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Unrest in Myanmar in August 2017 resulted in the movement of over 700,000 Rohingya refugees to overcrowded camps in Cox's Bazar, Bangladesh. A large outbreak of diphtheria subsequently began in this population. Data were collected during mass vaccination campaigns (MVCs), contact tracing activities, and from 9 Diphtheria Treatment Centers (DTCs) operated by national and international organizations. These data were used to describe the epidemiological and clinical features and the control measures to prevent transmission, during the first 2 years of the outbreak. Between November 10, 2017 and November 9, 2019, 7,064 cases were reported: 285 (4.0%) laboratory-confirmed, 3,610 (51.1%) probable, and 3,169 (44.9%) suspected cases. The crude attack rate was 51.5 cases per 10,000 person-years, and epidemic doubling time was 4.4 days (95% confidence interval [CI] 4.2-4.7) during the exponential growth phase. The median age was 10 years (range 0-85), and 3,126 (44.3%) were male. The typical symptoms were sore throat (93.5%), fever (86.0%), pseudomembrane (34.7%), and gross cervical lymphadenopathy (GCL; 30.6%). Diphtheria antitoxin (DAT) was administered to 1,062 (89.0%) out of 1,193 eligible patients, with adverse reactions following among 229 (21.6%). There were 45 deaths (case fatality ratio [CFR] 0.6%). Household contacts for 5,702 (80.7%) of 7,064 cases were successfully traced. A total of 41,452 contacts were identified, of whom 40,364 (97.4%) consented to begin chemoprophylaxis; adherence was 55.0% (N = 22,218) at 3-day follow-up. Unvaccinated household contacts were vaccinated with 3 doses (with 4-week interval), while a booster dose was administered if the primary vaccination schedule had been completed. The proportion of contacts vaccinated was 64.7% overall. Three MVC rounds were conducted, with administrative coverage varying between 88.5% and 110.4%. Pentavalent vaccine was administered to those aged 6 weeks to 6 years, while tetanus and diphtheria (Td) vaccine was administered to those aged 7 years and older. Lack of adequate diagnostic capacity to confirm cases was the main limitation, with a majority of cases unconfirmed and the proportion of true diphtheria cases unknown. To our knowledge, this is the largest reported diphtheria outbreak in refugee settings. We observed that high population density, poor living conditions, and fast growth rate were associated with explosive expansion of the outbreak during the initial exponential growth phase. Three rounds of mass vaccinations targeting those aged 6 weeks to 14 years were associated with only modestly reduced transmission, and additional public health measures were necessary to end the outbreak. This outbreak has a long-lasting tail, with Rt oscillating at around 1 for an extended period. An adequate global DAT stockpile needs to be maintained. All populations must have access to health services and routine vaccination, and this access must be maintained during humanitarian crises.

Rohingya- the Forcibly Displaced Myanmar Nationals (FDMN)- are largely characterized by a high total fertility rate (TFR) and a low contraceptive prevalence rate. This study aimed to explore the reasons behind their high fertility behavior by utilizing the Theory of Planned Behavior. We adopted a cross-sectional qualitative research approach. Fifteen semi-structured, face-to-face in-depth interviews were conducted with the Rohingya husbands, wives, and community leaders (Majhi and Imam/Khatib) living in Camps 1 and 2 of Ukhiya Refugee Camp, Cox's Bazar, Bangladesh. We analyzed the qualitative data using the thematic analysis approach. The Muslim-majority FDMN predominantly constructed the fertility outcome as the will and order of Allah. On the one hand, the Rohingya parents highlighted various religious, political, economic, and social advantages of having more children, especially sons. On the other hand, beliefs about religious restriction, fear of side effects, and community pressure against contraception sustained the reality of the low contraceptive prevalence rate in the community. Alarmingly, the Rohingya religious leaders and mass people were found highly politically motivated to continue the practice of high fertility with a view to 'expanding the Rohingya community' or 'to increase Muslim soldiers', so that they may fight back and take control of their ancestors' place in Myanmar in the future. Furthermore, these pronatalist attitudes and beliefs translated into high TFR through various high-fertility-supportive social norms and practices widely prevalent in the Rohingya community. These include child marriage, gendered division of labor, women's subordinate nature, the Purdah system, and joint-family members' support during childbirth and rearing. Religion, ethnic identity, and the unique political context and experiences of the Rohingya people jointly explain their high fertility behavior. This study warrants the urgency of initiating social and behavior change communication programs to change the religiopolitically-motivated high-fertility notions that prevailed in the Rohingya community.

