Improved water, sanitation and hygiene (WASH) facilities in water-scarce areas is one of the most important barriers to improving the standards of people's life, which is even worse in a locality with forcibly displaced people (e.g., nearly 1 million Rohingya refugees in Bangladesh). In attempting to understand the extent of vulnerability and risks of WASH facilities, their impacts, and adaptive practices in the communities, an exploratory study has been carried out in five selected camps (13, 15, 16, 24 and 27) in Cox's Bazar, Bangladesh. Examination of water facilities shows that households in camps 13, 15 and 16 suffered from an adequate supply of water during summer as there is no direct access to surface water from adjacent water reservoirs, while camps 24 and 27 have such facilities. The frequency of water shortage for drinking purposes in camps 13, 15 and 16 was not so severe as in camps 24 and 27. Drinking water collectors had to spend 3–5 h in queues. All latrines were communal/shared latrines, which made users feel uncomfortable and vulnerable. This study implies that WASH facilities need to be reinforced, and community sensitization on WASH behavior needs to be strengthened to reduce WASH-related health hazards.

  • WASH facilities and their impacts on households (HHs) of forcibly displaced Myanmar nationals in five Rohingya camps were investigated.

  • HHs in three camps were satisfied, while HHs in two camps raised concerns about water distribution centers.

  • Water shortages for drinking or other purposes are severe in all camps.

  • HHs raised alarms about the feasibility of latrines for women, children, the elderly and people with disabilities.

Access to safe and sustainable drinking water facilities, improved sanitation systems and an adequate supply of water for the maintenance of hygiene are fundamental challenges worldwide (Gleeson et al. 2012; Ritchie & Roser 2021). Globally, 1.1 billion people lack access to water facilities, 2.2 billion people do not have basic sanitation facilities and 4 billion people face water scarcity at least one month per year (Mekonnen & Hoekstra 2016; WWF 2020). The lower and lower-middle-income countries are the worst sufferers of adequate safe drinking water and improved sanitation and hygiene facilities (WHO & UNICEF 2017). The lack of safe drinking water, sanitation and hygiene (WASH) facilities is considered one of the most important barriers to improving the quality and standards of people's lives (WHO 2015). Globally, over 1.2 million deaths yearly are caused by unsafe water, 0.77 million deaths result from hazardous sanitation and 0.7 million deaths are caused by lack of access to handwashing facilities (Ritchie & Roser 2021). Even WASH facilities are worst in localities with forcibly displaced people because of overcrowding and limited water supply. Globally, the vast majority of refugees and forcibly displaced populations live in developing countries. For example, over 50% of refugees live in seven countries (Turkey, Lebanon, Jordan, Pakistan, Iran, Ethiopia and Kenya) (World Bank 2016).

Bangladesh, a lower-middle-income country, has seen a large inflow of Rohingya individuals fleeing violence in Myanmar. Nearly 1 million Rohingya refugees have fled to Bangladesh to date due to the brutal attacks by the Myanmar army and Buddhist vigilantes (UNHCR 2020). Joint Response Programme (JRP) 2019 stated that a violent crackdown in Myanmar in August 2017 resulted in the deaths of thousands of Rohingya Muslims, prompting a huge migration of roughly three-quarters of a million to Bangladesh. While the Rohingyas are officially considered ‘de jure stateless’, the Bangladeshi government recognizes them as ‘Forcibly Displaced Myanmar Nationals’. Bangladesh government hosted those stateless Rohingya people in the hilly area of Cox's Bazar District. The majority of displaced Rohingyas have taken up residence in Ukhia and Teknaf regions in Cox's Bazar district, where 6,000 acres of hills and woods have been cleared to offer temporary housing (JRP 2019). Nearly 1 million Rohingyas are currently staying in 34 camps, including the two officially recognized camps of Kutupalong and Nayapara (Milton et al. 2017).

WASH facilities are limited to Rohingya camps due to overcrowding and limited availability of surface and subsurface water. Many water-borne health hazards have already been recorded in some camps. For instance, in a study, it has been shown that 13% of samples were found positive for hepatitis B and 9% of samples tested positive for hepatitis C (Mazhar et al. 2021), which are considered water-borne diseases largely resulting from the unsafe and inadequate WASH facilities. The deaths caused by inadequate WASH facilities are highest in lower and lower-middle countries (WHO 2015). The water-related problems in the Rohingya camps have also been reported in a recent study (Mahmud et al. 2019; Jeffries et al. 2021). These studies reported that 74% (n = 4,644) and 34.7% (n = 2,179) of drinking water samples collected from stored household sources contained fecal coliform and Escherichia coli, respectively. Tubewells water was also found contaminated with these two pathogens. For example, 28% (n = 893) and 10.5% (n = 333) of drinking water samples collected from the tubewells in 21 Rohingya camps contained fecal coliform and E. coli, respectively (Mahmud et al. 2019). Mahmud et al. (2019) also reported that over 80% of point-of-use (household) water samples of nearly one-third of their studied camps (i.e., camps 3, 4, 6, 9, 31 and 34) contained fecal coliforms.

The presence of pathogenic microorganisms in both surface and groundwater has raised concerns among the responsible departments of Bangladesh government (e.g., Department of Public Health and Engineering, Ministry of Health, etc.), international organizations (e.g., Handicap International), donor agencies (e.g., UNICEF), local and national NGOs, media and the civil society. These WASH-related problems may trigger the outbreak of chronic diseases among the Rohingya community in the future if adequate measures are not taken to improve the quality of water. As it has been reported in many previous studies that the Rohingya refugees have been suffering from water-related problems (Mahmud et al. 2019; Jeffries et al. 2021; Mazhar et al. 2021), it is thus important to understand the extent and magnitude of WASH-related issues in these camps, which will provide necessary guidance to the organizations working in the camps and will contribute to the literature for further academic research.

In this study, 5 out of 34 Rohingya camps were considered with a view to assessing the existing status of WASH facilities, practices and vulnerabilities, which may provide evidence to the government departments, donor agencies, I/NGOs and policymakers for taking necessary management plans and amendment of existing plans.

The specific objectives of the study are given below:

  • to assess the extent of WASH vulnerability due to limited space and high population density in the selected five Rohingya camps and

  • to explore the mechanism of WASH risk assessment and the impact of WASH facilities on the Rohingya community.

