Study design

This study employs a phenomenological qualitative research design [56,57]. We explored participants’ thoughts, perceptions, and practices regarding maintaining personal hygiene during and after two hydro-meteorological hazards: tropical cyclones and floods. We examined the direct and short-term effects of cyclone and flood on maintaining personal hygiene of people with disaiblities that occurred during and immediately after the events (up to two weeks).

Study sites

We selected Satkhira and Gaibandha districts based on Bangladesh’s multi-hazard risk assessment [58]. Satkhira, situated in the southern coastal region, is vulnerable to cyclones, sea-level rise, and saltwater intrusion [26,59]. In contrast, Gaibandha, located in the northern inland region, is prone to frequent flooding and river erosion [58]. Cyclone Amphan struck Satkhira along with eight other southern districts of the country in 2020, causing 26 deaths and affecting 2.6 million people [60]. Flooding events in 2019, 2020, and 2022 were each reported to have affected over 5 million people across multiple districts in the country including Gaibandha [60]. The respondents were recruited from the Kulia, Parulia, Debhata Sadar unions in Satkhira, as well as the Ghagoya, Gidari, and Kholahati unions in Gaibandha.

Study population and sampling method

Our study included individuals with disabilities (aged 15+) and their caregivers who had experienced a cyclone or flood within the past five years. The caregivers provided WASH support, including toileting, handwashing, bathing, and laundry. World Vision Bangladesh, which collaborated in this study and supports people with disabilities in rural Satkhira and Gaibandha, provided the initial list of potential participants. We purposively selected participants from this list, and subsequently administered the Washington Group Short Set on Functioning – Enhanced (WG-SS Enhanced) to verify eligibility in line with our study’s inclusion criteria [61]. The WG-SS Enhanced, recommended for disaggregating data by disability, includes questions on seven functional domains: vision, hearing, mobility, cognition, self-care, communication, and upper body [61]. People were classified as having a disability if they reported ‘a lot of difficulty’ or ‘cannot do at all’ in any of the first six functional domains. Caregivers were selected if they supported the person with a disability with their hygiene. We also used snowball sampling to ensure representation across these variables. We recruited participants between 23 August and 31 October 2023. We generated qualitative data from 35 individuals with disabilities and 16 caregivers. No eligible participants declined participation or withdrew after enrolment,

Data collection methods

We used in-depth interviews and observations (S1 Data). We developed two in-depth interview guidelines: one for conducting interviews with people with disabilities and another for caregivers (S1 and S2 Text), drawing on existing evidence at the intersection of climate resilience, disability, and WASH, as well as our team members’ research expertise. Using reflexive thematic analysis, we developed themes that reflected how people with disabilities and their caregivers managed personal hygiene during climate-related hazards, including access to bathing, laundry, and handwashing facilities; menstrual health and hygiene, and incontinence management; management strategies; and the perceived effects of these strategies on health and well-being. The research team repeatedly reviewed and refined the guidelines, tested them with participants in Satkhira, and made further modifications based on feedback. We conducted 24 in-depth interviews with people with disabilities (14 from Satkhira and 10 from Gaibandha) and 16 with caregivers (seven from Satkhira and nine from Gaibandha).

We used a separate guideline with instructions for the observations (S3 Text) and conducted 11 across Satkhira and Gaibandha. Participants demonstrated where they collected water, bathed, and managed menstrual materials. Through these demonstrations, we explored barriers related to accessibility, privacy, and safety, including distance to the water source, the ability to use facilities independently, visibility to others, the adequacy of lighting, the availability of functional locks, and the provision of spaces for washing, drying, or disposing of hygiene products. The process also helped participants recall additional issues and provided the research team with a clearer understanding of their lived experiences, thereby strengthening subsequent data analysis. Participants were approached in person by the research team with support from World Vision Bangladesh. Data collection took place between August and October 2023 and continued until thematic saturation was reached. Only the participants and the researcher team members were present at the interview, which was conducted in Bangla and recorded with the interviewee’s consent. No repeat interviews were conducted.

