Czech Frontline and Intercultural Health Workers’ Perspectives on Ukrainian Refugees Crisis

Abstract Background Following the Russian invasion of Ukraine in February 2022, the Czech Republic experienced an influx of war refugees. The arrival of displaced populations put unexpected pressure on the Czech health workforce. We explore how frontline health professionals and intercultural workers coped with this surge in demand, and what system-level factors supported-or limited-their capacity to respond. Methods We conducted 30 semi-structured interviews with Czech frontline health workers -physicians and nurses working in emergency and primary care. We also held three focus groups with 20 intercultural workers-bilingual community workers with migrant backgrounds who assist refugees in navigating public institutions, including healthcare. Health policy documents and statistical data were analysed to contextualise findings. Qualitative data were thematically analysed. Results The arrival of patients with complex needs and unfamiliar cultural backgrounds placed considerable strain on frontline workers. Their efforts to provide support lacked coordination and was hindered by the absence of mandatory intercultural training in medical and nursing education. This lack of preparation contributed to a generally low level of soft skills among Czech frontline health workers-particularly in the areas of intercultural communication and legitimacy. These gaps showed the importance of intercultural workers in enabling culturally sensitive care. Despite their key role, intercultural workers operated without legal recognition. They reported a persistent paternalistic approach by frontline staff towards Ukrainian refugee patients. Although some Ukrainian health professionals were willing and available to contribute, the Czech system failed to utilise their potential due to the length and administrative complexity of diploma recognition procedures. Pre-existing workforce shortages and uncoordinated support efforts exacerbated the burden. Key messages • Frontline health workers acted under pressure, but systemic gaps hindered effective response. • Intercultural workers played a key role, yet lacked legal status and institutional support.