Refugee Survey Quarterly, 2016, 35, 41–55 doi: 10.1093/rsq/hdw004 Advance Access Publication Date: 12 April 2016 Article Detention of Migrants and Asylum-Seekers: The Challenge for Humanitarian Actors Ioanna Kotsioni* ABSTRACT The systematic detention of migrants and asylum-seekers is increasingly used as a tool to restrict the influx of migrants and refugees, affecting hundreds of thousands of migrants in host and transit countries. Médecins Sans Frontières (MSF) has worked in immigration detention settings and has exposed the detrimental impact of detention on migrants’ health. This work has also led to a series of ethical challenges related to working within an incarceration system that inherently limits efforts to alleviate suffering. The dilemmas faced by aid workers include issues of independent action, access, acceptance, and responsiveness to beneficiary needs. First, unrestricted access is impossible in prison-like facilities where daily operations are dependent on state consent. Secondly, when access is granted, MSF teams risk being perceived as part of the detention system, or at least seeming to collaborate with and accept it. Thirdly, the relevance and effectiveness of intervention is limited when the intervention setting is inherent to the suffering that humanitarian action seeks to alleviate. Such issues raise the question of when MSF’s “ethic of refusal” should apply, as well as illustrating the sacrifices aid agencies have to make in difficult and restrictive conditions. K E Y W O R D S : detention, medical care, advocacy, humanitarianism 1. INTRODUCTION Immigration detention has been increasingly used around the world over the last 15 years. It serves as a tool for governments to restrict irregular migration flows, including secondary movements of forcibly displaced populations, as well as facilitating the return of irregular migrants and rejected asylum-seekers. Linking migration with security has influenced policy-making and public rhetoric, prioritising public order – often in a xenophobic climate – over humanitarian requirements to protect displaced populations. The practice of immigration detention has been described by scholars in public health as “a threat to key human rights principles”, including the right to seek asylum, the right to be free from arbitrary arrest, the right to freedom of movement, and the right to be free from torture and cruel, inhuman or degrading treatment or punishment.1 * Victims of Torture Project Coordinator, Comprehensive care for migrants who have suffered torture and other forms of ill treatment, Médecins Sans Frontières, OCB Greece Mission; previously Migration Referent, Médecins Sans Frontières Greek Section. 1 Z. Steel, B. J. Liddell, C. R. Bateman-Steel & A. B. Zwi, “Global Protection and the Health Impact of Migration Interception”, PLoS Medicine Series on Migration and Health, 8(6), 2011, 2–3. C Author(s) [2016]. All rights reserved. For Permissions, please email: journals.permissions@oup.com V  41