Shahpara Nawaz , Jane Wilbur , Tasnia Alam Upoma , Arka Goshami , Bithy Podder, Jarin Akter, Kazy Farhat Tabassum, Mehedi Hasan , Dewan Muhammad Shoaib, Doug Ruuska , Lauren D'Mello-Guyett , Mahbub-Ul Alam 

Human-induced climate change, marked by frequent and severe climate hazards, damages water and sanitation facilities, limiting safe and independent access for people with disabilities. In Bangladesh, where 8% of the population has a disability, the challenges are heightened by climate hazards, including cyclones and floods.  Evidence on how these hazards affect the sanitation experiences of people with disabilities and their caregivers is limited. This study aimed to explore the impacts of climate hazards on the sanitation experiences of people with disabilities in Bangladesh, along with the impacts of management strategies in response to them and their caregivers.
This mixed-methods study combined a nationwide population-based survey across 32 districts and a qualitative in-depth assessment across two districts (cyclone-prone Satkhira and flood-prone Gaibandha) of Bangladesh. The survey used the Washington Group Short Set on Functioning to identify 1021 people with and 909 without disabilities, comparing their access to sanitation facilities during climate hazards. Data were analyzed using descriptive statistics and multivariable analyses. The qualitative assessment included 39 people with disabilities and 16 caregivers through purposive and snowball sampling. Methods were in-depth interviews, photovoice ranking, and accessibility audits, with data analyzed thematically.
The survey found that 77% of participants had access to basic sanitation, mainly through pit latrines (47%). 13% of households reported damage to sanitation facilities due to climate hazards, and leading issues included waste overflow during floods (49%) and structural collapse or slab breakage during cyclones (57%). Qualitative findings revealed that both people with disabilities and caregivers sustained injuries while accessing or supporting access to sanitation facilities during and after climate hazards due to muddy, slippery and inaccessible paths.  
The survey also found that 45% of people used alternative sanitation facilities during climate hazards. Additionally, 21% of them reported changing their sanitation behaviours due to using alternative sanitation. Common changes in behaviours included restricting their use of sanitation facilities (61%), limiting or restricting food intake (30%), and fluid intake (9%). There was some evidence that people with disabilities changed sanitation-related behaviours more during floods (AOR 3.83, 0.99-14.86 95%CI, p=0.052) than those without disabilities.
Qualitative data showed flood-affected individuals with disabilities in Gaibandha faced verbal abuse using relative or neighbour’s facilities and resorted to open defecation. Privacy concerns and increased reliance on caregivers led to limiting toileting and adjusting food and water intake, especially for women. In Satkhira, cyclone-affected individuals continued using damaged facilities to avoid humiliation despite contact with human waste.
In sub-group analysis of cyclone-affected populations, people with disabilities experiencing incontinence had a 74% lower likelihood of using alternative sanitation facilities than individuals without incontinence (AOR 0.26, 0.07-0.93 95%CI, p=0.038). Damaged facilities led some participants to defecate in clothes and bedding, resulting in faecal contact for both of them and their caregivers and increased physical and emotional stress for caregivers. 
This study underscores the challenges faced by people with disabilities and their caregivers due to climate hazards, stressing the need for targeted interventions to promote climate-resilient inclusive sanitation facilities and participation of people with disabilities in disaster planning.