Description of Rohingya camps

The Rohingya camps in Bangladesh house a significant population of Rohingya communities who fled violence and persecution in Myanmar (Alam et al. 2020). These camps, primarily located in Cox's Bazar district, are home to a large number of forcibly displaced individuals and families. As of June 2023, the total population in the camps was estimated to be over 1.1 million. According to a joint assessment in 2021 conducted by the United Nations High Commissioner for Refugees (UNHCR) and the International Organization for Migration (IOM), approximately 52% of the Rohingya refugees are female, while 48% are male. Around 54% of the refugee population consists of children under the age of 18. The average household size is estimated to be around 5.5 individuals. According to UNHCR, around 55% of Rohingya children aged 3–14 years have access to primary education, while only 17% of adolescents aged 15–18 years have access to secondary education. The majority of Rohingya communities in the camps are dependent on humanitarian assistance for their basic needs (JRP 2019). Limited livelihood opportunities exist within the camps, and they face restrictions on freedom of movement and employment outside the camps. Within the camps, some Rohingya engage in informal economic activities to sustain their livelihoods. These activities include small-scale trading, manual labor and informal services. The camps consist of makeshift shelters constructed from bamboo, tarpaulins and other locally available materials. These shelters are often densely packed, providing minimal privacy and protection from the elements (JRP 2022). Medical services are provided through health clinics and facilities established by humanitarian organizations within the camps. These facilities offer basic healthcare services, including primary healthcare, emergency care and reproductive health services. However, the capacity and resources of these facilities are often stretched due to the large population and limited infrastructure. The camps have a network of pathways and dirt roads that connect different sections of the camps. These pathways are often narrow and can become muddy and challenging to navigate during the monsoon season. Access to electricity within the camps is limited. Some areas have solar-powered streetlights and charging stations, while individual households often rely on small-scale solar panels or battery-powered devices for basic lighting and charging needs. Telecommunication networks and internet connectivity have expanded within the camps, providing some level of communication and access to information for the Rohingya community (UNHCR 2019).

Study area

The study was conducted in five Rohingya camps (camps 13, 15, 16, 24 and 27) located in two sub-districts (Ukhiya and Teknaf) of Cox's Bazar district in Bangladesh (Figure 1). As of 30 April 2020, the total population in camp 13 was 41,610, in camp 15 it was 49,593, in camp 16 it was 20,859, in camp 24 it was 26,206, and in camp 27 it was 14,921 (JGB 2020).
Figure 1

The five studied camps in two sub-districts (camps 13, 15 and 16 at Ukhiya and camps 24 and 27 at Teknaf) in Cox's Bazar district of Bangladesh.

Figure 1

The five studied camps in two sub-districts (camps 13, 15 and 16 at Ukhiya and camps 24 and 27 at Teknaf) in Cox's Bazar district of Bangladesh.

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Data collection

The study employed a mixed methodology, combining qualitative and quantitative research approaches, to gather information from various stakeholders, including the Rohingya community, NGO representatives, and government officials from relevant departments. This mixed methodology allows for a comprehensive understanding of WASH status by capturing both qualitative insights and quantitative data.

Qualitative data

A qualitative assessment was done to get more detailed and accurate information from the community representatives, Government departments, WASH Sector Platform, etc. In all cases, various Participatory Rural Appraisal (PRA) tools and techniques, namely focus group discussion (FGD) and key informant interview (KII) were used (Rahman et al. 2014).

Focus group discussion

Two FGDs were conducted in two sub-districts (Supplementary Figure S1) and each FGD had 12 participants (Supplementary Table S1). The participants in FGDs were the community people inside the camp, including the block leader (also called Majhi). Each FGD was 45 min long. FGD had four sections. In Section 1, respondents' basic information such as age, sex and household information (e.g., are there any pregnant women, elderly and children under 5 years) was recorded. In Section 2, WASH-related information, including the sources of drinking water, latrine facility, bathing cubicles and drainage system, was noted. Section 3 consists of sanitation, health and hygiene-related issues. In the final section, WASH-related vulnerability was discussed by asking several health-associated questions (Supplementary Section 1).

Key informant interview

Ten KIIs were conducted in the camps, sub-district and district levels (Supplementary Table S1). The KIIs include five Camps in Charge who are government representatives, two I/NGO representatives, two Primary Health Care (PHC) centers, and one WASH Sector Coordinator of Inter Sector Coordination Group (ISCG) (Supplementary Figure S2). Using the selected questionnaire, the required information, including the WASH facility, problems and challenges, etc., was obtained (Supplementary Section 2).

Direct observations of WASH infrastructure

A considerable number of environmental observations of WASH facilities (e.g., water supply source point operated by NGOs) were recorded to supplement the findings of the household survey, FGDs and KIIs (Supplementary Figure S3).

Quantitative data

The quantitative data were collected from the respondents of 195 households in five camps (Table 1) using a semi-structured questionnaire survey (Supplementary Figure S4). Addressing the study objectives, 32 questions were included in the questionnaire (Supplementary Section 3) that covered existing WASH facilities (e.g., drinking water sources), accessibility of latrines for the community (e.g., pregnant women and elderly), hygiene facilities (e.g., sanitary waste disposal), awareness level on hygiene (e.g., hygiene kit) and WASH vulnerability (e.g., health hazards).

Table 1

Characteristics and distribution of study participants in five Rohingya camps (camps 13, 15 and 16, in Ukhiya sub-district and camps 24 and 27 in Teknaf sub-district) in Cox's Bazar district

CharacteristicsIndicatorCamp 13Camp 15Camp 16Camp 24Camp 27
Age Average (years) 28.2 30.2 25.5 28.2 35.3 
Gender Male (%) 55.77 54.84 51.85 48.57 55 
Female (%) 44.23 45.16 48.15 51.43 45 
Household member Average number 7.3 7.9 7.1 8.1 5.4 
Total households Total number 8,796 10,478 4,477 5,778 3,250 
Surveyed households Number 52 61 27 35 20 
CharacteristicsIndicatorCamp 13Camp 15Camp 16Camp 24Camp 27
Age Average (years) 28.2 30.2 25.5 28.2 35.3 
Gender Male (%) 55.77 54.84 51.85 48.57 55 
Female (%) 44.23 45.16 48.15 51.43 45 
Household member Average number 7.3 7.9 7.1 8.1 5.4 
Total households Total number 8,796 10,478 4,477 5,778 3,250 
Surveyed households Number 52 61 27 35 20 

Respondents’ characteristics

The average age of the respondents across the five camps ranged from 25 to 35 years (Table 1). The average age of the participants is 28.2 years in camps 13 and 24, 30.2 years in camp 15, 25.5 years in camp 16 and 35.3 years in camp 27. Both males and females were considered for the interview. Thus almost equal representation of male and female were ensured, although male participants were slightly higher in camp 13 (56%), camp 15 (55%) and camp 27 (55%). The average number of household members was 7.3, 7.9, 7.1, 8.1 and 5.4 in camps 13, 15, 16, 24 and 27, respectively (Table 1). The number of surveyed households was 52 in camp 13, 61 in camp 15, 27 in camp 16, 35 in camp 24 and 20 in camp 27 (Table 1).

Data processing and analysis

Pearson's Chi-square test was used to determine if there is a significant association between different categorical variables in the five studied camps (McHugh 2013). The ‘vcd’ package was used for performing visualizations and statistical analysis. The p-value, degree of freedom (df) and X-squared values were obtained for each category.