Data management and analysis

To minimise recall bias when exploring participants’ experiences of the cyclone three years earlier, interviews began by establishing rapport and situating participants in that context. Using a structured interview guide, questions followed a chronological sequence, covering events before, during, and after the cyclone and flood, with additional prompts to facilitate detailed recollection. Interviewers actively probed for clarification and cross-checked responses during interviews to ensure consistency. The analysis took an interpretive approach, recognising that participants’ accounts reflected not only remembered events but also the meanings they ascribed to those experiences. Each day, the researchers reviewed field notes to identify key issues and patterns that informed ongoing data collection. The Bangla-speaking research team members translated and transcribed interview transcripts into English and checked them against the original recordings to ensure accuracy and quality.

We employed an iterative thematic analysis approach, beginning with the development of a codebook of a priori codes [56]. Coding initial transcripts and reviewing field notes enabled us to add inductive codes (e.g., ‘availability of water’, ‘managing menstrual product’, and ‘caregiver’s incontinence support’) in the codebook to capture any new insights. We coded transcripts using NVivo 14 (Lumivero, Colorado, USA) and assessed inter-coder and intra-coder reliability to ensure consistency and resolve coding disagreements. We created a data display matrix to compare coded data case-by-case and identify key themes. We also identified quotes pertinent to each theme and captured those in this paper. We summarised the data for each theme, triangulating findings from the two data collection methods. Finally, we reviewed the summaries and compiled the results for each thematic area presented in this paper. We use pseudonyms with quotes instead of participants’ real names to ensure anonymity.

Ethical considerations

We obtained ethical approval for the study from the ethics review board of Icddr,b (reference 23072) and the LSHTM (reference 28925). Before starting data collection, we obtained written informed consent from all participants. The research team assessed the capacity to provide informed consent by discussing the study’s purpose, procedures, and the voluntary nature of participation with each potential participant. For participants under 18 years or those with cognitive limitations who could not fully understand the consent process, we used simplified information sheets to obtain assent and sought consent from their caregivers. We interviewed caregivers as proxies but also tried to involve participants directly. We read information sheets aloud to explain the study’s purpose, procedures, benefits, risks, confidentiality, and the right to refuse or withdraw from the study. We conducted the interviews privately in Bangla, ensuring participants that their information would remain confidential and anonymous in compliance with Bangladeshi law.

Research team and reflexivity

Icddr,b staff conducted all interviews. The team consisted of four Bangladeshi nationals (two female and two male) fluent in Bangla, with academic backgrounds in anthropology (two), environmental science (one), and public health (one). The Principal Investigator from the LSHTM attended the initial interviews to provide support, ensure consistency in data collection, and gain first-hand insight into the data. The same research team members who conducted interviews also completed data coding. All interviewers had over two years of experience in qualitative research and had received training in disability-inclusive ethical research, safeguarding, and child protection. Their diverse disciplinary backgrounds, prior experience, and deep cultural familiarity facilitated rapport-building and enabled a nuanced exploration of participants’ experiences. Throughout data collection and analysis, the research team engaged in regular reflexive discussions to examine their positionality, assumptions, and interactions with participants, thereby minimising potential bias and promoting accurate, respectful interpretation of participants’ perspectives. This study is reported in accordance with the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist for qualitative research reporting (S4 Text) [62].

Characteristics of study population

Among people with disabilities, 14 were female, and 21 were male. Participants varied in age; most were adults aged 18–64, and six were adolescents (aged 15–17). Across both districts, participants reported varying types of functional limitations. While multiple limitations were most common in Satkhira, mobility limitations predominated in Gaibandha. Caregivers in both districts primarily supported people with multiple functional limitations. These combinations most commonly included cognition and self-care; mobility and self-care; and cognition, communication, and self-care limitations (Table 1).

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Table 1. Study population characteristics.

https://doi.org/10.1371/journal.pclm.0000922.t001

Experiences of climate hazards

Participants described experiencing cyclones and floods (climate hazards) between 2018 and 2023. In Satkhira, all referenced hygiene challenges that occurred during and after the tropical Cyclone Amphan (2020). In Gaibandha, participants described challenges in managing hygiene during and after severe floods, with experiences linked to major floods in 2019, 2020, 2022 and 2023. Respondents affected by the cyclone in Satkhira did not evacuate their homes or seek refuge in designated shelters. Only a few flood-affected respondents from Gaibandha evacuated, temporarily staying in makeshift shelters on roadsides or in NGO offices. Cyclones in Satkhira and floods in Gaibandha were cited as significant factors that reduced access to WASH facilities and disrupted participants’ hygiene practices.

