Unmet need for health care services among Rohingya Refugees living in Cox’s Bazar and Bhasan Char in Bangladesh

Rohingya refugees in Bangladesh face major healthcare challenges, and access to services to those relocated to Bhasan Char is a growing global concern. This study explores the prevalence of unmet healthcare needs across physical and mental health conditions among Rohingya refugees, compare variations between camps in Cox's Bazar and Bhasan Char, and identifies key determinants of unmet healthcare needs overall and by camp location. We analyzed data from 11,421 individuals using two surveys: the 2023 Bhasan Char Needs Assessment and the 2024 Joint Multi-Sectoral Needs Assessment (J-MSNA) in Cox's Bazar, both conducted using similar procedures. The outcome variable was unmet healthcare needs (yes vs no), and explanatory variables included age, sex, disability level, age of household head, household size, distance to the nearest health facility from home, and mode of travel to healthcare facilities. Multivariable logistic regression models were used to explore the associations between the outcome and explanatory variables. We found approximately 10% of Rohingya refugees reported unmet healthcare needs, with the highest unmet needs observed for acute illnesses (80%), followed by preventive care (18.3%), chronic conditions (14.7%), and trauma care (4.8%). Significant variation was observed within Cox's Bazar's camps, with refugees in Teknaf camps having a 25% (aOR: 1.25; 95% CI: 1.07-1.46) higher odds of unmet healthcare needs compared to those in Ukhiya camps. Key determinants of unmet healthcare needs include older age, moderate to severe disabilities, and larger household size. No significant differences in unmet healthcare needs were found between residents of Cox's Bazar and Bhasan Char. These findings highlight that, although overall differences between Bhasan Char and Cox's Bazar were not evident, substantial inequalities exist across camps within Cox's Bazar. This underscores the need for targeted interventions, particularly in Teknaf camps, and tailored strategies to support vulnerable groups such as those living with disabilities.