone.0310878.ref032","author":"Guttmacher Institute","year":"2020"},{"key":"pone.0310878.ref033","volume-title":"Gap Analysis: the inclusion of people with disability and older people in humanitarian response; Part 2: beyond the evidence: implications for innovation and practice","author":"P Wesley","year":"2020"},{"key":"pone.0310878.ref034","author":"S Ba\u0161karada","year":"2013"},{"key":"pone.0310878.ref035","author":"Rohingya Refugee Response"},{"key":"pone.0310878.ref036","author":"ISCG","year":"2022"},{"issue":"1","key":"pone.0310878.ref037","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough? An experiment with data saturation and variability in qualitative research","volume":"18","author":"G Guest","year":"2006","journal-title":"Field Methods"},{"key":"pone.0310878.ref038","article-title":"Module 1: qualitative research methods overview.","volume-title":"Qualitative research methods: a data collector\u2019s field guide","author":"Family Health International"},{"issue":"8","key":"pone.0310878.ref039","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1080\/0142159X.2020.1755030","article-title":"Thematic analysis of qualitative data: AMEE Guide No. 131","volume":"42","author":"ME Kiger","year":"2020","journal-title":"Med Teach"},{"issue":"2","key":"pone.0310878.ref040","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"pone.0310878.ref041","unstructured":"Health Sector, Cox\u2019s Bazar. Health sector gender action plan 2021. 2021."},{"key":"pone.0310878.ref042","author":"Protection Sector, Cox\u2019s Bazar","year":"2022"},{"key":"pone.0310878.ref043","author":"Health Sector, Cox\u2019s Bazar","year":"2021"},{"key":"pone.0310878.ref044","author":"Health Sector, Cox\u2019s Bazar","year":"2020"},{"key":"pone.0310878.ref045","author":"Inter-Agency Standing Committee","year":"2021"},{"key":"pone.0310878.ref046","author":"Gender in Humanitarian Action Working Group"},{"key":"pone.0310878.ref047","unstructured":"Health Sector, Cox\u2019s Bazar. Health sector quarterly monitoring report (Jan \u2013 Mar 2022) [Internet]; 2022 [cited 2022 Aug 30]. Health Sector Quarterly Bulletin (April \u2013 June 2022)."},{"key":"pone.0310878.ref048","volume-title":"Health sector quarterly bulletin (April \u2013 June 2022)","author":"Health Sector, Cox\u2019s Bazar"},{"key":"pone.0310878.ref049","first-page":"104","volume-title":"Water and sanitation for health facility improvement tool (WASH FIT): a practical guide for improving quality of care through water, sanitation and hygiene in health care facilities","author":"World Health Organization","year":"2017"},{"issue":"1","key":"pone.0310878.ref050","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1007\/s12126-020-09400-y","article-title":"Humanitarian emergencies of Rohingya older people in bangladesh: a qualitative study on hopes and reality","volume":"47","author":"HTA Khan","year":"2020","journal-title":"Ageing Int"},{"key":"pone.0310878.ref051","author":"Help Age"},{"key":"pone.0310878.ref052"},{"key":"pone.0310878.ref053","author":"Health Sector, Cox\u2019s Bazar","year":"2020"},{"key":"pone.0310878.ref054","volume-title":"Health sector cyclone and monsoon contingency plan","author":"Health Sector, Cox\u2019s Bazar","year":"2021"},{"key":"pone.0310878.ref055","volume-title":"Mobile medical team operational plan, Cox\u2019s Bazar","author":"Health Sector, Cox\u2019s Bazar","year":"2020"},{"key":"pone.0310878.ref056","volume-title":"Self-efficacy: the exercise of control","author":"A Bandura","year":"1997"},{"issue":"1","key":"pone.0310878.ref057","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/1069072705281347","article-title":"Career self-efficacy theory: Back to the future","volume":"14","author":"NE Betz","year":"2006","journal-title":"J Career Assess"},{"issue":"2","key":"pone.0310878.ref058","doi-asserted-by":"crossref","first-page":"183","DOI":"10.2307\/258770","article-title":"Self-efficacy: a theoretical analysis of its determinants and malleability","volume":"17","author":"ME Gist","year":"1992","journal-title":"Acad Manage Rev"},{"key":"pone.0310878.ref059","author":"European Institute for Gender Equality","year":"2022"},{"key":"pone.0310878.ref060","volume-title":"Solar power brings 24-hour healthcare to rohingya refugees, local communities in Bangladesh","author":"IOM","year":"2017"},{"key":"pone.0310878.ref061","author":"Reliefweb","year":"2021"},{"issue":"4","key":"pone.0310878.ref062","doi-asserted-by":"crossref","first-page":"45","DOI":"10.3126\/jucms.v2i4.12070","article-title":"Biomedical waste management in Nepal: a review","volume":"2","author":"N Chaudhary","year":"2015","journal-title":"J Univers Coll Med Sci"},{"key":"pone.0310878.ref063","author":"UNICEF"},{"key":"pone.0310878.ref064","article-title":"Gender-based violence among Rohingya refugees in Bangladesh: a public health challenge","author":"MM Hossain","year":"2018","journal-title":"Indian J Med Ethics"},{"issue":"31","key":"pone.0310878.ref065","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/S0968-8080(08)31353-6","article-title":"Health services for survivors of gender-based violence in northern Uganda: a qualitative study","volume":"16","author":"M Henttonen","year":"2008","journal-title":"Reprod Health Matters"},{"issue":"5","key":"pone.0310878.ref066","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.3390\/ijerph17051685","article-title":"South sudanese refugee survivors of sexual and gender-based violence and torture: health and justice service responses in northern Uganda","volume":"17","author":"H Liebling","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0310878.ref067","doi-asserted-by":"crossref","first-page":"1169050","DOI":"10.3389\/fpubh.2023.1169050","article-title":"Understanding the challenges and gaps in community engagement interventions for COVID-19 prevention strategies in Rohingya refugees: a qualitative study with frontline workers and community representatives","volume":"11","author":"CE Halder","year":"2023","journal-title":"Front Public Health"},{"issue":"7","key":"pone.0310878.ref068","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0199300","article-title":"Evaluating the effectiveness of sexual and reproductive health services during humanitarian crises: a systematic review","volume":"13","author":"NS Singh","year":"2018","journal-title":"PLoS One"},{"key":"pone.0310878.ref069","volume-title":"Community engagement: a health promotion guide for universal health coverage in the hands of the people","author":"World Health Organization","year":"2020"},{"key":"pone.0310878.ref070","author":"IOM"},{"key":"pone.0310878.ref071","author":"UNICEF","year":"2021"},{"key":"pone.0310878.ref072","author":"World Health Organization, International Organization for Migration","year":"2021"},{"key":"pone.0310878.ref073","author":"A Bessonov","year":"2020"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0310878","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T13:38:06Z","timestamp":1751377086000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0310878"}},"subtitle":[],"editor":[{"given":"Md. Feroz","family":"Kabir,","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":73,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0310878","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.09.10.24313420","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,1]]}}}