The qualitative data from the FGD and KII were analyzed using thematic content analysis (Hossain et al. 2023). A systematic coding process was applied to identify the key themes emerging from the data. The 10 most mentioned themes, as reported, were used as a basis for coding. Each theme, such as water collection time and handwashing after toilet, was assigned a unique code or label. The categorized data segments were analyzed to identify patterns, commonalities and variations within and across the themes. The authors examined the data to understand the participants' concerns, perspectives and key issues related to each theme. The findings of the analysis were summarized and presented in a clear and concise manner. The 10 most uttered themes were reported to highlight the participants' concerns regarding WASH conditions in the selected camps.

In order to validate our survey findings, the SPHERE indicators were used. SPHERE indicators provide a standardized framework for assessing and monitoring WASH interventions in humanitarian settings (Frison et al. 2018). Using the survey data, the satisfaction of the Rohingya community was categorized into five classes, ranging from high concern to high satisfaction. Then, the findings were compared with SPHERE indicators. For example, according to SPHERE indicators, each person needs 15 liters of water per day, water collection time for a round trip should be ≤30 min and <20 users per latrine. A total of six categories, including water supply, sanitation, hygiene, excreta disposal, hygiene promotion and water management, were considered in our study. Each category contains multiple indicators. For example, the water quantity, water quality and collection time indicators were considered under the water supply category. Based on these categories and indicators, the overall situation of WASH from the community perspective was portrayed for the five camps.

Ethical statement

Free and informed consent of the participants or their legal representatives was obtained, and the study protocol was approved by the Ethical Review Committee for the Protection of Human Participants by the Khulna University, Khulna, Bangladesh, MDS182102 on 31 August 2021.

Access to improved water sources

Type and status of water facility

Irrespective of camps, all surveyed household respondents (100%) use piped water throughout the year. Piped water comes from either ground or surface water reservoir (e.g., river or pond) and is purified by the authority (e.g., NGOs) before being distributed to the households (Figure 2). During the monsoon season, 100% of households collect rainwater and utilize it for their domestic use (Figure 2). A considerable number of households store rainwater in earthen pots, plastic buckets and plastic bottles. As camps 24 and 27 have the facility of the surface water reservoir, a substantial number of households (83% in camp 24 and 85% in camp 27) also collect pond water during the limited water supply from the piped water. The other three camps (i.e., camps 13, 15 and 16) have no surface water facility. The results indicate that the indicators in both the type of water facility and water facility status questions show a significant association with other variables (both p < 0.001, Table 3). None of the five camps have the facility of dug wells, and few households have the tubewell facility (Table 2). When collection time is considered, it is observed that the water supply facility in camps 13, 15 and 16 was comparatively better than in camps 24 and 27. However, these three camps (camps 13, 15 and 16) had no other water facilities except rainwater harvesting compared to camps 24 and 27, which have pond water facilities (Table 2).
Table 2

The types (e.g., surface and subsurface water) and status (e.g., improved, the requirement of less collection time) of water sources in the studied camps

QuestionIndicatorCamp 13 (n = 52)Camp 15 (n = 61)Camp 16 (n = 27)Camp 24 (n = 35)Camp 27 (n = 20)
Type of water facility Tubewell 15.38 22.58 18.52 17.14 15 
Dug well 
Pond, surface water 82.86 85 
Rainwater 100 100 100 100 100 
Bottle water by INGO 
Piped water 100 100 100 100 100 
Water facility status Water facility improved and treated 
Improved and collection time less than 30 min 100 100 100 
Improved collection time by more than 30 min 100 100 
Unimproved water source 
Surface water 82.86 85 
QuestionIndicatorCamp 13 (n = 52)Camp 15 (n = 61)Camp 16 (n = 27)Camp 24 (n = 35)Camp 27 (n = 20)
Type of water facility Tubewell 15.38 22.58 18.52 17.14 15 
Dug well 
Pond, surface water 82.86 85 
Rainwater 100 100 100 100 100 
Bottle water by INGO 
Piped water 100 100 100 100 100 
Water facility status Water facility improved and treated 
Improved and collection time less than 30 min 100 100 100 
Improved collection time by more than 30 min 100 100 
Unimproved water source 
Surface water 82.86 85 
Table 3

Results of Chi-square tests for categorical variables

Categoryp-valueDegree for freedomX-squared
Type of water facility <0.001 12 214 
Water facility status <0.001 667 
Member who collects drinking water <0.05 16 28 
Frequency of water shortage for drinking purposes <0.001 12 558 
Frequency of water shortage for other purposes <0.001 12 573 
Fulfillment of water needs for drinking purposes <0.001 29 
Type of latrine household access <0.05 18 
Protection (e.g., door lock, undamaged door) <0.001 169 
Location of latrine <0.001 326 
Availability of water supply in latrine >0.05 
Availability of soap and handwashing in the latrine >0.05 
Person uses one latrine <0.001 16 780 
Disposal of excreta from the latrine >0.05 
Categoryp-valueDegree for freedomX-squared
Type of water facility <0.001 12 214 
Water facility status <0.001 667 
Member who collects drinking water <0.05 16 28 
Frequency of water shortage for drinking purposes <0.001 12 558 
Frequency of water shortage for other purposes <0.001 12 573 
Fulfillment of water needs for drinking purposes <0.001 29 
Type of latrine household access <0.05 18 
Protection (e.g., door lock, undamaged door) <0.001 169 
Location of latrine <0.001 326 
Availability of water supply in latrine >0.05 
Availability of soap and handwashing in the latrine >0.05 
Person uses one latrine <0.001 16 780 
Disposal of excreta from the latrine >0.05 
Figure 2

Type of water facility: piped water supply (top left), rainwater harvesting at household level (top right), pond water in camp 27 (bottom left) and tubewell in camp 24 (bottom right). Photo credit: Khusnur Jahan Shapna.

Figure 2

Type of water facility: piped water supply (top left), rainwater harvesting at household level (top right), pond water in camp 27 (bottom left) and tubewell in camp 24 (bottom right). Photo credit: Khusnur Jahan Shapna.

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Accessibility of water facility and understanding of water quality test

All the surveyed participants at the household level in camps 16, 24 and 27 stated that their water facility is located on the plain land, while the water facility in camps 13 and 15 is placed in slightly upland/moderately sloped areas. Sometimes, it is difficult for the children, elderly and people with disabilities (PWD) to collect water from the source point in camps 13 and 15, as the location of water facilities in these two camps is slightly upland/slope land. When water quality test status was considered, 100% of participants in each camp said they did not know whether their water quality test was conducted or not (Supplementary Table S2).