Handwashing

Handwashing practices did not change during or immediately after climate hazards for most participants. Some participants used tubewell water for handwashing, occasionally with soap or ash. Even without the additional constraints introduced by the cyclone or flood, many people with disabilities found independent handwashing difficult, requiring caregiver support.

During climate hazards, caregivers continued assisting by bringing small bowls of water for handwashing: “I used a bowl…I gave her a bowl with water during cyclone… she washed her hands there because she cannot go outside...” (Mala, female with communication, mobility and self-care limitations, Satkhira)

Due to affordability challenges, most participants were unable to purchase soap or detergent. Instead, they used ash as an alternative cleaning agent, both in everyday situations and during climate-related hazards. “Soap is not always available. Sometimes, I wash my hands with ash after returning from the toilet….” (Mokbul, male with cognitive, vision and hearing disability)

Bathing and laundry

Most participants bathed and did laundry independently or with the assistance of a caregiver at the tube wells. However, accessing these tube wells became challenging during or after Cyclone Amphan in Satkhira and prolonged floods in Gaibandha, due to waterlogged paths and submerged tube wells. Our observations revealed that, in rural areas, the paths used by participants or their caregivers to reach tube wells were primarily unpaved, narrow and uneven, often lacking handrails or other accessibility features. While some tube wells had concrete platforms, many others were situated directly on soil without raised bases or proper drainage, leading to persistent waterlogging. Even where platforms existed, they were often too high, uneven, or slippery, making independent use difficult for some people with disabilities, especially during or after flooding, when the surrounding area remained inundated and hazardous. Similarly, after heavy rainfall, they became muddy, slippery, or waterlogged:

“There was water on the road during [Cyclone] Amphan… There was so much mud in the road towards the tube well that I was in the mud up to my knees.” (Fulbanu, female caregiver of a male with multiple limitations, Satkhira)

Some participants refrained from bathing during periods of heavy rainfall and flooding and expressed dissatisfaction with their inability to bathe, as described by Liton: “[During the flood] I waited for the area to dry…I did not take a bath in these 3 to 4 days. When I cannot shower for three-four days, I feel helpless and bad.” (Liton, male with mobility limitation, Gaibandha)

During the floods in Gaibandha, tube wells and access paths were submerged in floodwater that was likely contaminated by overflowing latrines, widespread open defecation, and animal waste from fields. Unable to access clean water, many participants resorted to bathing in the contaminated floodwaters surrounding their households.

“There was water everywhere. At that time, I used flood water for our bathing. I was unable to reach the tube well traversing through the flood water, so I took a bath in the flood water.” (Romila, female with mobility limitation, Gaibandha)

Floodwaters in Gaibandha also prevented residents from reaching water points to collect water for laundry and bathing. “I washed [laundry] in flood water. The portion of the flood water that seemed clean, I washed the clothes there. I didn’t have any other option. Where could I wash the clothes when there is water everywhere? (Rabeya, female caregiver of a female with multiple limitations, Gaibandha).”

Participants from Gaibandha self-reported health issues related to bathing and doing laundry in flood water: “During the flood, we faced rash and itching on our skin…I just applied a mixture of mustard oil and turmeric to my affected area.” (Liton, male with mobility limitation, Gaibandha)

Shongku explained that he believed frequent bathing in floodwater had affected his health, leading to a fever that lasted several days. “I took a bath on the road with flood water during the flood of August 2018… I suffered from fever for three days during that flood because of bathing in flood water.” (Shongku, male with mobility limitation, Gaibandha)

Managing incontinence

The challenges with bathing and laundry were heightened for people with disabilities experiencing incontinence. Most lacked incontinence products (e.g., absorbent underwear or mattress protectors), resulting in frequent soiling of clothes and an increased need for regular bathing and laundry. During and after cyclones and floods, the inability to access toilets led to increased defecation and urination on clothes and bedding, further heightening the demand for household water for bathing and laundry. However, this need often went unmet, compromising cleanliness and well-being.

