50  Ioanna Kotsioni j Detention of Migrants and Asylum-Seekers 5 . M S F ’ S WO R K I N IM M IG R A TI O N D E T E NT IO N S E T T I N G S : D I LE M MA S , CH A L LE N G ES , O P P O R T UN IT IE S Working in immigration detention settings has been particularly challenging both for MSF as an organisation and for MSF workers as individual professionals. It is not only due to operational limitations inherent to a context of incarceration which MSF had to manage but also the political and ethical implications of working within a system that subjects persons to the deprivation of a fundamental human right on administrative grounds. This section reflects on the dilemmas and challenges MSF has faced when working in immigration detention settings, based on the author’s experience of MSF activities in immigration detention facilities in Greece and of relevant debates within the organisation and with other humanitarian and human rights actors. It should first be underlined that MSF has considered activities in immigration detention rather atypical and that such activities have been cautiously resourced and remained very small in absolute and relevant volume. This caution is mandated by the recognition of the constraints and ethical challenges inherent to operating in an environment of incarceration, including violation of independence, risk of manipulation by the authorities, and lack of acceptance by beneficiaries.42 Acknowledging the challenges of independence and autonomy in detention settings, the organisation has opted to intervene with a limited timeframe and including, from the onset, témoignage (witnessing) and advocacy as core objectives.43 Moreover, while interventions in immigration detention settings have been triggered, as elsewhere, by unmet medical and humanitarian needs and the presence of obstacles to accessing medical care, the decision to take action in Greece took place within the wider debate about MSF’s positioning towards the detrimental impact of migration restrictive policies. In that sense, the decision to provide assistance to migrants and asylum-seekers in detention, especially in Europe, was significantly influenced by the potential to achieve policy change through advocacy. It thus stemmed, to use the words that Rony Brauman uses in his comparative analysis of MSF and ICRC’s application of humanitarian principles, “from an analysis of MSF’s political responsibilities rather than from bearing witness in the strict sense”.44 The understanding of this political responsibility was translated in the following operational imperatives: 1) MSF should avoid complicity with the detention regime and should therefore undertake the minimum possible responsibility within this system (for example, choosing not to take action to improve detention conditions even when these where directly linked with ill health); and 2) MSF should prioritise advocacy action – both quiet diplomacy and speaking out – to exert pressure on the responsible authorities to improve detention conditions and to address the harmful impact of 42 J. Biquet, “Working in a Prison in Myanmar: Médecins Sans Frontières’ Experience Working in Insein Prison”, Group URD Paper: Humanitarian Aid on the Move, No. 14, Oct. 2014, 6–10, available at: http:// www.urd.org/IMG/pdf/URD_HEM_14_EN.pdf (last visited 22 Feb. 2016). 43 For more details on MSF and the principle of témoignage, see in this special issue the introduction by T. Scott-Smith, “Humanitarian Dilemmas in a Mobile World”; and P. Redfield, Life in Crisis, Berkeley, University of California Press, 2013, 98–123. 44 R. Brauman, “Médecins Sans Frontières and the ICRC: Matters of Principle”, International Review of the Red Cross, 94(888), 2012, 1533.