"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.

"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.

Exploring healthcare-seeking behavior of most vulnerable groups amid the COVID-19 pandemic in the humanitarian context in Cox's Bazar, Bangladesh: Findings from an exploratory qualitative study.

The COVID-19 pandemic has raised new concerns about healthcare service availability, accessibility, and affordability in complex humanitarian settings where heterogeneous populations reside, such as Rohingya refugees in Bangladesh. This study was conducted in ten Rohingya camps and four wards of the adjacent host communities in Cox's Bazar to understand the factors influencing healthcare-seeking behavior of the most vulnerable groups (MVGs) during COVID-19 pandemic. Data were extracted from 48 in-depth interviews (24 in each community) conducted from November 2020 to March 2021 with pregnant and lactating mothers, adolescent boys and girls, persons with disabilities, elderly people, and single female-household heads. This study adopted Andersen's behavioral model of healthcare-seeking for data analysis. Findings suggest that the healthcare-seeking behavior of the participants amid COVID-19 pandemic in the humanitarian context of Cox's Bazar was influenced by several factors ranging from socioeconomic and demographic, existing gender, cultural and social norms, health beliefs, and various institutional factors. Lack of household-level support, reduced number of healthcare providers at health facilities, and movement restrictions at community level hampered the ability of many participants to seek healthcare services in both Rohingya and host communities. Most of the female participants from both communities required permission and money from their male family members to visit healthcare facilities resulting in less access to healthcare. In both communities, the fear of contracting COVID-19 from healthcare facilities disproportionately affected pregnant mothers, elderly people, and persons with disabilities accessing health services. Additionally, the economic uncertainty had a significant impact on the host communities' ability to pay for healthcare costs. These findings have the potential to influence policies and programs that can improve pandemic preparedness and health system resilience in humanitarian contexts.

"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.

An assessment of gender vulnerability in the humanitarian crisis in Cox's Bazar, Bangladesh: Developing a gender-based vulnerability index in the Rohingya and Host community contexts

The massive influx of Rohingya refugees in Cox's Bazar district of Bangladesh has created a severe humanitarian crisis, which has been exacerbated by the COVID–19 pandemic. The research focused on the most vulnerable groups (MVGs) of Rohingya and adjacent host communities, such as pregnant and/or lactating women, elderly people (64+ years), persons with disabilities (PWD), single female household heads, and adolescents, with the aim to assess the vulnerability among the MVGs and between the households in both communities by developing a gender-based vulnerability index (GBVI), using data from a cross-sectional study in selected Rohingya camps and surrounding host communities. The GBVI―developed as a linear combination of several indicators under nine different themes reflecting vulnerabilities in humanitarian crisis―was used to classify the households of both communities into three levels of vulnerability: low (bottom 33.33%), medium (middle 33.33%) and acute (upper 33.33%). Findings show the intensity of vulnerability is significantly greater among the Rohingya households than those in the host community;almost 65% of Rohingya households were ‘acutely vulnerable’ compared to 2% of host households. In both communities, female-headed households (including single female) are found to be more vulnerable (the highest percentage of households with acutely vulnerability), followed by households with elderly and PWDs. Further analysis suggests that households with acute vulnerability in both communities are deprived of receiving certain services, such as COVID–19 monetary support and disability allowances. It is recommended to identify acutely vulnerable households consisting of MVGs from both communities, understand their needs, and implement urgent policies/interventions.

Implications of COVID-19 for safeguarding in international development research: learning, action and reflection from a research hub.

COVID-19 brings uncertainties and new precarities for communities and researchers, altering and amplifying relational vulnerabilities (vulnerabilities which emerge from relationships of unequal power and place those less powerful at risk of abuse and violence). Research approaches have changed too, with increasing use of remote data collection methods. These multiple changes necessitate new or adapted safeguarding responses. This practice piece shares practical learnings and resources on safeguarding from the Accountability for Informal Urban Equity hub, which uses participatory action research, aiming to catalyse change in approaches to enhancing accountability and improving the health and well-being of marginalised people living and working in informal urban spaces in Bangladesh, India, Kenya and Sierra Leone. We outline three new challenges that emerged in the context of the pandemic (1): exacerbated relational vulnerabilities and dilemmas for researchers in responding to increased reports of different forms of violence coupled with support services that were limited prior to the pandemic becoming barely functional or non-existent in some research sites, (2) the increased use of virtual and remote research methods, with implications for safeguarding and (3) new stress, anxiety and vulnerabilities experienced by researchers. We then outline our learning and recommended action points for addressing emerging challenges, linking practice to the mnemonic 'the four Rs: recognise, respond, report, refer'. COVID-19 has intensified safeguarding risks. We stress the importance of communities, researchers and co-researchers engaging in dialogue and ongoing discussions of power and positionality, which are important to foster co-learning and co-production of safeguarding processes.