In Satkhira, many people with incontinence could not bathe as needed and relied on caregivers, who faced challenges maintaining their privacy and dignity.

“...he defecated in the room that night… After the storm had stopped the next morning, I got water from the tube well with a bucket and threw the water on him, keeping him seated on the balcony.” (Fulbanu, Female caregiver of a male with multiple limitations, Satkhira)

In Gaibandha, doing laundry for those with incontinence was even more difficult during the floods. Clothes and bedding soiled with urine and faeces posed a health risk, but frequent washing was significantly challenging. Caregivers had to wash soiled clothes in floodwater, increasing the risk of exposure to waterborne diseases. Washing soiled clothes and bedding in contaminated floodwater posed significant health risks for caregivers and individuals with incontinence.

“He (person with disability) urinates and defecates in clothes and cannot control it. I cleaned his soiled clothes during the flood. I used flood water to wash those clothes.” (Asiya, Female caregiver of a male with multiple limitations, Gaibandha)

Menstrual health and hygiene

Eight women with disabilities in Satkhira and Gaibandha reported menstruating during and immediately after cyclones and floods. Most participants regularly used old, worn-out pieces of folded cloth for menstrual management because disposable or reusable products were unaffordable. This practice remained unchanged even during cyclones or floods. Typically, menstrual cloths were washed with soap, detergent, and water from tube wells, but cyclones and floods disrupted access to tube wells, as well as the storage of water at home and outdoor drying.

Floods in Gaibandha worsened access to clean water for washing menstrual materials, forcing people to use contaminated floodwater. One caregiver described the situation: “During the flood, there was flood water everywhere. Our tube well was also flooded; I had to wash her menstrual clothes in flood water.” (Sokina, female caregiver of a female with multiple limitations)

Participants and their caregivers typically dried menstrual materials in direct sunlight outside, indicating positive menstrual behaviours. However, adverse weather conditions during cyclones and floods made outdoor drying unfeasible for most participants in both districts. Therefore, they had to dry their menstrual cloths inside the home, as reported by the caregiver of Mollika:

“Usually, she puts the cloths on a rope in the sunlight. But during the flood, she put it (the cloth) to dry in the corner of our house, but there was no sunlight in that place.” (Proxy interview, caregiver of Mollika, female with multiple limitations, Gaibandha)

Observations revealed that most participants disposed of used menstrual materials by burying them, while some discarded them with other household waste. During cyclones and floods, however, these practices became impossible, as yards were submerged and the ground waterlogged, compromising both hygiene and privacy. For instance, one of the caregivers from Satkhira reported that instead of burying her daughter’s menstrual cloth during Cyclone Amphan, she stored it at home until the storm dissipated.

“I buried the cloths under the ground after she used them during normal days. I could not dispose of them at the time of the cyclone. I kept those in the corner of the room, wrapped in paper. Then, when the storm/rain stopped, I buried them outside under the ground.” (Jaheda, female caregiver of a female with multiple limitations, Satkhira)

Two participants from Gaibandha, one with mobility limitations and another with multiple limitations, were unable to bury their used menstrual materials as they usually would in the backyard because floodwater had submerged their yards and the path to the usual disposal site. As reaching this area became unsafe and extremely difficult for them during the flood, they discarded the materials into the surrounding floodwater: “I threw them [the cloths] into the flood water because at that time I could not go to the backyard. It was very difficult for me to pass through the flood water.” (Romila, female with mobility limitation, Gaibandha)

The inability to maintain menstrual health and hygiene during climate hazards negatively affected their reported health and well-being. Two women with disabilities who experienced incontinence and menstruation during climate hazards experienced rashes and skin problems due to limited bathing and washing.

“I changed her [menstrual] cloths less frequently at that time. Due to remaining in unclean condition for a long time, she faced allergies and rashes in her private part due to waste [faecal] and menstruation.” (Khaleda, female caregiver of a female with multiple limitations, Satkhira)

Two women with disabilities who evacuated their homes with their caregivers during the floods were menstruating. Both reported a reduced sense of privacy and struggled with changing, cleaning, and drying their menstrual materials in a makeshift shelter, which was not a designated evacuation shelter.

