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Bangladesh Journal of Bioethics 2021; 12 (1): 49-53 

49 

 

COVID-19 Pandemic: Ethical and Medical issues arising for people with 

disability in Bangladesh  

Taslim Uddin1, Hassan Tasdeed Mohammad2, Naima Siddiquee3 

1. Professor and Chairman, Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical 

University, Dhaka. Bangladesh. Email: taslimpmr@gmail.com  (Corresponding Author) 

2.Asstt Surgeon, Colonel Malek Medical College Hospital, Manikgonj. Dhaka. Bangladesh. 

Email:drtasdeed@gmail.com   

3. Department of Physical Medicine and Rehabilitation, United Hospital, Dhaka. Bangladesh.  

Email: drnaima_2008@yahoo.com  

DOI: https://doi.org/10.3329/bioethics.v12i1.51901  

Abstract: The disability viewpoint is the fundamental for understanding social justice in a given 

population. Disability rights need to be obeyed in the inclusive preparedness and response to all the disasters 

or during the crisis period including COVID-19 pandemic. COVID-19 pandemic jeopardized the health 

and rehabilitation services globally. The impact is much more in low resource developing countries like 

Bangladesh. In general, people with disability (PWD) suffer from multiple medical and rehabilitation 

complications and they need frequent rehabilitation consultations or hospital admissions in comparison to 

people without disability. As a developing country, Bangladesh has poor ratios of doctors, nurses and 

technologists of 1:0.4:0.24 (WHO: 1:3:5) to face the COVID-19 challenge. Rehabilitation services have 

been disrupted in almost two-thirds (63%) of countries of the world. Even though rehabilitation is the key 

to recovery following severe illness from COVID-19. There are many concerns and debates about the 

preparedness, response and mitigation the process of COVID-19 on the part of the national government. 

According to recent study reports, the lives of about 100% of PWD have been impacted by the COVID-19 

pandemic. COVID-19 National Technical Advisory Committee is working for strategic planning, response 

and mitigation process but omission of a representative of PWD or a rehabilitation physician in the 

committee has created much dissatisfaction. The difficult COVID-19 testing process due to country wide 

shutdown of rehabilitation essential services and central pulling of rehabilitation physicians have side lined 

the PWD inclusiveness. It is expected that the rehabilitation preparedness, response and mitigation of the 

pandemic should be based on an ethics driven process.  

Key words: COVID-19, Bangladesh, Ethical issues, Medical issues, people with disability,    

Introduction: During March 11, 2020 the World 

Health Organization (WHO) declared the 

outbreak of the novel coronavirus disease 

(COVID-19) to be a pandemic1. In Bangladesh 

first case of COVID-19 was detected on 08th 

March 2020, it reached 100 cases on April 9th and 

exceeded 200 cases (Case Doubling Time) within 

next two days. As of October12, 2020, there were 

379,738 confirmed cases including 5,555 deaths 

with the case fatality rate (CFR) 1.85% and 

recovery rate 77.5% respectively2. Recent survey 

reports show that about 100% of the people with 

disability lives have been changed by COVID 19 

pandemic 3. It is talk of the town that the 2nd wave 

of COVID-19  should learned lessons from the 

worse 2nd wave of the 1918 Spanish Flu. During 

the COVID-19 Pandemic there were resource 

constraints at emergency e.g. central oxygen 

supply, rationing ventilators and intensive care 

beds4. Great concerns about the COVID-19 

preparedness, health and rehabilitation response 

for people with disability (PWD) in Bangladesh 



Bangladesh Journal of Bioethics 2021; 12 (1): 49-53 

50 

 

were given.  COVID-19 related rehabilitation 

challenges were highlighted and strategy to  

adapt during the pandemic was documented but 

issues in relation to people with disability were 

not addressed5. An attempt was made in this 

communication to examine the key concerns and 

issues affecting health care and life of PWD 

impacted by COVID-19 pandemic in this low 

resource developing country. 

COVID-19 preparedness: Recently, three 

ethical duties for health care leaders as part of 

COVID-19 pandemic preparedness are proposed 

e.g. (a) the duty to safeguard (supporting workers 

and protecting vulnerable populations), (b) the 

duty to plan (managing uncertainty), and (c) the 

duty to guide (contingency levels of care and 

crisis standards of care) 6. As a useful source of 

updated information, a “COVID-19 dashboard” 

has been developed in the webpage of the 

Directorate General of Health Services. 

