ABSTRACTBackground: European health care workers recently experienced serious challenges to their mental health. Following the extremely stressful experience of the COVID-19 pandemic, the war in Ukraine caused a humanitarian influx of refugees in need of social and healthcare. We aimed to explore: (1) how working with refugees has affected the mental well-being of health care workers in the context of the COVID-19 pandemic, and (2) the nature of health care workers' emotional strain related to the refugee situation and the war in Ukraine.Methods: We used a combination of quantitative regression analyses and qualitative content analysis to assess data collected by an online questionnaire in 2022. The study included 1121 health care workers from the Czech arm of the international HEROES Study.Results: Quantitative findings did not indicate that working with Ukrainian refugees was reliably associated with a greater occurrence of symptoms of depression, anxiety, distress, or burnout. Qualitative analysis revealed five categories of emotional strain: impacts on working conditions, emotional reactions to refugees and the war, comparisons with the COVID-19 pandemic, and coping strategies.Conclusions: This study highlights the resilience of health care workers but also points to the need for ongoing support to address the complex emotional challenges they face during health crises.

Although we did not find a significant association between working with refugees and mental health issues, health professionals encountered emotionally challenging situations.Emotionally challenging situations involved reactions to the war and refugees, worsening working conditions, and higher subjective strain than during the COVID-19 pandemic.When comparing health workers caring for with refugees and COVID-19 patients, we found differences in their mental health issues.

• Keywords
• COVID-19 pandemic, Migración, Migration, Russian-Ukrainian war, emotional strain, guerra ruso-ucraniana, malestar psicológico, pandemia de COVID-19, psychological distress,
• MeSH
• Adaptation, Psychological MeSH
• COVID-19 * psychology   epidemiology   MeSH
• Depression psychology   epidemiology   MeSH
• Adult MeSH
• Mental Health * MeSH
• Middle Aged MeSH
• Humans MeSH
• Pandemics MeSH
• Burnout, Professional * psychology   epidemiology   MeSH
• Surveys and Questionnaires MeSH
• Stress, Psychological * psychology   MeSH
• SARS-CoV-2 MeSH
• Refugees * psychology   MeSH
• Anxiety psychology   epidemiology   MeSH
• Health Personnel * psychology   statistics & numerical data   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Ukraine ethnology   MeSH