“At that time, I changed my menstrual cloths and cleaned my private parts in our roadside makeshift house. I felt shy and nervous; I thought people could see me when I changed my menstrual cloths.” (Putul, female with mobility limitation, Gaibandha)

“Because we were staying at the NGO office during the flood, many men and women were there. There was no place to dry the [menstrual] cloths: people could see those.” (Sokina, female caregiver of a female with multiple limitations)

Moreover, caregivers faced the emotional strain of balancing support for the person’s menstruation with other caregiving tasks, which intensified during cyclones and floods.

“During the flood, I had to wash her menstrual clothes in flood water. It was tough for me. Sometimes I feel irritated. But I cannot show her my feelings. If I show her that I am bothered, she will feel hurt. My life is miserable.” (Kamrunnesa, female caregiver of a woman with multiple limitations, Gaibandha)

Tellingly, a caregiver from Satkhira expressed relief that her daughter with multiple limitations did not menstruate during the cyclone since it would have increased her hygiene-related tasks.

“No, no, she was not menstruating during the cyclone; it was a relief. We were saved a big time. If she had been menstruating during the cyclone, it would have raised more problems. If she had been menstruating then, I [would have] had to clean everything.” (Morjina, caregiver of a female with multiple limitations, Satkhira)

Handwashing

Climate hazards disrupt handwashing practices for everyone, but people with disabilities are more likely to restrict handwashing due to the unaffordability of soap, household displacement, delayed caregiver support during emergencies, with inaccessible and inadequate water and hygiene services further exacerbating these challenges [17,55,68]. In both Satkhira and Gaibandha, most people with disabilities relied on their caregivers for handwashing, even in normal conditions. They continued to do so during and immediately after cyclones and floods, when access to water and hygiene materials was constrained. A nationwide survey in Bangladesh similarly found that people with disabilities were more likely to require caregiver assistance for handwashing compared to those without disabilities, highlighting persistent barriers to access to handwashing facilities and hygiene products [47].

We recommend using universal design and climate-risk–informed approaches to support the planning and construction of WASH infrastructure that is accessible, safe, resilient, and responsive to the needs and preferences of people with diverse disabilities. Affordable, locally led innovations are increasingly available, such as a low-cost handwashing solution for public settings and humanitarian responses, ‘soapy water’, made by combining a 30-gram powdered detergent packet with 1.5 litres of water [69]. Evidence from Bangladesh indicates that this technology is more affordable than soap, can be prepared at home, and is effective against microorganisms. To promote accessibility, the dispenser should incorporate universal design features, such as a push tap for users unable to twist a tap head and soap placement that is visible and easily reachable from a wheelchair.

Bathing and laundry

Climate-induced water insecurity, exacerbated by floods and cyclones, disproportionately affects people with disabilities due to inaccessible WASH facilities, discrimination, stigma and economic barriers [70]. In Satkhira and Gaibandha, our study found that cyclones and floods exacerbated these challenges, as muddy, slippery, and flooded paths to water points, as well as inaccessible water points, made it difficult and dangerous for people with disabilities and caregivers to collect and store safe water, resulting in days without bathing or laundry. Similar challenges have been documented in Vanuatu, Cambodia, Bangladesh, and Malawi, where people with disabilities reported difficulties accessing water independently and relying on caregivers for bathing and laundry due to inaccessible water points and safety concerns [39,43,71–73]. Furthermore, a scoping review across low- and middle-income countries found that people without disabilities coped with climate hazards by harvesting rainwater, walking longer distances to collect water, or rationing supplies [23]. Only two of the 22 included studies addressed disability, highlighting greater challenges for people with disabilities, including impassable paths after heavy rains and reliance on friends, neighbours, and church networks to access water [23]. As water scarcity intensifies, such informal support mechanisms may erode, further heightening vulnerability. Arguably, this reflects the reality that people without disabilities are often able to independently adapt their hygiene practices, whereas infrastructural, communication and systematic barriers, in combination with the functional limitation experienced, restrict people with disabilities’ access.