Drinking water collection and availability

The household survey results reveal significant associations between the indicators in the respective questions studied (all p < 0.05, Table 3). The different indicators under the respective questions, including the member who collects drinking water, frequency of water shortage for drinking purposes, frequency of water shortage for other purposes and fulfillment of water needs for drinking purposes, all demonstrate statistically significant associations among them (Table 3). Household survey results show that the vast majority of the persons responsible for drinking water collection were the girls across the camps. For example, 75% of girls in camp 13, 63% in camp 15, 52% in camp 16, 66% in camp 24 and 55% in camp 27 were drinking water collectors from the supply source points. Moreover, on many occasions, female and elderly people also collect water in all the camps (Table 4; Supplementary Figure S5). The majority of the participants reported that they get less water than their daily requirement. Nearly 68% of households in camp 15 and 74% in camp 16 faced a shortage of drinking water once a week. In camp 13, three in four households (75% of the participants) suffered from drinking water shortage twice a week. The drinking water shortage in camps 24 and 27 was even more compared to the other three camps. A substantial number of households also faced drinking water shortages almost every day (13.46, 17.74 and 7.41% of households in camps 13, 15 and 16, respectively) (Table 4). In order to meet the water demand during the drinking water shortage, the vast majority of the households stated they take water from neighboring households. Some households also said they do not know how they fulfill drinking water demand, and some said they take less drinking water during the shortage period. Each household in camps 13 and 15 spent approximately 4 h collecting drinking water. The drinking water collection time in camps 24 and 27 was higher (approximately 5 h) compared to other camps (Table 4).

Table 4

The surveyed household respondents' perceptions of water availability for drinking and other purposes

QuestionIndicator (%)Camp 13 (n = 52)Camp 15 (n = 61)Camp 16 (n = 27)Camp 24 (n = 35)Camp 27 (n = 20)
Member who collects drinking water Children (Boys) 1.92 3.23 7.41 2.86 
Children (Girls) 75. 62.90 51.85 65.71 55 
Male 1.92 4.84 3.70 5.71 10 
Female 15.38 22.58 18.52 17.14 15 
Elderly person (male/female/both) 5.77 4.84 14.81 5.71 10 
PWD (male/female/both) 1.61 3.70 2.86 
Availability of water for drinking and other purposes Don't know 
Yes 17 15 11 15 
No 83 95 85 89 85 
Frequency of water shortage for drinking purposes Almost everyday 13.46 17.74 7.41 82.86 85.00 
Twice a week 75.00 8.06 14.81 8.57 15.00 
Once in a week 7.69 67.74 74.07 8.57  0 
Bi-monthly 3.85 6.45 3.70  0  0 
Monthly  0  0  0  0  0 
Frequency of water shortage for other purposes Almost everyday 15.38 9.68 3.70 85.71 90 
Twice a week 78.85 9.68 11.11 14.29 10 
Once in a week 5.77 75.81 85.19 
Bi-monthly 4.84  0 
Monthly  0  0  0  0  0 
Fulfillment of water needed for drinking purposes Don't know 11.53 17.74 11.11 31.43 
Get from neighbor 88.46 82.26 88.89 68.57 85 
Buy bottled water 
Exchange water with other goods 
No management 10 
Required time for drinking water collection Time spend (approximate hours) 
QuestionIndicator (%)Camp 13 (n = 52)Camp 15 (n = 61)Camp 16 (n = 27)Camp 24 (n = 35)Camp 27 (n = 20)
Member who collects drinking water Children (Boys) 1.92 3.23 7.41 2.86 
Children (Girls) 75. 62.90 51.85 65.71 55 
Male 1.92 4.84 3.70 5.71 10 
Female 15.38 22.58 18.52 17.14 15 
Elderly person (male/female/both) 5.77 4.84 14.81 5.71 10 
PWD (male/female/both) 1.61 3.70 2.86 
Availability of water for drinking and other purposes Don't know 
Yes 17 15 11 15 
No 83 95 85 89 85 
Frequency of water shortage for drinking purposes Almost everyday 13.46 17.74 7.41 82.86 85.00 
Twice a week 75.00 8.06 14.81 8.57 15.00 
Once in a week 7.69 67.74 74.07 8.57  0 
Bi-monthly 3.85 6.45 3.70  0  0 
Monthly  0  0  0  0  0 
Frequency of water shortage for other purposes Almost everyday 15.38 9.68 3.70 85.71 90 
Twice a week 78.85 9.68 11.11 14.29 10 
Once in a week 5.77 75.81 85.19 
Bi-monthly 4.84  0 
Monthly  0  0  0  0  0 
Fulfillment of water needed for drinking purposes Don't know 11.53 17.74 11.11 31.43 
Get from neighbor 88.46 82.26 88.89 68.57 85 
Buy bottled water 
Exchange water with other goods 
No management 10 
Required time for drinking water collection Time spend (approximate hours) 

Access to improved sanitation practices

Comfortability of the use of latrine

More than three-quarters of the household respondents in each camp used pit latrines with water seals, which ranged between 75% in camp 27 and 85% in camp 13 (Table 5) and different indicators under type of latrine household access across camps exhibited significant association (p < 0.001, Table 3). A small number of participants in all camps (varied between 11% in camp 24 and 23% in camp 15) mentioned that they use the toilet with septic tanks and water seals. None of the participants in any camps used a pit latrine without a water seal and bio-fill toilet (Table 5). Each respondent in five camps indicated that there is no segregation of latrines for males and females. Although in the direct observation, it was observed that there is a clear indication of ‘Female Toilet’ and ‘Male Toilet’, people do not follow the instructions as there is a long waiting time for the usage of the toilet (Figure 3). Participants in all camps also emphasized that the latrines are not friendly to children, elderly and pregnant women (Table 5).
Table 5

The surveyed household respondents’ perceptions of comfortability of the use of latrine

QuestionIndicator (%)Camp 13 (n = 52)Camp 15 (n = 61)Camp 16 (n = 27)Camp 24 (n = 35)Camp 27 (n = 20)
Type of latrine household access I do not know 
Pit latrine with water seal 84.62 77.42 77.78 82.86 75.00 
Pit latrine without water seal 
Toilet with septic tanks and water seal 11.54 22.58 22.22 11.43 20.00 
Bio-fill toilet 
Direct pit latrine 3.85 5.71 5.00 
Others 
Distance of latrine Distance (in feet) 10–15 
Gender defined latrine Don't know 
Yes 
No 100 100 100 100 100 
Feeling uncomfortable and vulnerable using a common latrine Never/I do not feel uncomfortable/vulnerable at all 
Sometimes/slightly low 
Almost always/high 
Always/very high 100 100 100 100 100 
Friendliness of latrine to children, elderly and pregnant women Don't know 
Yes 
No 100 100 100 100 100 
QuestionIndicator (%)Camp 13 (n = 52)Camp 15 (n = 61)Camp 16 (n = 27)Camp 24 (n = 35)Camp 27 (n = 20)
Type of latrine household access I do not know 
Pit latrine with water seal 84.62 77.42 77.78 82.86 75.00 
Pit latrine without water seal 
Toilet with septic tanks and water seal 11.54 22.58 22.22 11.43 20.00 
Bio-fill toilet 
Direct pit latrine 3.85 5.71 5.00 
Others 
Distance of latrine Distance (in feet) 10–15 
Gender defined latrine Don't know 
Yes 
No 100 100 100 100 100 
Feeling uncomfortable and vulnerable using a common latrine Never/I do not feel uncomfortable/vulnerable at all 
Sometimes/slightly low 
Almost always/high 
Always/very high 100 100 100 100 100 
Friendliness of latrine to children, elderly and pregnant women Don't know 
Yes 
No 100 100 100 100 100 
Figure 3

Conditions of the latrines in camp 13 (top). Although these latrines are gender defined, they are not maintained by the households due to a shortage of latrines. This is because in the early morning, people have to wait a long time to use the latrines. Outside view of water drainage from the bathing facility in camp 16 (bottom left) and camp 15 (bottom right). The channel of wastewater from the bathing and washing facilities. Sewerage lines have been found clogged by plastics and other non-degradable waste. Photo credit: Khusnur Jahan Shapna.