“Bangladesh preparedness and response plan” 

(BPRP) for the coronavirus disease 2019 

document was published during July 2020 with 

the goal to prevent and control the spread of 

COVID-19 in order to reduce its impact on the 

health, to scale up its core capacities, wellbeing 

and economy of the country and to set out the 

framework to treat the infected people.7 The 

Health Ministry has established a high-level 

National Technical Advisory Committee 

consisting of government and independent 

experts to advise COVID-19 health related 

issues. However, there was no mentioning of the 

most vulnerable group of PWD. Although about 

14 million people live with some form of 

disability in the country, omission of 

representation from disability and rehabilitation 

sector is a concern. The Government has 

recruited an additional 2000 doctors and 5000 

nurses to start addressing this situation but no 

news or indication was available on escalation of 

members from the rehabilitation team7. 

COVID-19 Testing: According to the number of 

COVID-19 cases, Bangladesh is positioned 16th 

in the world. The numbers of new cases are added 

on regularly. The strategic recommendation of 

COVID-19 preparedness and response was to 

detect the virus with increasing the testing 

capacity following the health guidelines provided 

by WHO and endorsed by the government. 

However, there was a great public health 

concerns and criticizing of the lowest corona 

virus testing capacity with charging a fee for the 

test.8 That hampered COVID -19 responses as 

many of the poor or PWD had disadvantages. 

Most of Polymerase Chain Reaction (PCR) 

testing facilities were based mostly concentrated 

in the Capital City Dhaka that required an online 

PWD non-user-friendly appointment system.  

Another issue was test results, in some cases it 

was a week-long delay or in some other cases it 

did not at all arrived to the patient 8. Many of the 

patients with non-communicable diseases 

(NCD)s or with disabilities could not be admitted 

in hospitals because of the delayed COVID-19 

test results. There was a delay for permitting 

COVID-19 serological tests in Bangladesh. 

According to the drafted government policy, the 

rapid antibody testing kit can be used for sero-

surveillance, convalescent plasma therapy and 

research9.  

Bangladesh and disability & rehabilitation 

health Sector. Bangladesh is a small country 

with about 165 million populations. It is the most 

densely populated country in the world.  The load 

was further burdened with the largest Pakistani 

and Rohinga refugees with the fear of mass 

infections by the corona virus agent.10 

Bangladesh has poor ratios of doctors nurses  and 

technologists of 1:0.4:0.24 (WHO: 1:3:5) 11. It is 

a lower-middle-income developing country 

(LMIC) with less than 3% of GDP is spent on 

health sector 10. It has poor emergency treatment 

facilities including hospital beds, central oxygen 

supply and has limited rehabilitation facilities. 



Bangladesh Journal of Bioethics 2021; 12 (1): 49-53 

51 

 

Quality of services at these facilities, however, is 

quite low due to insufficient allocation of 

resources, institutional limitations and 

absenteeism or negligence of providers. 

According to the WHO about 15% of 

Bangladesh's total population is disabled. 

Because of lower immune protection they are 

more likely prone to be infected with corona virus 

than others. Bangladesh had few rehabilitations 

works forces with mal-distribution of the 

therapists and rehabilitation physicians5. Article 

11 of the United Nations Convention on the 

Rights of Persons with Disabilities (UNCRPD) 

requires that every state shall adopt all necessary 

measures to ensure the protection and safety of 

PWDs in situations of risk, including situations of 

armed conflict, humanitarian emergencies and 

the occurrence of natural disasters.12 In 

Bangladesh, according to a recent country wide 

survey, 28.4% of the PWD did not know anything 

about the coronavirus. This survey also reports 

that 47% of persons with disabilities are the sole 

earners in their families and due to COVID -19 

lockdown restrictions the income of 61.6% of 

working persons with disabilities decreased13. 

The report recommended completing the 

disability identification (and registration process) 

survey of 2012 with prioritizing the women and 

children. Another report states that about 50% of 

Bangladeshi PWD did not have access to 

personal protective equipment (PPE) at family 

level and at works to protect the family members 

and themselves3. this papa is better suit under 

heading of Bangladesh and Disability & 

rehabilitation health sector. 

COVID-19 disability impact and ethical 

issues: PWD with major disabling events like 

traumatic brain injury (TBI), spinal cord injury 

(SCI), limb amputations, or other neuro-

musculoskeletal disorders including stroke have 

need more health and rehabilitation care and 

require frequent hospitalization and rehabilitation 

team care14. The problem was further intensified 

when rehabilitation health care professionals 

were pulled in to the centrally administered 

COVID-19 emergency duty roster then the 

rehabilitation OPDs were shutdown5.  