Participants expressed frustration over their inability to bathe regularly during the climate hazards, given the cultural and religious importance of hygiene in Bangladesh [74], with many reporting distress at feeling unclean and dissatisfied when unable to bathe. In flood-prone Gaibandha, many used contaminated floodwater for bathing and laundry due to submerged water sources, resulting in reported skin problems and fever- findings echoed in other flood-affected areas of Bangladesh [35]. Contaminated floodwater increases the risk of infectious diseases [36,37,75]. However, there is limited epidemiological evidence that direct contact with floodwater alone is a primary source of infection. Rather, the health risks are more likely linked to inadequate access to clean water, safe sanitation, and hygiene during and after floods. People with disabilities are more likely to experience negative health outcomes due to pre-existing health conditions, poverty, stigma, discrimination, limited healthcare access, inadequate understanding by healthcare workers, lack of social support and exclusion from response efforts [51,76]. The absence of inclusive, flood-resilient facilities can feasibly increase participants’ risk of infection and disease.

We recommend identifying climate-related risks to people with disabilities, considering functional limitations, gender, and caregiver dependence, and taking action to mitigate them, enabling safer access to water and hygiene services for people with disabilities and their caregivers during and after climatic events.

Managing incontinence

Managing hygiene for people with incontinence requires significantly more water, soap and accessible facilities [77]. Studies from Bangladesh, Ethiopia, Ghana, Malawi, and Vanuatu highlight the increased demands for water, hygiene products, and accessible bathing and laundry facilities during climate-related hazards, particularly for incontinence management [17,43,77,78]. For example, in Vanuatu, Mactaggart et al. found that people with disabilities experiencing incontinence often remained soiled overnight due to inaccessible latrines, leading to health risks from prolonged exposure to excreta [21]. In Satkhira, some individuals with incontinence and their caregivers could not reach bathing facilities despite needing immediate washing after urination or defecation. Consequently, some remained soiled until the cyclone subsided, limiting the support caregivers could provide and compromising the privacy and dignity of those affected. In Gaibandha, caregivers reported washing soiled clothes in floodwater, increasing the risk of infection. Prolonged exposure to urine and faeces can lead to skin infections, diarrhoeal disease, and urinary tract infections [77], which are more commonly experienced by people with disabilities [51,76].

Based on the heightened hygiene demands and health risks associated with incontinence during and after climate hazards, we recommend ensuring access to incontinence products and assistive devices such as bedpans, urinals, commodes with lids, and mattress covers and equipping caregivers with tools (e.g., lifting devices) that remain usable before, during, and after climate events could support timely, safe, and dignified hygiene management.

Menstrual health and hygiene

Maintaining menstrual health and hygiene during cyclones and flooding was particularly challenging for women with disabilities. Water shortages, damaged paths, and heavy rainfall disrupted access to clean water, making it difficult to wash or dry reusable materials. These findings align with other emergency contexts in which limited water resources affected women with disabilities’ ability to maintain menstrual health and hygiene, including washing materials and cleaning their bodies [79]. Nuzhat et al. found that during water shortages following cyclones, women without disabilities in coastal Bangladesh were at least able to access and use available saline water to wash their bodies and menstrual materials [80].

Some of our study participants washed menstrual materials in floodwater, increasing infection risk, especially given their limited access to healthcare. Similar strategies are reported in flood-prone Jamalpur, where women used polluted floodwaters to wash their menstrual materials [35]. Previous studies also highlight the health risks of using poor-quality water during menstruation (e.g., floodwater or saline water), including discomfort, rashes, burns, and urinary tract infections [80]. While using unsafe water for menstrual health and hygiene maintenance poses health risks for all women, these risks are amplified for women with disabilities due to their heightened health vulnerabilities, greater barriers to accessing clean water, and reliance on caregivers for managing menstrual health and hygiene.

Persistent moisture and inadequate sunlight further hindered the drying of menstrual materials, contributing to discomfort and increasing the risk of infections. Incomplete drying of reusable menstrual materials has been linked to persistent rashes and urinary tract infections in other contexts [7,81]. Disposal also emerged as a significant concern. Some participants reported storing used materials inside their homes due to a lack of safe disposal options, thereby compromising hygiene and privacy. In many settings, safe, hygienic, and environmentally friendly disposal mechanisms are absent, posing risks to privacy, emotional well-being, and the environment [20,47,82–84].