Figure 3

Conditions of the latrines in camp 13 (top). Although these latrines are gender defined, they are not maintained by the households due to a shortage of latrines. This is because in the early morning, people have to wait a long time to use the latrines. Outside view of water drainage from the bathing facility in camp 16 (bottom left) and camp 15 (bottom right). The channel of wastewater from the bathing and washing facilities. Sewerage lines have been found clogged by plastics and other non-degradable waste. Photo credit: Khusnur Jahan Shapna.

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Feasibility and safety issues of latrine

The variables ‘person uses one latrine’, ‘location of latrine’ and ‘protection measures’ show significant associations (all p < 0.05), while the variables related to water supply, soap/handwashing and excreta disposal do not exhibit strong relationships across camps (all p > 0.05, Table 3). The majority of the household respondents in camps 13, 15 and 16 (more than 83% of households in respective camps) reported that latrines are well protected, i.e., latrines contain door locks, doors are undamaged or repaired (Table 6). In the case of camps 24 and 27, nearly three-quarters of respondents complained that their latrines were not well managed and thus not protected. It is also noted that the location of the latrines is not ideal for people of all categories (e.g., pregnant women), because most of the latrines are located on top of the hill for camps 13, 15 and 16, and slightly upland area for the camps 24 and 27 (Supplementary Figure S6). However, some latrines in all camps are located on plain land. On average, the distance of the latrine from the nearest water source varies from 4.4 m in camp 24, 5.3 m in camp 27, 5.5 m in camp 16, 7.3 m in camp 15, to 10.4 m in camp 13 (Table 6). The majority of the respondents stated that the distance of the latrine from the water source is not a big concern to them; rather, the pressing problem is the supply of water in the latrine. Likewise, more than 92% of respondents in each camp reported that the availability of soap and handwashing in the latrine was slightly low. Because of the sharing of the latrine among the households, they had to face long waiting times to use the latrine, particularly in the early morning and afternoon. This was also reflected when they were asked about the average waiting time for using latrines. The waiting time to use latrines was lowest (15.4 min) in camp 16 and highest (30.1 min) in camp 24. The waiting time in other camps was 20.1 min in camp 13, 20.3 min in camp 15 and 27.4 min in camp 27 (Table 6).

Table 6

The surveyed household respondents’ perceptions of the feasibility and safety issues of latrine

QuestionIndicator (%)Camp 13 (n = 52)Camp 15 (n = 61)Camp 16 (n = 27)Camp 24 (n = 35)Camp 27 (n = 20)
Protection (e.g., door lock, undamaged door) Don't know 
Yes 84.62 83.87 85.19 28.57 25 
No 15.38 16.13 14.81 71.43 75 
Location of latrine Don't know 
On plain land 11.54 19.35 22.22 17.14 20 
A bit upland/moderately sloped area 7.69 3.23 14.81 82.86 80 
On top of the hill 80.77 77.42 62.96 
Distance of latrine from the nearest water source Distance (in feet) 10.4 7.3 5.5 4.4 5.3 
Availability of water supply in latrine Never/low 
Sometimes/slightly low 94.23 96.77 88.89 97.14 95 
Almost always/high 5.77 3.23 11.11 2.86 
Always/very high 
Availability of soap and handwashing in latrine Never/low 
Sometimes/slightly low 96.15 98.39 92.59 94.29 95 
Almost always/high 3.85 1.61 7.41 5.71 
Always/very high 
Person uses one latrine (in number) 15–22 15–25 20–25 25–28 27–30 
Waiting time to use latrine (in minutes) 20.1 20.3 15.4 30.1 27.4 
Disposal of excreta from latrine Don't know 40.38 41.94 33.33 45.71 40 
Never disposed yet 
Fecal Sludge Management (FSM) by NGO's 59.62 58.06 66.67 54.29 60 
Others 
QuestionIndicator (%)Camp 13 (n = 52)Camp 15 (n = 61)Camp 16 (n = 27)Camp 24 (n = 35)Camp 27 (n = 20)
Protection (e.g., door lock, undamaged door) Don't know 
Yes 84.62 83.87 85.19 28.57 25 
No 15.38 16.13 14.81 71.43 75 
Location of latrine Don't know 
On plain land 11.54 19.35 22.22 17.14 20 
A bit upland/moderately sloped area 7.69 3.23 14.81 82.86 80 
On top of the hill 80.77 77.42 62.96 
Distance of latrine from the nearest water source Distance (in feet) 10.4 7.3 5.5 4.4 5.3 
Availability of water supply in latrine Never/low 
Sometimes/slightly low 94.23 96.77 88.89 97.14 95 
Almost always/high 5.77 3.23 11.11 2.86 
Always/very high 
Availability of soap and handwashing in latrine Never/low 
Sometimes/slightly low 96.15 98.39 92.59 94.29 95 
Almost always/high 3.85 1.61 7.41 5.71 
Always/very high 
Person uses one latrine (in number) 15–22 15–25 20–25 25–28 27–30 
Waiting time to use latrine (in minutes) 20.1 20.3 15.4 30.1 27.4 
Disposal of excreta from latrine Don't know 40.38 41.94 33.33 45.71 40 
Never disposed yet 
Fecal Sludge Management (FSM) by NGO's 59.62 58.06 66.67 54.29 60 
Others 

Insights in WASH from FGD and KII participants

Table 7 provides a snapshot of different WASH aspects, the perspectives of participants and the key issues they highlighted during their discussions or interviews. The discussions and interviews shed light on challenges related to water collection, hand hygiene, rainwater harvesting, gender-segregated toilets, water safety, sanitation practices and infrastructure limitations. Addressing these issues requires a comprehensive approach involving infrastructure improvements, behavior change initiatives, and ongoing monitoring and evaluation to ensure sustainable access to adequate and improved WASH facilities.

