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Description: Background The Rohingya people of Myanmar have been subject to government-sponsored discrimination, detention, violence, and torture, causing several waves of a mass exodus to Bangladesh. Since August 2017, when the latest wave of migration began, there has been a rapid expansion of refugee camps in Cox’s Bazar, Bangladesh, with camps now accommodating approximately 335,000 new refugees. In this rapidly changing scenario, assessing the needs of the Rohingya and the host communities in Cox’s Bazar is critical for prioritizing resource allocation. We conducted a rapid needs assessment survey in both the Rohingya and host communities in Cox’s Bazar to highlight the most pressing needs in the community. Methods We conducted a randomized survey of 402 recently-arrived Rohingya households and 400 households in the local host community, from March 15 to March 18, 2018. The survey collected information on household demographics, mortality, education of all members, income, and livelihoods, access to food and water, vaccination, and access and utilization of healthcare. We calculated descriptive statistics and appropriate standard errors for survey responses on these topics. Findings The sampled Rohingya households were younger than the host community households. Two-thirds of the reported deaths in the Rohingya households in the last 12 months were among male household members, with a low overall mean age at death (38.7 years). The majority (76·0%) of Rohingya household members, above the age of 15, reported having had no education, and 52·6% of Rohingya children were not attending school. Nearly all (93·5%) Rohingya households reported a decrease in income over the last 12 months, with 79.9% reporting no current income. Mean reported income in the host community was not significantly different between 2018 and the previous two years. We found high levels of reported food insecurity among the Rohingya, which was also reflected in their prioritization of food over all else if provided additional cash assistance, and in their borrowing money to procure food. The majority (61·7%) of Rohingya children, under two, had received zero doses of injectable vaccines in Myanmar, and of them, 24·8% had also not received any injectable vaccines in Bangladesh. For oral vaccines, 57·5% of children, under two, had received zero doses in Myanmar, of whom 29·6% had also not received any oral doses in Bangladesh. In comparison, children in the host community had much higher rates of vaccination. Some Rohingya households reported challenges in accessing healthcare (14·2%), with the majority reporting distance to a healthcare facility as the main cause. In the host community, 32·5% of all surveyed households reported issues accessing healthcare, with wide variation (0 to 57·6%) among locations. Interpretation The results of this rapid needs assessment offer important insights into the most pressing challenges facing the Rohingya while providing contextual information about the neighboring Bangladeshi communities hosting them. The Rohingya population is greatly impoverished, with very low levels of education. While growing evidence globally demonstrates the prudence in formally integrating refugees into the labor force, doing so in Bangladesh will entail strategic investment in imparting skills and education to the host and migrant populations, with a particular focus on women. Resources should also be allocated to address pressing needs such as food shortages and vaccination gaps. Funding This study was supported by BRAC and the FXB Center for Health and Human Rights, Harvard TH Chan School of Public Health.