Social capital and accessing services and support during COVID-19 in informal settlements of Dhaka, Bangladesh: a cross-sectional study

Background Social capital, which describes the social ties enjoyed by groups and networks with common interests, is one of the most useful resources in society. These networks could be both formal and informal, with positive effects seen at both individual and community levels—especially during crisis management. In building urban resilience and to ensure access to support and services, social capital has been fundamental throughout the COVID-19 pandemic. We aimed to explore different forms of social capital networks in the informal urban settlements (known as slums) of Dhaka, Bangladesh, and how these networks were helpful during the pandemic. Methods This qualitative study was conducted in three urban slums (Kallyanpur pora bosti, Dholpur, and Shyampur) in Dhaka city). In-depth phone interviews with residents (aged ≥18 years) of the slums were carried out by the research team, using a semi-structured questionnaire of 13 open-ended questions. Additional probing was done as necessary, depending on the clarity and specificity of the information provided by respondents. We used a snowballing sampling technique and verbal, informed consent was obtained before interviews. Thematic analysis was done. Ethical clearance was acquired from the institutional review board of BRAC James P Grant School of Public Health (2019-034-IR). Findings Between Oct 21, 2020, and Jan 12, 2021, 30 phone interviews were conducted with 22 women and 8 men. Thematic analysis showed that the most marginalised individuals in urban slums are highly dependent upon their social structures, in whom bonding social capital through informal networks is most evident. These networks are based on the trust and reliance built among people whilst living together in close proximity for a long time. Immediate family members and relatives were described as the primary point of contact for any support during emergencies. Respondents who had bridged social capital networks, and were now affiliated with different local community groups, had greater access to relief (such as food, face masks, and soap) and financial support than those who did not form social networks beyond the slums. Informal networks with landlords, local shopkeepers, pharmacies, and neighbours played a crucial role during the COVID-19 pandemic, by providing food or cash support or lending goods in credit. Interpretation Strengthening different forms of social capital is vital in building urban resilience and our findings highlight the importance of prevailing social capital networks and their roles during the COVID-19 pandemic. Funding GCRF UKRI funded ARISE Consortium.

Perception and attitudes towards COVID-19 vaccination among urban slum dwellers in Dhaka, Bangladesh

Background Vaccine hesitancy was identified as a major threat to global health by WHO in 2019. This hesitancy was also observed with COVID-19 vaccination rollout in many countries including Bangladesh, where it began on Feb 7, 2021. Reasons for this include lack of knowledge, misinformation, low trust in health systems, and so on. Vaccine hesitancy is context specific and varies across time, place, and socioeconomic groups. People living in urban slums should be prioritised for COVID-19 vaccination because they are more prone to COVID-19 infection due to their poor living conditions and inability to practice preventive measures. Therefore, we aimed to understand the perceptions and attitudes of urban slum dwellers in Dhaka, Bangladesh, towards COVID-19 vaccination through time. Methods This qualitative study was done in three urban slums of Dhaka city, Bangladesh. In-depth telephone interviews were done with 36 adults (25 women and 11 men) from Oct 21, 2020 to Jan 12, 2021, using a semi-structured guideline. Participants were selected by use of snowballing and opportunistic sampling techniques. Follow-up interviews were done in April and August, 2021. We did thematic analysis on the collected data. Informed verbal consent was obtained from the participants, and ethical clearance was obtained from BRAC James P Grant School of Public Health (Dhaka, Bangladesh;2019–034-IR). Findings Before COVID-19 vaccine rollout, doubts, fears, and rumours about safety and effectiveness of the vaccine lead to hesitancy among many participants. With time, more people were willing to get COVID-19 vaccines when they found that many in their communities were getting vaccinated and that it was free of cost. Women knew more about the vaccine compared with men, due to the awareness sessions in courtyard meetings of non-governmental organisations (NGOs) attended by women. Trusted information sources were television news, community health workers, and government loudspeaker announcements. Youths (aged 18–24 years) in the slums were more interested in getting vaccinated as they had exposure to technology and social media where they learned about the benefits of vaccination, compared with people from older age groups. Besides structural inequities in the vaccination drive, such as the complicated online registration system, long queues at vaccination centres also meant many urban poor couldn't access COVID-19 vaccination as they worried about missing a day's work. Interpretation This study highlighted the importance of using sources such as NGO workers and television news to debunk myths and disseminate COVID-19 vaccine information to ensure compliance with vaccination among urban slum dwellers. Community perceptions shape individual practices, which can help policy makers design effective communication and strategies aimed at people who are poor to improve COVID-19 vaccine uptake. Funding GCRF UKRI funded ARISE Consortium.