These challenges were worse for those dependent on caregivers, who often had to manage menstruation in unsafe or crowded settings. Although few participants in our study evacuated, other research suggests menstruation can deter evacuation among women with disabilities. In Vanuatu, women reported avoiding evacuation during menstruation due to concerns about privacy, gender-based violence, and menstrual leakage [44]. In response, the LSHTM and World Vision implemented the Veivanua campaign (adapted from the Bishesta campaign in Nepal) to help young people with cognitive limitations manage menstruation with dignity [85]. Using characters, visual tools, and period packs, it built confidence during menstruation and emergencies. The campaign was found feasible and acceptable in Vanuatu and shows opportunities for adaptation in similar settings such as Bangladesh.

Considering the challenges associated with washing, drying, and disposing of menstrual materials during floods and cyclones, we recommend developing, testing and promoting locally led innovations in reusable menstrual products, alongside offering accessible guidance on hygienic reuse and environmentally sustainable disposal. These activities could reduce the health risks of people with disabilities and their caregivers and improve comfort and dignity.

Effect on emotional well-being

Everyone experiences hygiene disruptions during cyclones and floods, but people with disabilities face disproportionate burdens. Existing challenges, such as reliance on caregivers, limited mobility, incontinence needs, and inaccessible WASH facilities, intensify these issues. As a result, people with disabilities can become more dependent on caregivers, which can negatively impact their emotional well-being. Across Nepal, Pakistan, Cambodia, and Vanuatu, caregivers reported fatigue, pain, and concern about sustaining care because they were forced to take on physically demanding WASH tasks in environments lacking accessible infrastructure, appropriate equipment, or institutional support [42,43,71,86]. During climate-related emergencies in Satkhira and Gaibandha, these limitations in the built environment and the absence of adequate assistance made it even more difficult to meet the hygiene needs of people with disabilities, heightening stress for everyone involved.

In response to documented constraints on caregivers’ ability to provide hygiene support during climate events, we recommend equipping caregivers with appropriate tools, such as distributing gloves, brushes, and lifting devices, and providing guidance on their use, cleaning, and safe disposal of human waste. These activities could improve care provision and help protect dignity during emergencies. Furthermore, we recommend applying universal design principles, implementing accessible modifications, and implementing comprehensive disaster preparedness measures to ensure that water and hygiene services and information are accessible throughout all phases of climatic events. Promoting the meaningful participation of people with disabilities in developing WASH solutions, including their active involvement in planning and implementing climate-resilient WASH and disaster preparedness and management activities at the household and community levels, could strengthen individual and community resilience and help reduce inequalities for people with disabilities amid growing climate threats. Strengthening support for caregivers by providing appropriate equipment, training, and social recognition may further enable safe, hygienic care during climate events, especially when caregivers are involved in climate-resilient WASH planning and their experiences, needs, and ideas are used to shape household- and community-level solutions. Finally, working with Organisations of Persons with Disabilities and Disability Service Providers at every stage of climate-resilient WASH interventions and visiting people with disabilities and their caregivers at home when they are unable to attend community meetings could help ensure disability-inclusive planning and enable information to be shared in accessible ways.

Strengths and limitations

One strength of this study is its in-depth exploration of the unique challenges faced by people with disabilities during climate hazards in Bangladesh, a topic often underrepresented in disaster and public health research. Secondly, the study covers a wide range of hygiene practices of people with disabilities, including an emphasis on persons experiencing incontinence, including bathing, laundry, and menstrual health and hygiene, offering a holistic view of personal hygiene experiences. Regarding study limitations, we did not include epidemiological evidence linking inadequate hygiene practices to specific health outcomes, as this was beyond the scope of our research. Therefore, any association between disease and hygiene is anecdotal. Yet this remains a critical area for future investigation. Additionally, the findings may not be generalisable to other climate hazards, such as reduced rainfall and drought. The study’s focus on the immediate aftermath of climate hazards may also overlook the long-term effects of a changing climate on hygiene practices and health outcomes.