Between Care and Control: Navigating Responsibility in Community Health Work among Rohingya Refugees in Bangladesh

Abstract (English)

In humanitarian settings characterized by mass displacement, political precarity, and cultural pluralism, Community Health Workers (CHWs) act as essential agents of care and representatives of institutional responsibility. This paper investigates how CHWs in the Rohingya refugee camps of Cox’s Bazar, Bangladesh, navigate competing programmatic objectives, fragmented power structures, and cultural expectations within contexts of limited resources. Drawing on semi-structured interviews with CHWs, NGO actors, Majhis (refugee leaders), religious figures, and government authorities—as well as participant observation and surveys with refugees—this ethnographic study examines how CHWs mediate care practices while simultaneously absorbing and negotiating the moral and logistical responsibilities imposed by both humanitarian regimes and their own communities. Framed within anthropological theories of care (Mol 2008; Kleinman 1997) and responsibility (Fassin 2012; Farmer 2004), this research reveals how CHWs are tasked with reconciling top-down health directives with grassroots needs, often without sufficient institutional support. As both caregivers and instruments of policy implementation, CHWs must negotiate conflicting loyalties, navigate informal governance hierarchies, and respond to community skepticism, particularly where biomedicine intersects with traditional healing and religious authority. The study highlights the burden of responsibility CHWs carry in environments where accountability is diffused, making care a terrain of contested authority and moral labor. By examining how CHWs embody and redistribute responsibility across complex social and political terrains, this paper contributes to broader discussions on the ethics and politics of care in crisis-affected contexts. It provides critical insights into the ways responsibility is enacted, resisted, and reshaped in frontline health work, revealing care not as a neutral act but as a deeply politicized and negotiated practice within humanitarian governance.