Bangladesh — “We bear it and accept our fate” Perceptions of healthcare access from people with disabilities in Cox’s Bazar (July 2022)

At any given time, multiple assessments are underway to inform the humanitarian response in Cox’s Bazar, Bangladesh, where more than 929,000 Rohingya have sought refuge since 2017. However, data is lacking on the unique needs, preferences, and perceptions of persons with disabilities. A series of workshops with the Age and Disability Working Group (ADWG) identified the need to know how people with disabilities – both in camps and in host communities – feel about the response and their barriers to healthcare access. We hope to identify ‘blind spots’ in programming, help national and international actors deliver more equitable services, inform more inclusive performance indicators, and build trust. In November 2021, Ground Truth Solutions (GTS) and the International Organisation for Migration’s (IOM) Needs and Population Monitoring unit (NPM) conducted qualitative interviews with persons with mobility and vision impairments from Rohingya refugee and host community populations with the aim of better informing and supporting agencies in developing disability-inclusive programmes and engagement activities. In line with our findings that “who asks the questions” can bias responses, 1 NPM mobilised a Bangladeshi–Rohingya enumerator team. Three days of specialised training included input from ADWG technical experts on disability-inclusive communication. This report’s ‘user journeys’ involve seven composite personas - fictional characters derived from 33 semi-structured interviews - which help establish a narrative of people’s lived experiences. Given available resources, the nature of this approach, and the prevalence of different types of disabilities, we focused on people with mobility and vision impairments.

Key findings

• People with disabilities face significant barriers in using feedback mechanisms. They worry that providing feedback will affect them negatively, or won’t be considered.

• There is widespread confusion over aid eligibility requirements, support groups, and care options.

• Although Covid-19 messaging is widespread, dangerous rumours persist about what happens to those who seek treatment.

• Spirituality and traditional beliefs influence people’s decision-making around healthcare. This highlights the importance of religious leaders in communication.

• Costs are prohibitive and facilities lack the reasonable accommodation and supplies necessary for people with disabilities or long-term illnesses.

• Precarious terrain is a barrier to healthcare access.