Table 7

Key points and perspectives on WASH conditions summarized by the content analysis of qualitative information (i.e., focus group discussion: FGD, and key informant interview: KII) in the studied camps, sub-districts and district

ThemeCategory of the participantAge group (year)GenderHighlighted point
Water collection time FGD 20–30 Female The time spent waiting in line for water affects our ability to efficiently plan and allocate time for these activities. It adds an additional burden to an already demanding routine, leading to delays and compromises in meeting basic household needs. 
Handwashing after toilet FGD 30–40 Female Despite our intention to practice proper hand hygiene after toilet use, we face challenges as the availability of soap is limited. Unfortunately, some users tend to take away the soap provided at the facility points, making it inaccessible to others. 
Rainwater harvest FGD 20–30 Female Filtering of rainwater is done using clothes before storage. Then used for cooking and drinking during the shortage of water availability in summer. 
Gender-segregated toilet FGD 20–30 Female While the toilet facilities are designated for specific genders, adherence to these instructions is not consistently followed, particularly in the morning when there is a high influx of users. The increased number of users during this time led to a disregard for gender-specific designations. 
Water collection problem KII >50 Male The community observed multiple instances of individuals slipping or losing balance while collecting water on slopes during the monsoon season. 
Water contamination KII 40–50 Male Due to improved management practices, the likelihood of water contamination originating from the latrine pit is minimal. 
Water safety KII >50 Male We maintain ongoing monitoring of the distribution networks and ensure that communities receive chlorinated drinking water through communal taps. 
SPHERE standards KII >50 Male During the initial phase of the emergency response, the SPHERE standards are employed, with coverage typically limited to a ratio of 1:50. As resources improve and the response progresses, the ratio is adjusted to 1:20. 
Sanitation KII 30–40 Female Shared facilities result in reduced ownership, impacting the sanitation facility functionality and maintenance due to user irresponsibility. Behavior change in this context takes time, spanning generations, primarily driven by community-led initiatives. 
Water distribution facility KII 30–40 Female Due to limited space within the studied camps, the water distribution points were not relocated to a safer distance. 
ThemeCategory of the participantAge group (year)GenderHighlighted point
Water collection time FGD 20–30 Female The time spent waiting in line for water affects our ability to efficiently plan and allocate time for these activities. It adds an additional burden to an already demanding routine, leading to delays and compromises in meeting basic household needs. 
Handwashing after toilet FGD 30–40 Female Despite our intention to practice proper hand hygiene after toilet use, we face challenges as the availability of soap is limited. Unfortunately, some users tend to take away the soap provided at the facility points, making it inaccessible to others. 
Rainwater harvest FGD 20–30 Female Filtering of rainwater is done using clothes before storage. Then used for cooking and drinking during the shortage of water availability in summer. 
Gender-segregated toilet FGD 20–30 Female While the toilet facilities are designated for specific genders, adherence to these instructions is not consistently followed, particularly in the morning when there is a high influx of users. The increased number of users during this time led to a disregard for gender-specific designations. 
Water collection problem KII >50 Male The community observed multiple instances of individuals slipping or losing balance while collecting water on slopes during the monsoon season. 
Water contamination KII 40–50 Male Due to improved management practices, the likelihood of water contamination originating from the latrine pit is minimal. 
Water safety KII >50 Male We maintain ongoing monitoring of the distribution networks and ensure that communities receive chlorinated drinking water through communal taps. 
SPHERE standards KII >50 Male During the initial phase of the emergency response, the SPHERE standards are employed, with coverage typically limited to a ratio of 1:50. As resources improve and the response progresses, the ratio is adjusted to 1:20. 
Sanitation KII 30–40 Female Shared facilities result in reduced ownership, impacting the sanitation facility functionality and maintenance due to user irresponsibility. Behavior change in this context takes time, spanning generations, primarily driven by community-led initiatives. 
Water distribution facility KII 30–40 Female Due to limited space within the studied camps, the water distribution points were not relocated to a safer distance. 

Comparison of findings with SPHERE indicators

The major findings of this study were categorized into 6 broad classes, which consist of 16 indicators related to WASH. Results show that the water quantity standard (15 liters per person per day) did not meet the SPHERE standard (i.e., the Rohingya community raised mild concern about the water quantity) in all camps (Table 8). Despite the water shortage, ‘drinking water intake’ standard in camps 13, 15 and 16 fulfilled the standard, while camps 24 and 27 did not meet the standard. As water quality was not tested in this study, it is reported as ‘unknown’. Irrespective of camps, water collection time did not fulfill the standard, and was reported as high concern. In the case of sanitation category, latrine cleanliness and gender-segregated facilities standards are reported as mild concerns for all camps and hygiene promotion indicator is reported as ‘satisfied’. Several indicators (e.g., water for handwashing facilities and handwashing knowledge) in the hygiene category showed satisfaction. Open defecation and hygiene promotion access indicators exhibited high satisfaction, while solid waste management and water treatment systems displayed mild concern in all camps. Handwashing facilities using soap were reported as a high concern in all camps (Table 8).

Table 8

Validation of major survey findings by SPHERE indicators in the studied camps

 
 

Water facility

Water source

All the respondents reported that they use piped water, which comes from either surface or subsurface sources. They also harvest rainwater during the monsoon season. However, the households in camps 13, 15 and 16 in Ukhiya sub-district face a water crisis during summer as the supply of piped water is limited, and there are no adjacent water reservoirs (i.e., ponds or river) in these camps. While the other two camps in Teknaf sub-district (i.e., camps 24 and 27) have surface water reservoirs from where the respondents get water supply year-round. Very few households have the tubewell facility in the studied camps, which is consistent with Alam et al. (2020), who studied in four other camps (i.e., camps 4, 18, 22 and 26) and found that in these four camps, ≤15% of households had the water facility from tubewell (Alam et al. 2020). In an FGD in camp 15, two respondents explained that their children suffered from acute jaundice syndrome nearly 2 years ago. According to them, this disease was caused by unsafe drinking water, which was revealed by a recent epidemiological surveillance study (Mazhar et al. 2021), which reported that hepatitis A and E are common in refugee camps. Although respondents in the studied camps explained that during monsoon season they harvest rainwater from their roof, the collected water contains dirt that comes from their roof. However, one female respondent in the FGD in camp 27 stated, ‘I filter the harvested rainwater using clothes before I use the water for cooking and drinking’.

Water facility accessibility

In our selected camps, the location of water supply points in camps 16, 24 and 27 are on plain land. Respondents in these three camps stated that they were happy with the location of the water facility, although there were numerous other problems related to the water facility they pointed out. The participants in camps 13 and 15 explained that their water facility centers are located on slope land, which they found very vulnerable to water collectors. As mostly the children and women used to collect the water, during monsoon, the paths become muddy and not feasible for the children. In a KII with a camp-in-charge in camp 13, the interviewee reported that ‘several incidents (falling down towards slope) had been noticed by the community during water collection time in monsoon season’.

Despite the well-managed water distribution points in all camps, there were latrine pits near the water distribution facility, which is not ideal for drinking water. Irrespective of camps, the distance between water distribution points and the nearest latrine pits ranged from 5 m in camps 24 and 27 to 10 m in camps 13 and 15. This situation was also observed during our field visits to the water facility points in the camps. Although the camp-in-charge in camp 24 during KII stated that ‘there is a less likely of water contamination from the latrine pit’, there may be leakage or overflow during monsoon, which may contaminate the water. The respondents in the studied camps stated that they did not know the water quality test status, and they were not informed by any respective authority about the water test results. However, the KII with WASH Sector Coordinator stated that ‘we continually monitor distribution networks and provide chlorinated drinking water to the communities through communal taps’, thus it can be considered safe for drinking and cooking purposes.

