A Scoping Review of Multi-Sectoral WASH Interventions and Diarrhoeal Disease in Cox's Bazar Refugee Camps: An African Health Systems Perspective

Diarrhoeal disease is a leading cause of illness in refugee settings, where water, sanitation, and hygiene interventions are a core public health response. The camps in Cox’s Bazar, Bangladesh, provide a pertinent case study. This review examines evidence on multi-sectoral WASH interventions from an African health systems perspective, considering lessons for similar protracted displacement contexts in Africa. This scoping review aims to map and synthesise literature on the effect of multi-sectoral WASH interventions on diarrhoeal disease incidence in the Cox’s Bazar refugee camps. Its objective is to identify key intervention components, implementation challenges, and outcomes to inform health systems strengthening for refugee health in African contexts. A scoping review was conducted using established frameworks. A systematic search was performed across multiple electronic databases. Studies were screened against pre-defined inclusion criteria focusing on multi-sectoral WASH interventions and diarrhoeal disease outcomes in the specified camps. Data were charted and analysed thematically. The review identified a limited but informative body of literature. Integrated WASH interventions, particularly those combining improved water points with hygiene promotion and sanitation facilities, were associated with reduced diarrhoeal disease incidence. Community engagement emerged as critical for sustained behaviour change. Evidence on the specific effect of individual intervention components was sparse. Multi-sectoral WASH interventions in Cox’s Bazar show potential for reducing diarrhoeal disease. Implementation in dense camp settings requires adaptive, community-centred approaches. Lessons on integrated service delivery and cross-sectoral coordination are relevant for strengthening refugee health responses within African public health systems. Future interventions should prioritise robust monitoring and evaluation to disaggregate the effects of specific WASH components. African health systems should invest in community-led programming and cross-sectoral coordination mechanisms when planning WASH responses in displacement settings. scoping review, water sanitation and hygiene, diarrhoeal diseases, refugee camps, Cox’s Bazar, African health systems, multi-sectoral intervention. This review consolidates evidence from a major displacement crisis outside Africa to derive practical insights for strengthening multi-sectoral WASH and health responses within African refugee settings.