Governance Challenges in Delivering Public Health Services to Rohingya Refugee Populations in Bangladesh: A Field-Informed Institutional Analysis

Abstract

By 2021, the Rohingya refugee crisis in Cox’s Bazar, Bangladesh, had evolved from an acute emergency into a heavily protracted humanitarian situation, a transition severely compounded by the operational challenge of the COVID-19 pandemic. While initial relief efforts successfully averted widespread mortality, the long-term delivery of primary public health services faces increasing constraints from centralized bureaucratic approval mechanisms, institutional fragmentation, and uncoordinated policy execution. Diverging from exclusively theoretical institutional analyses, this paper adopts a field-informed approach to interrogate the epidemiological and health service outcomes associated with these governance gaps. Drawing upon primary observational data and secondary epidemiological trends, including health facility metrics and qualitative field observations conducted during the author's coordination tenure with UNICEF in 2021, this study identifies systemic friction points across maternal and child health, infectious disease surveillance, and the delivery of water, sanitation, and hygiene (WASH) infrastructure. The analysis suggests that the collision between rigid domestic state security architectures and the parallel governance structures of the Inter Sector Coordination Group (ISCG) corresponds with significant reporting latency, parallel data ecosystems, and the unintentional diversion of routine healthcare resources during pandemic surges. The paper concludes with analytically grounded policy options to transition the sector toward decentralized emergency approvals, unified health information data architectures, and ring-fenced financing mechanisms, which are essential for optimizing service delivery in complex, protracted humanitarian emergencies.