During the FGDs in camps 15 and 27, participants were asked whether they received any water treatment tablets (e.g., chlorine tablets) from the NGOs/government and used them in treating drinking water. Most of the respondents stated that they received tablets but never used them because of fear. They thought that if they put the tablet in drinking water and drink this water, there might be some symptoms in their body (e.g., tattoos will be visible), or they may die. These findings are consistent with Alam et al. (2020), who also found that the Rohingya communities in camps 4, 18, 24 and 26 are afraid of using chlorine tablets.

Water collection responsibility, water availability and transportation time

Irrespective of camps in this study, mostly girls collect the drinking water, followed by women, the elderly and men. These findings are in accordance with previous studies in other camps in Rohingya communities (Hsan et al. 2019; Akhter et al. 2020; Faruque et al. 2021). For example, Akhter et al. (2020) reported that in two camps (camps 2 and extension 4) in Ukhiya sub-district, the responsibility for fetching drinking water is bestowed on women and girls. In a few households, male and elderly people also had to collect drinking water.

Like in many other Rohingya camps studied by Alam et al. (2020) and Akhter et al. (2020) regarding water crisis for drinking and other purposes, the present study also revealed that the majority of the households (over 83% of respondents, irrespective of camps) had been facing inadequate supply of water. Very few households stated that they received adequate water for their drinking and other purposes. Examination of their households' information showed that these respondents have fewer members in their households compared to other households who reported inadequate supply of water. The frequency of water shortage reported by the households in the camps at Ukhiya sub-district (i.e., camps 13, 15 and 16) was not so severe on a daily basis; rather, the majority of the households face water shortage twice a week in camp 13 and once in a week in camps 15 and 16.

Irrespective of camps, households spend 3–5 h collecting drinking water from their allotted collection points. Although the distance between households and water distribution points is not long, water collectors have to spend a long time in queues. The findings in this study are consistent with Akhter et al. (2020), who reported that 64% of the households in camp 2 spent 1–3 h collecting their drinking water from the neighboring distribution points.

The government of Bangladesh, donor agencies and I/NGOs have been trying to improve the water distribution networks and supply adequate water to the camps. This evidence has been noted during the KIIs. For instance, in response to a question (i.e., how WASH scenario has changed from the beginning to now?) in the KII questionnaire, WASH Sector Coordinator stated that ‘There has been a continual increase in the improvement of the quality of infrastructure and this will continue constantly. There is better access to clean treated water and hygiene item access continues. In the initial phase of the response, the SPHERE standards are used and the coverage is often limited as the ratio in an initial emergency is 1:50 and then changes to 1:20 when resources are improved. In the Rohingya response, the ability to move from 1:50 to 1:20 was hampered by the lack of space allocated to the response and the density of shelters and locations of tubewells that restrict where a latrine can be built. In 2022, the WASH sector will concentrate on quality and functionality’.

Sanitation practices

Latrine use

Improved sanitation practices are important for promoting good health (Farah et al. 2015; Moreira et al. 2022). The vast majority of the households in the studied camps have been using pit latrines with water seals, and some households have been using toilets with septic tanks and water seals. All the latrines in the studied camps are communal latrines (blocks of multiple toilets available to all adjacent households). Similar findings have been reported in previous studies in camps 2 and extension 4 (Akhter et al. 2020), and in two camps in Balukhali and Kutupalong (Hsan et al. 2019) in the Rohingya communities. Despite the latrines are gender defined, people do not follow the instructions because of long queues, particularly in the morning.

Latrine protection

All respondents stated that they feel uncomfortable and vulnerable in using communal latrines because, after the use of a latrine by many people, it becomes unusable. Moreover, these latrines are not feasible for children, the elderly and pregnant women. In the case of protection of latrines (e.g., door lock and undamaged door), the majority of the respondents in the camps in Ukhiya sub-district stated that their latrines are protected, while in Teknaf sub-district the majority explained that their latrines are not protected. KIIs revealed that there are challenges in the maintenance of latrines because households are reluctant to protect common property. For instance, WASH Sector Coordinator (KII) stated that ‘The lack of ownership due to shared facilities also impacts on the serviceability of the facility with a lack of responsibility by users. For behavior change, this is something that would normally take many generations to bring around and is normally led by the community’.

Proximity of water source from latrine

Most of the latrines are located in slope areas in camps 24 and 27 and on top of the hill in camps 13, 15 and 16. The distance between the latrine and the nearest water source has been recorded lowest (4.4 ft) in camp 24 and highest (10.4 ft) in camp 13, which are considered unsafe in terms of water contamination by coliform bacteria. These findings are inconsistent with Akhter et al. (2020), who reported that the distance between the water sources and the latrine is more than 30 ft. The KIIs with PHC reported that ‘These water distribution points were not moved to safe distance because of space limitation in the studied camps’. The statement of interviewees (i.e., KIIs with PHC) was also validated by the Camp-in-Charge.

Water supply facility and use of latrine

More than 88% of respondents reported that the water supply in latrines is lower than the required volume, which makes them unable to clean the toilet after their use. Moreover, the number of people used per latrine was also high compared to the standard level (20 people per latrine) suggested by UNHCR (2019). This higher number of people per latrine creates long queues in the morning, which is another problem in performing cleaning works in the latrine after its use. For instance, on average, the waiting time to use the latrine was the lowest (15.4 min) in camp 16 and the highest (30.1 min) in camp 24. Similar findings have also been reported in other camps in some previous studies (Akhter et al. 2020; Alam et al. 2020).

Soap and handwashing facility

According to the household survey, the availability of soap and handwashing facilities in latrines was low. FGDs revealed that communities often take away the supplied soaps in the latrine and steal the water tape from the water tanks. This FGDs evidence is also supported by KIIs findings. For instance, one KII respondent stated, ‘For all infrastructure, there are often issues with the communities stealing parts of the infrastructure for their own needs’.

Assessment of WASH conditions using SPHERE indicators

The findings of the study reveal both strengths and areas of concern in the assessed camps. Based on the SPHERE standard, our study findings indicate a persistent shortage of water, which is a significant concern for the Rohingya community residing in these camps. While the water quantity was insufficient, the drinking water intake standard was met in camps 13, 15 and 16 but not in camps 24 and 27. This suggests that despite the overall water shortage, efforts were made to ensure access to drinking water in some camps, but improvements are needed in others. The study did not test water quality, so it remains unknown whether the water quality in the camps meets the SPHERE standard. Further assessment and monitoring of water quality are necessary to ensure safe drinking water for the Rohingya community. The study found that water collection time, which should ideally be within a 30 min round trip, did not meet the standard in any of the camps. This indicates a high level of concern as the time required to collect water is prolonged, potentially affecting the community's access to water and their daily activities. The indicators related to latrine cleanliness and gender-segregated facilities were reported as a mild concern in all camps. This highlights the need for improved maintenance and cleanliness of latrines, as well as the provision of facilities that respect gender-specific needs. The hygiene promotion indicator was reported as ‘satisfied’ in all camps, indicating that efforts have been made to promote good hygiene practices. Additionally, indicators such as water for handwashing facilities and handwashing knowledge were reported as ‘satisfied’, suggesting that the community has access to necessary resources and knowledge for proper hygiene practices. Open defecation and hygiene promotion access indicators were reported as highly satisfactory, indicating positive practices and access to hygiene promotion initiatives. Solid waste management and water treatment systems displayed a mild concern in all camps, suggesting the need for improved waste management practices and water treatment facilities. Overall, the findings highlight the pressing need to address water quantity, water collection time, water quality, latrine cleanliness, gender-segregated facilities, provision of soap for handwashing, solid waste management and water treatment systems in the assessed camps. These areas require targeted interventions and improvements to ensure that the WASH needs of the Rohingya community are adequately met, promoting better health, hygiene and sanitation conditions in the camps.

