Refugee Survey Quarterly  49 confinement negated their most fundamental identity, that of a human”.34 The impact of detention on the mental health of migrants and asylum-seekers is well documented by academic research, which records high prevalence of anxiety, depression, post-traumatic stress disorder, self-harm, and thoughts of suicide, but it is also borne out by research conducted with MSF patients.35 “Now I’m starting to have psychological issues”, reported a 34-year-old man after 17 months in detention; “we have lost our hope. I am beginning to have insomnia. I was 72 kg; now I have reached 64 kg. I cannot express in words the situation we are in.”36 Most importantly, incarceration exacerbates pre-existing symptoms and hinders the healing process for patients who have already suffered traumatic experiences.37 People on the move, in particular those forcibly displaced, are often exposed to violence and trauma prior to and during the journey. It is indicative that during 2013–2014, 36 per cent of MSF patients seen in mental health sessions in immigration detention centres in Greece reported previous exposure to violence.38 This does not come as a surprise if one considers that the majority of the patients came from unstable, violence-ridden places, such as Afghanistan, that they have undertaken a harsh journey to Greece via human smugglers, and that they may have been exposed to racist and police violence during their stay in Greece.39 It is not just a small minority of asylum-seekers and migrants who are affected by these levels of trauma. It is estimated that between 5 and 35 per cent of asylum-seekers worldwide have suffered torture.40 Besides, the act of migration is stressful in its own right as it involves uprooting, multiple losses, separation from family members, disruption of daily life, and uncertainty about the future. People in immigration detention are therefore extremely vulnerable. In the words of Zachary Steel et al.: Immigration detention provides a clear example of the intrinsic link between the denial of basic human rights and deterioration in health and mental health in particular. Confinement, isolation, lack of freedom, perceptions of being arbitrarily punished, uncertainty about the future, and fear of being returned to situations of danger all converge to create a pattern of deteriorating mental health.41 34 Bosworth & Kaufman, “Inside Immigration Detention”, 429–454. 35 Robjant et al., “Mental Health Implications of Detaining Asylum Seekers”; Steel et al., “Impact of Immigration Detention”; Coffey et al., “The Meaning and Mental Health Consequences”; Lorek et al., “The Mental and Physical Health Difficulties”; Keller et al., “Mental Health of Detained Asylum Seekers”. 36 MSF doctor working in a Greek immigration detention centre, interviewed in Feb. 2014. MSF, Invisible Suffering, 9. 37 N. Tsangarides, The Second Torture; T. Storm & M. Engberg, “The Impact of Immigration Detention on the Mental Health of Torture Survivors Is Poorly Documented – A Systematic Review”, Danish Medical Journal, 60(11), 2011, A4728. 38 Data recorded from mental health consultations between Sep. 2013 and Mar. 2014. MSF project in immigration detention centres in the North of Greece (on file with the author). 39 UNHCR et al., Racist Violence Recording Network – 2013 Annual Report, undated, available at: http:// rvrn.org/wp-content/uploads/2014/04/Report2013_EN.pdf (last visited 22 Feb. 2016); Médecins du Monde, National Report on Racist Violence, Médecins du Monde, 2014, available at: https://mdmeuro blog.files.wordpress.com/2014/05/554_enough_report_2014_eng_net.pdf (last visited 22 Feb. 2016). 40 Tsangarides, The Second Torture. 41 Steel et al., “Global Protection and the Health Impact of Migration Interception”, 2–3.