Background: Food security and access to healthcare are crucial determinants of health, but their impact on chronic disease risk among forcibly displaced populations is understudied. This study delves into the relationship between food security, accessibility to healthcare services, and chronic disease risk among Rohingya refugees in Bangladesh. Methods: Drawing from a nationally representative cross-sectional survey, this research investigates how the availability of food, accessibility to healthcare facilities, and utilization of services impact the likelihood of chronic diseases within this marginalized population. Using a cross-sectional survey collated from the UNHCR 2020 Joint Multi-Sector Needs Assessment survey, we deployed a series of multivariate logistic regression models to examine the relationship between food security, healthcare proximity, chronic disease, and sociodemographic characteristics. Results: Food security significantly decreased the risk of chronic diseases (OR = 0.65, 95% CI: 0.43, 0.98). Living far from healthcare facilities increased the risk (OR = 1.63, 95% CI: 1.03, 2.54). Conclusion: This study’s findings underscore the urgent need for targeted interventions aimed at enhancing food security and improving healthcare accessibility to alleviate the burden of chronic diseases among Rohingya refugees. By identifying key social determinants and barriers to healthcare access, this research equips policymakers with evidence-based strategies to design targeted interventions that improve nutrition, healthcare delivery, and chronic disease management for displaced populations.

Background The Rohingya refugee crisis in Bangladesh continues to outstrip humanitarian resources and undermine the health and security of over 900,000 people. Spatial, sector-specific information is required to better understand the needs of vulnerable populations, such as women and girls, and to target interventions with improved efficiency and effectiveness. This study aimed to create a gender-based vulnerability index and explore the geospatial and thematic variations in gender-based vulnerability of Rohingya refugees residing in Bangladesh by utilizing pre-existing, open source data. Methods Data sources included remotely-sensed REACH data on humanitarian infrastructure, United Nations Population Fund resource availability data, and the Needs and Population Monitoring Survey conducted by the International Organization for Migration in October 2017. Data gaps were addressed through probabilistic interpolation. A vulnerability index was designed through a process of literature review, variable selection and thematic grouping, normalization, and scorecard creation, and Pareto ranking was employed to rank sites based on vulnerability scoring. Spatial autocorrelation of vulnerability was analyzed with the Global and Anselin Local Moran’s I applied to both combined vulnerability index rank and disaggregated thematic ranking. Results Of the settlements, 24.1% were ranked as ‘most vulnerable,’ with 30 highly vulnerable clusters identified predominantly in the northwest region of metropolitan Cox’s Bazar. Five settlements in Dhokkin, Somitapara, and Pahartoli were categorized as less vulnerable outliers amongst highly vulnerable neighboring sites. Security- and health-related variables appear to be the most significant drivers of gender-specific vulnerability in Cox’s Bazar. Clusters of low security and education vulnerability measures are shown near Kutupalong. Conclusion The humanitarian sector produces tremendous amounts of data that can be analyzed with spatial statistics to improve research targeting and programmatic intervention. The critical utilization of these data and the validation of vulnerability indexes are required to improve the international response to the global refugee crisis. This study presents a novel methodology that can be utilized to not only spatially characterize gender-based vulnerability in refugee populations, but can also be calibrated to identify and serve other vulnerable populations during crises.

\"Rohingya Muslims escaping the violence in their homeland of Myanmar are now so desperate that some are trying to swim to safety in neighboring Bangladesh. In just a week, more than three dozen boys and young men used cooking oil containers like life rafts to swim across the mouth of the Naf River and wash up ashore in Shah Porir Dwip, a fishing town and cattle trade spot.\" (Associated Press) Read more about Rohingya Muslims fleeing Myanmar.

The decree ordered the government of Myanmar to comply with several directives: to take measures to prevent genocide against the Rohingya people; to ensure that its military refrain from acts prohibited by the Genocide Convention; and to preserve evidence and submit a report to the court within four months, detailing compliance with the court's order. The unanimous decision by the fifteen-judge court represented only the third time that the Genocide Convention has been invoked before the World Court in a contentious case-and the first case ever to consider the claims, under the Convention, of non-contiguous, non-warring countries. Gambia was permitted to bring its case against Myanmar to the World Court-a civil, not criminal court-because both nations are parties to the Genocide Convention, which explicitly gives the court jurisdiction to resolve any disputes between state parties relating to \"the interpretation, application, or fulfilment of the Convention.\" The January order, technically referred to as \"provisional measures,\" was intended to \"protect the rights claimed by The Gambia while the underlying case proceeds on the merits.\" Because Myanmar is a party to the Genocide Convention of 1948, the court's order essentially requires Myanmar \"to take all measures within its power to prevent the commission of all acts\" prohibited by that Convention.