Contribution of UN and NGOs to address crises in Rohingya camps

The Joint Response Plan for the Rohingya humanitarian crisis was launched in 2022 by the Government of Bangladesh, IOM and UNHCR. The JRP brings together the activities of 136 partners, of which 72 are Bangladeshi organizations, 52 are international NGOs and 10 are UN agencies (JRP 2022). The efforts of these organizations in the WASH sector have achieved significant milestones in improving water and sanitation conditions within the Rohingya camps. For example, (i) increased access to clean water through the establishment of water supply systems and infrastructure development, (ii) expansion and maintenance of sanitation facilities, such as latrines and bathing facilities, to improve hygiene and sanitation practices, (iii) hygiene promotion campaigns and educational activities that have raised awareness and facilitated behavior change among the Rohingya community, (iv) strengthened coordination and partnerships among stakeholders, enabling more effective and efficient WASH interventions and (v) enhanced resilience and capacity-building within the community and local organizations to sustain WASH services. While progress has been made, challenges persist, including the need for ongoing maintenance, addressing population growth and ensuring the sustainability of WASH services in the long term. Continuous efforts by the UN, NGOs and other stakeholders are essential to maintain and build upon the achievements in the WASH sector and further improve the living conditions for the Rohingya community in the camps.

Significance of the study

This study provides a key insight into WASH-related problems in the five camps in Rohingya communities in the densely populated Cox's Bazar district. This study suggests that (i) improved WASH facilities, particularly the supply of safe drinking water, and establishment of improved sanitation and hygiene facilities need to be ensured and (ii) community sensitizing activities for improving their WASH behavior, particularly maintenance of all five steps in a Water Safety Plan (WSP) and handwashing behavior need to be strengthened in order to reduce WASH-related health hazards in these studied camps. The better WASH facilities in the Rohingya camps will improve the quality of living standards of these forcibly displaced peoples, which will contribute to achieving targets 6.1–6.3 of the Sustainable Development Goals 2030.

Future research direction

Research on solid waste disposal and management

Based on our observation of the waste disposal site and drainage facilities (Supplementary Figure S7), in the future, researchers may focus on solid waste management practices in these camps or other camps of the Rohingya community. Sewerage systems have been found blocked by solid waste, which mostly contains plastic bottles, packaging materials, sanitary napkins, broken glasses, etc. This stagnant water in the drains creates odor, generates water-borne microorganisms and contributes to mosquito-borne and water-borne diseases (Salam et al. 2012).

Exploration of the feasibility of establishment of small-scale enterprise

Furthermore, most of the solid waste in the studied camps has been burnt, which creates air pollution and damages the environmental settings in and outside of the camps. Future efforts to assess the feasibility of the establishment of small-scale enterprises for converting non-biodegradable waste into usable goods can be attempted (Supplementary Figure S8), which will reduce waste-related problems and contribute to alternative income generation. Some NGOs in other camps have started this waste-to-resource project, which we found feasible in our study camps.

Globally, access to safe and sustainable drinking water facilities, improved sanitation systems and an adequate supply of water for the maintenance of hygiene are the fundamental challenges (Karanis et al. 2007). Using both qualitative (i.e., FGD and KII) and quantitative (i.e., household survey) methods, this study assessed the vulnerability and risks of WASH facilities in five Rohingya camps and their impacts on the households. This study highlights the following key conclusions:

  • (i)

    Households obtained water from different sources, but the supply of water was not adequate for meeting their drinking water demand and maintaining sanitation and hygiene practices. Although a substantial number of households have been undertaking adaptive practices (i.e., rainwater harvesting and water filtration), these practices are either limited by seasonality or not safe in terms of filtration, as harvested water may contain pathogenic microorganisms.

  • (ii)

    Households in three camps were found satisfied in the case of the location of water facility centers, while the respondents in the other two camps (i.e., camps 13 and 15) raised concerns about their water distribution points, which become risky for girls and women, who were mostly involved in water collection from these points.

  • (iii)

    Water shortage for drinking or other purposes is severe in all camps, but the frequency of drinking water shortage in camps 24 and 27 was higher than in the other three camps.

  • (iv)

    The communities felt uncomfortable in using communal/shared latrines. Moreover, the respondents raised concerns about the feasibility of the latrines for women, children, the elderly and PWD because, irrespective of camps, most of the latrines are located either on sloping land or on top of hills, which are risky for the mentioned users. The close proximity of latrines to the water sources was also a great concern in terms of water contamination from the leakage of adjacent latrine pits.

  • (v)

    Household sanitation practices were also affected due to an inadequate supply of water and limited soap and handwashing facilities, although KII respondents stated that some communities were reluctant to maintain sanitation practices because they were not used to practicing such sanitation works, especially handwashing with soap after using latrines.

This study sheds light on the significant challenges faced by Rohingya communities in accessing safe and sustainable drinking water facilities, improved sanitation systems and an adequate supply of water for maintaining hygiene. These findings underscore the urgent need for improved water and sanitation infrastructure, as well as targeted interventions to address the specific challenges faced by Rohingya camps. Efforts should focus on ensuring sufficient and safe water supply, addressing location and safety concerns, promoting proper sanitation practices and providing accessible facilities for all community members, especially those who are vulnerable.

The authors would like to thank the participants of this study, including household members, focus group discussants and key informant interviewees, for agreeing to be photographed and participating in this research. Volunteers assisted during data collection. The authors extend gratitude to the faculty members of the Development Studies Discipline, Khulna University, Bangladesh.

K.J.S.: Conceptualization, Methodology, Data Collection, Investigation, Curation and Analysis, Writing – Original Draft. K.H.: Conceptualization, Methodology, Supervision, Administration, Writing – Review & Editing. K.H.K.: Methodology, Supervision. J.L.: Software, Writing – Review & Editing. M.L.H.: Software, Visualization, Writing – Review & Editing.

This article was a part of the Master's thesis prepared by the first author. The expenses associated with field visits and the volunteer's salaries were borne by the first author. The authors did not receive any other funding.

All relevant data are included in the paper or its Supplementary Information.

The authors declare there is no conflict.

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