One in every five adult Rohingya refugees in Cox’s Bazar is living with Hepatitis C, a trend echoed among thousands of newly arrived refugees.
The warning comes from a study by icddr,b, published in May in BMC Public Health, alongside the latest operational data from the Refugee Relief and Repatriation Commissioner (RRRC) and Médecins Sans Frontières (MSF).
Viral hepatitis prevalence among Rohingya refugees stood at 18.97 percent, compared with 2.01 percent among the surrounding Bangladeshi host population, according to the icddr,b study.
The disparity was driven overwhelmingly by Hepatitis C, which affected 17.24 percent of refugees, compared with just 1.01 percent of local residents, said the study “Prevalence and risk factors of Hepatitis B and C virus infections among Rohingya refugees and host communities in Teknaf, Cox’s Bazar, Bangladesh”.
As many as 20 to 22 percent of the nearly 150,000 Rohingyas who entered Bangladesh in recent months tested positive for Hepatitis C, said Sarwar Jahan, assistant medical coordinator at RRRC.
The figures strongly suggest that most infections originated in Myanmar rather than through widespread transmission inside the camps, he said.
Kamal Hossain, a 30-year-old who fled Myanmar in 2017, is one such case. His Hepatitis C diagnosis in 2025 finally explained years of unexplained exhaustion and episodes where his vision suddenly darkened.
Patients typically complain only of fatigue, poor appetite or abdominal pain but many arrive without obvious symptoms as hepatitis C often remains symptomless for years, according to Sumaiya Yousuf, a medical doctor with the MSF Hepatitis C Project.
Looking back, Kamal, whose parents and sister were also found to be infected, believes unsafe medical practices in Myanmar were largely responsible.
“Doctors sometimes used the same syringe for several patients without changing it. At the time, we thought that was normal because nobody explained the risks,” said Kamal, who has now been cured after completing antiviral treatment in the camp.
Nearly 59,000 patients have been enrolled in antiviral therapy, but about 50,000 others remain untreated because of funding shortages, according to RRRC data.
If untreated, Hepatitis C can progress to liver cirrhosis or liver cancer.
The early alarm on this hidden crisis was sounded by Professor Dr Mohammad Ali, founder and secretary general of the National Liver Foundation of Bangladesh (NLFB).
His pioneering study in 2021 through the NLFB first exposed the high HCV burden among refugees, identifying major risk factors in Myanmar such as unsterile syringe reuse, unhygienic traditional procedures, unsafe birth care and unscreened blood transfusions.
Controlling hepatitis requires protecting both refugee and host populations through coordinated action, he said.
Hepatitis C prevalence among Bangladeshis living in Ukhiya and Teknaf has reached 2.3 percent, more than double the national average of around 1.1 percent, highlighting the importance of sustained surveillance in both refugee and host communities.
Routine screening of pregnant women, safe blood transfusion practices and targeted testing have significantly reduced new transmission inside the camps, said RRRC’s Sarwar.
“We need expanded screening, universal access to treatment, stronger infection prevention and sustained awareness programmes so that transmission can be interrupted before more people develop advanced liver disease,” Ali said.
The icddr,b researchers similarly called for Rohingya refugees to be fully integrated into Bangladesh’s national viral hepatitis elimination strategy.
They recommended culturally appropriate health education, wider access to rapid and confirmatory testing, free antiviral treatment for all active cases, routine hepatitis screening during pregnancy and timely Hepatitis B vaccination for newborns.
