Prevalence of COVID-19 symptoms, risk factors, and health behaviors in host and refugee

Mushfiq MobarakC. Austin DavisPaula López-PeñaShabib Raihan


This paper examines the prevalence of COVID-19 symptoms and associated risk factors in Rohingya refugee camps and host communities in Cox’s Bazar, Bangladesh.

The analysis draws on a phone‐based survey conducted in April 2020 with a sample of 899 households. The sample was drawn from the longitudinal Cox’s Bazar Panel Survey (CBPS), representative of Rohingya refugees and the host population. Data from the 2019 CBPS baseline survey shows that refugee households have significantly lower levels of  income and assets. Housing conditions that favor community transmission of the virus (e.g. shared toilets and shared water sources) are more often observed in camps.

Key findings:

  • Refugees report COVID-19 symptoms almost twice as frequently as members of the host community. 25 percent of camp residents and 13 percent of host community members reported at least one of the three most common symptoms of COVID-19 (fever, dry cough and fatigue). Differences in self-reported non-COVID-19 symptoms are not statistically significant. It is possible that refugees experience higher rates of other common illnesses with overlapping symptoms or that some refugees over report adverse life events and health outcomes.
  • Residents of refugee and host communities are equally vulnerable to COVID-19 symptoms after adjusting for basic socio-demographic characteristics and pre‐ COVID-19 living conditions (e.g. toilet sharing, employment, and household assets).
  • Return migration is the strongest predictor of COVID-19 symptoms. Respondents in communities where at least one migrant returned in the previous two weeks are more likely to report at least one symptom of COVID-19.
  • Gender is the second strongest predictor of COVID-19 symptoms, with women being significantly more likely to report at least one symptom—possibly explained by gendered differences in willingness to report ill health.
  • Respondents who report having been unable to buy essential food items in the week prior to the survey are also more likely to report at least one symptom of COVID-19, indicating that food insecurity is a strong predictor of COVID-19 symptoms.
  • Lifetime trauma and depression severity are not significantly correlated with COVID19 symptoms. For those who experienced at least one symptom of any health conditions,
    pharmacies were the first stop for advice and treatment (70 percent and 42 percent in host communities and camps respectively). Among refugees, health information providers in camps are the second most common healthcare provider (35.8 percent visited one to treat their symptoms).
  • Trusted sources of advice on COVID-19 prevention vary greatly across refugees and hosts, but information provided by friends and acquaintances is important for both groups. Among refugees, NGOs are also trusted sources, followed by informational campaigns on the street and local leaders (e.g. block  majhees). Among hosts, newspapers, radio, and TV are the most trusted sources of information, as well as social media.
  • Most respondents understand how COVID-19 is transmitted and practice good respiratory hygiene. However, attendance at social and religious events is widespread—especially in the refugee population—and is strongly correlated with COVID-19 symptoms. Between 77 percent (camps) and 52 percent (host community) had attended a communal prayer in the previous week. Another 47 percent (camps) 34 percent (host community) had attended a non‐religious social gathering.

The following main conclusions emerge from this research: (1) COVID-19 symptoms are highly prevalent in Cox’s Bazar, especially in refugee camps; (2) widespread attendance at religious and social events undermine efforts to contain the spread of the disease; (3) pharmacists (as front-line health workers) pharmacists should receive training, PPE, and other supportive interventions; and (4) religious leaders could provide a mechanism to disseminate public health information and offer alternatives to prayer gatherings that have been widely adopted in other parts of the Muslim world.