Medical Sociology of Cox's Bazar Refugee Camp Health-Post Closures and Care-Seeking Substitution Among Displaced Women: A Difference-in-Differences Estimation of Closure Exposure and Facility Switching

The contraction of humanitarian health financing has produced a wave of health-post closures in the refugee camps of Cox's Bazar, yet the consequences for displaced women's care-seeking behaviour remain poorly specified. The argument proceeds from a critique of the dominant access-barrier model, which treats distance and cost as the principal determinants of care-seeking and therefore misreads substitution as a failure of access rather than as an active reorganisation of therapeutic itineraries. Drawing on the sociology of therapeutic itineraries, the literature on informal health markets, and the political economy of humanitarian rationing, the paper specifies a substitution mechanism in which closure exposure reallocates care-seeking from formal camp facilities to informal providers, private pharmacies and cross-border facilities. The proposed design exploits variation in the timing of health-post closures across camp blocks and compares changes in facility-switching behaviour among displaced women in exposed and unexposed blocks, with a difference-in-differences estimator. It argues that closure exposure is likely to produce substitution rather than abandonment of care, with consequences for the quality and continuity of maternal and reproductive health services that current access metrics cannot detect.