Although the Constitution guarantees equality before the law and the right to healthcare, millions of ordinary citizens still struggle to obtain legal protection and medical treatment.
Legal experts and former judges have repeatedly observed that the justice system often remains inaccessible for the poor because of high legal expenses, lengthy procedures, corruption, and social inequality.
At the same time, rising healthcare costs are forcing countless families into poverty, while many people die without receiving proper treatment.
Bangladesh, a nation of nearly 180 million people, has achieved remarkable progress in economic growth, education, and poverty reduction. Life expectancy has increased, maternal and child mortality have declined, and the country has become a global example in several development indicators.
Yet, access to justice and healthcare remains deeply unequal, especially for poor families living in rural areas, urban slums, and climate-vulnerable regions.
The reality of healthcare
According to the World Health Organization (WHO), universal health coverage means ensuring that all people receive healthcare services without suffering financial hardship. However, Bangladesh still faces major challenges in achieving this goal. Out-of-pocket healthcare expenditure in Bangladesh remains among the highest in South Asia, forcing many families into debt and poverty because of medical costs.
When a family member suffers from cancer, kidney disease, heart complications, or serious injuries, families often sell land, livestock, or jewelry and borrow money at high interest rates to continue treatment. Those who cannot afford care frequently abandon treatment or die without proper medical attention.
A simple consultation with a specialist doctor in private hospitals may cost between Tk 800 and Tk 2,500, while MRI, CT scan, and cardiac tests cost several thousand taka. Dialysis treatment may cost Tk 3,000 to Tk 5,000 per session, placing lifesaving treatment far beyond the reach of low-income citizens.
In rural Bangladesh, the situation is even more severe. Government hospitals at district and upazila levels are overcrowded, understaffed, and poorly equipped. Essential medicines are often unavailable, forcing patients to buy costly drugs from private pharmacies. Poor families also struggle to pay for diagnostic and pathological tests. Many patients travel long distances to Dhaka or divisional cities for treatment, increasing transportation and accommodation costs
Climate change is also worsening this crisis. Floods, cyclones, river erosion, and salinity intrusion are destroying livelihoods and pushing thousands into overcrowded urban settlements where healthcare and sanitation facilities remain inadequate.
Poor women, girls, and children are among the worst victims of this inequality. Many rural women cannot seek medical treatment without permission or financial support from male family members. Pregnant mothers frequently lack access to quality maternal healthcare, while adolescent girls suffer from malnutrition, anemia, and reproductive health complications. Poor women facing domestic violence, rape, or sexual harassment often remain silent because they cannot afford legal support or fear social humiliation.
UN Women has highlighted that poor women in Bangladesh face major barriers in accessing justice because of gender discrimination, financial dependency, and lack of legal awareness. Unicef has also warned that children from poor communities remain highly vulnerable to malnutrition, trafficking, violence, and child labour. Street and slum children are particularly exposed to disease, abuse, and exploitation.
The justice system reflects a similar pattern of inequality. Court cases often continue for years, requiring repeated travel, legal fees, and unofficial payments. A poor farmer, garment worker, or day labourer frequently cannot afford to hire a lawyer or spend years attending court hearings. Lawyers’ fees, documentation costs, and transportation expenses place enormous pressure on poor litigants.
Women are especially neglected within the justice system. Female victims of domestic violence, dowry abuse, rape, or property disputes often encounter intimidation and discrimination. In many rural areas, the absence of female lawyers, judges, and doctors creates additional barriers for women seeking justice and healthcare.
A former Chief Justice of Bangladesh once remarked that the justice system often does not work for the poor. Amnesty International and Human Rights Watch have also raised concerns regarding lengthy court procedures and barriers to legal support for poor women and children. Although Bangladesh has introduced legal aid services through the National Legal Aid Services Organization (NLASO), awareness remains limited in rural communities.
What can Bangladesh do to address these crises?
First, Bangladesh should introduce a low-cost national health insurance system for poor and lower-middle-income families. Even a small monthly contribution through mobile banking services such as bKash or Nagad could gradually create a social protection fund for emergency healthcare support.
Second, the government can establish mobile medical units and floating hospitals in remote char, haor, hilly areas and coastal regions where access to healthcare remains extremely limited. Telemedicine services using smartphones and community digital centers can also help rural patients consult specialist doctors without traveling to major cities.
Third, every district hospital should establish a “Poor Patients Support Desk” operated jointly by government officials, NGOs, and volunteers. This desk could help vulnerable families obtain medicine support, emergency blood donations, low-cost diagnostic services, and information on treatment options.
Fourth, Bangladesh should introduce community-based legal aid centers in every upazila. Law students, young lawyers, retired judges, and civil society volunteers could provide free legal advice and mediation support for poor citizens, especially women and children.
Fifth, digital court systems and online case tracking could significantly reduce delays, corruption, and unnecessary travel expenses. Village-level mediation and arbitration systems should also be strengthened to resolve minor disputes quickly and cheaply.
Sixth, Bangladesh needs more female doctors, nurses, lawyers, police officers, and judges, particularly in rural areas. Women and girls require safe and supportive environments to seek justice and healthcare without fear or intimidation.
Seventh, stronger monitoring and transparency are essential. Corruption within hospitals and courts continues to weaken public trust. Transparent pricing systems for private hospitals and diagnostic centers should be introduced to prevent hidden charges and unethical practices.
Bangladesh should also encourage corporate social responsibility programs where banks, large companies, and private hospitals contribute to health and legal support funds for poor citizens. Universities and medical colleges can organize regular free medical camps and legal awareness campaigns in underserved communities.
Civil society organizations, journalists, NGOs, and international development partners also have important roles to play. Investigative journalism can expose corruption and inequality, while NGOs can provide legal education, healthcare outreach, and community support.
Bangladesh has overcome enormous challenges in the past through resilience, innovation, and collective effort. However, sustainable development cannot be achieved if millions remain excluded from justice and healthcare.
Economic growth alone is not enough. A truly developed nation ensures that ordinary citizens, regardless of wealth or social status, can receive fair treatment in court and proper medical care in times of need.
Shahiduzzaman is a freelance writer.
