Addressing Barriers to Health Care Access and Their Impact on Social Cohesion Among Rohingya Refugees and Host Community in Cox's Bazar, Bangladesh: Protocol for a Qualitative Study.

Background: Access to health care remains a critical issue in protracted forced displacement contexts globally. In Cox's Bazar, Bangladesh, the co-existence of Rohingya refugees and the host community for many years has generated complex health care dynamics. While humanitarian interventions have increased service availability for refugees, barriers still persist, and disparities in health care access between refugees and host populations exist. Objective: This study aims to understand the experiences and coping strategies of refugees, host community members, and health care providers involved in accessing and delivering health care services, and to explore how these dynamics influence social cohesion between the two communities. Methods: The study will use a qualitative design involving focus group discussions (FGDs) with Rohingya refugees and host community members, and in-depth interviews (IDIs) with health care providers in Cox's Bazar, Bangladesh. Separate FGDs will be conducted with men and women from both refugee and host communities. Participants will be recruited through purposive sampling, complemented with snowball sampling, where required. Each IDI and FGD will be guided by guides developed from prior studies and contextual insights. The anticipated sample includes approximately 3 to 5 FGDs with Rohingya refugees, 3 to 5 FGDs with host community members, and 10 to 12 IDIs with health care providers. Data will be analyzed using Braun and Clarke's reflexive thematic analysis, and the analysis will be primarily inductive, while also considering the wider social, institutional, and structural conditions that shape participants' experiences. Since the data will be transferred to Sweden for secure storage, management, and analysis, ethical approval has been obtained from both Sweden and Bangladesh. Results: Preparatory work began in 2025 following ethical approval, focusing on stakeholder engagement, field coordination, tool refinement, and recruitment planning. Findings are expected to be submitted for publication by 2027. Conclusions: Guided by a critical realist paradigm, this study is grounded in the understanding that individuals' lived experiences of accessing and delivering health care are shaped by deeper social, structural, and institutional mechanisms that may not be immediately visible. By integrating the perspectives of refugees, host community members, and health care providers, the study will generate context-specific evidence to inform more equitable and socially responsive health care delivery in Cox's Bazar and similar humanitarian settings. Additionally, by exploring how disparities in health care access affect perceptions of inequalities, the study will shed light on the broader implications for social cohesion between these coexisting communities. Findings will help inform future strategies to improve equitable health care delivery and policies in displacement-affected regions.