No record available for reference about the 

number of PWD affected by COVID-19, but the 

sufferings including child hood disabilities are 

much more than it was thought15. The entire 

health system including rehabilitation services 

were jeopardized by COVID-19 which raises 

challenging bioethical dilemmas16. 

Understanding of disability rights is central in an 

all-inclusive COVID-19 preparedness; which 

was not obeyed by the policy makers. This has 

created significant disruptions and additional 

risks to their autonomy, health and daily living 

activities. Limited and selective rehabilitation 

therapies were available to PWD resulted to gross 

reduction of previously attained functional 

capabilities of the neuro-musculo-skeletal and 

cardiorespiratory system.17. 

Health care workers had to work hard under lot of 

anxiety and agony during the pandemic; still 

there were arguments about their prioritization at 

the work places18. PWD are not always patients 

and service seekers; it requires a recognition that 

doctors and nurses serving PWD have been 

working at the frontline in this pandemic19. PWD 

in Bangladesh are regularly subjected to 

discrimination and they suffer greatly during the 

COVID-19 crisis period. Many of them could not 

get reliefs provided by the different public and 

private agencies because they could not stand in 

queues or compete with crowds13. Maintenance 

of social distancing and using masks remain as a 

barrier for blind and deaf person. “Social 

distancing” is not a better term for PWD, it may 

be replaced with “physical distancing” 20. There 

was a threat on patient- rehabilitation health care 

worker (RHCW) relationship during the COVID-

19 crisis period. Unlike acute and short-term 

illnesses and disease, this relationship is long 

term bondage of trust based on moral rules and 



Bangladesh Journal of Bioethics 2021; 12 (1): 49-53 

52 

 

principles. While examining the COVID-19 

related prevailing ethical issues following 

recommendation are provided in the box 1. 

Conclusion: There was limited application of 

existing frameworks of emergency planning for 

PWD in the COVID-19 pandemic. COVID-19 

rehabilitation preparedness, response and 

mitigation should be based on ethics driven 

process. The right of vulnerable populations in 

the areas of equality of access to health care and 

supports should not be forgotten during the crisis 

periods or at peace. Access to COVID-19 

information system and a special response 

inclusive plan for PWD is of paramount 

importance.  

Box: 1 Recommendations for PWD inclusive 

COVID-19 preparedness and response  

1. Inclusion of representatives of Rehabilitation 

team members and PWD in the National 

Technical Advisory Committee (NTAC). 

2. NTAC working groups should explicitly recruit 

physiatrist, PWD and chronic illnesses in 

rehabilitation response strategies.  

3. Increase rehabilitation capacity building with 

empowerment of PWD21. 

4. Improved information for PWD and establishing 

mandatory sign language in all crisis information.  

5. Establishing special dedicated high level control 

cell 24 hours services for PWD.  

6. To follow the WHO’s advice for disability-

inclusive COVID-19 considerations to mitigate 

the barriers for PWD22. 

7. Providing accommodations to PWD who work in 

a distant place. 

8.  More online job market should be created for 

PWD so as to they can work staying at home.  

 

 

References:  

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https://www.who.int/docs/default-

source/searo/bangladesh/covid-19-who-

bangladesh-situation-reports/who-ban-covid-19-

sitrep-10.pdf?sfvrsn=c0aac0b8_4. (Accessed 

October15, 2020.) 

2. World Health Organization, Bangladesh. 

https://www.who.int/docs/default-

source/searo/bangladesh/covid-19-who-

bangladesh-situation-reports/who-covid-19-

update-33-20201012.pdf?sfvrsn=8e5f58c7_2 

accessed October 14, 2020 

3. http://www.edf-feph.org/sites/default/files/i2i-

covid19-survey-accessible.pdf. (Accessed 

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5. Uddin T, Siddiq AB, Islam MT Strategies to 

Adapt COVID-19 Impacted Low Resource 

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Author contribution: 1st author Taslim Uddin 

conceived the idea, designed of the manuscript, 

performed the literature search, wrote the initial draft, 

checked the manuscript meticulously and gave final 

approval of the manuscript for submission. 2nd author 

Hassan Tasdeed Mohammad did the critical revision 

of the article, performed the literature search and gave 

the final approval of the manuscript for submission. 3rd 

author Naima Siddiquee performed the literature 

search, revised the article critically and checked the 

manuscript meticulously and gave final approval of 

the manuscript for submission.  

 

Conflict of interests: No conflict of interest in this 

study to declare. 

 


