54  Ioanna Kotsioni j Detention of Migrants and Asylum-Seekers communication component – was much more pronounced than in “regular” MSF operations. Several reports were published about the conditions in immigration detention centres and their detrimental impact on migrants’ health, which were extensively used by human rights organisations, even to support litigation cases before the European Court of Human Rights.48 However, the impact of MSF’s work in immigration detention has not been adequately assessed or acknowledged by the organisation, partly because it is difficult to measure the impact of advocacy, but also because it challenges the neutrality of MSF: another classical humanitarian principle that has a long history within the organisation. Concerns about breaching MSF’s neutrality were most pronounced when MSF’s public communication was placed within the wider immigration debate. The debates around MSF position on restrictive migration policies, for example, were considerable, as they involved questioning the direct and indirect complicity of EU Member States and institutions. This was an issue that arose particularly in MSF advocacy surrounding the EU co-financing of immigration detention facilities in Greece and elsewhere, the EU pressure on first-entry countries to contain the influx of migrants and refugees, and the EU’s influence on neighbouring third countries such as Libya to stop migrants from leaving their territory towards Europe.49 In general, MSF avoided opposing the practice of immigration detention per se in these matters, focusing instead on advocating for beneficiaries to be released on medical grounds and for ending the detention of vulnerable groups such as children, chronic patients, and victims of torture. There was, however, a considerable internal debate on this matter, which concerned the principle of humanitarian neutrality. On the one hand, some in MSF argued that the organisation needed to recognise the sovereign right of States to regulate migration. They suggested that MSF could not object to immigration detention per se and that the emphasis of advocacy should instead insist on States meeting their obligations according to international and national standards. The public messages, according to this view, should focus on the deplorable detention conditions, and they should advocate for their amelioration and the improvement of the immigration detention system in general. MSF advocacy, however, should stop short of challenging the system as such, because to do otherwise would stray too far into the political realm, and would be contrary to the classical humanitarian principle of neutrality. An opposing view suggested that MSF should take a position against the policy of immigration detention, arguing that it is a system that harms the health of migrants – a population with increased vulnerabilities. This opinion came most strongly, as could be expected, from MSF workers in the field. Aid workers who had experienced 48 MSF, Invisible Suffering; MSF, Torture, Exploitation and Abuse of Migrants in North Africa; MSF, Over the Wall; MSF, Migrants in Detention; MSF, “Not Criminals”. 49 Amnesty International, The Human Cost of Fortress Europe: Human Rights Violations against Migrants and Refugees at Europe’s Borders, London, Amnesty International, 2014, available at: http://www.sos-europeamnesty.eu/content/assets/docs/The_Human_Cost_of_Fortress_Europe_July_2014.pdf (last visited 22 Feb. 2016); Frontex, FRAN Quarterly, Quarter 1, January – March 2013, Warsaw, Frontex, 2013, 5, 21, available at: http://frontex.europa.eu/assets/Publications/Risk_Analysis/FRAN_Q1_2013.pdf (last visited 22 Feb. 2016) on the decrease of migrants and refugees entering through the Greek–Turkish land border; and MSF, Torture, Exploitation and Abuse of Migrants in North Africa.