48  Ioanna Kotsioni j Detention of Migrants and Asylum-Seekers Moreover, conditions in immigration detention centres have often failed to meet even the minimum standards for incarceration set by international institutions such as the United Nations Minimum Rules for the Treatment of Prisoners,32 or by national regulations for prisons. This has, for instance, been observed by MSF in Malta and Greece where the main problems were overcrowding, inadequate sanitation and lack of basic relief items. In immigration detention facilities, MSF’s medical activities have included primary healthcare provision, mental health and psychosocial support, identification and referral of vulnerable persons, and referrals for further medical care. In addition to medical activities, MSF has addressed people’s urgent relief needs by, for example, distributing personal hygiene items and clothing. The lengthiest experience of MSF has so far been in Greek immigration detention centres, where between 2008 and 2014 MSF implemented seven projects in response to the absence of healthcare provision and provided 9,921 individual medical and mental health consultations to migrants and asylum-seekers in detention. MSF’s experience in Greece and other countries indicates the extensive impact of detention on the health of migrants and asylum-seekers. Most of the medical conditions MSF teams treated in immigration detention facilities have been caused or aggravated by substandard detention conditions and the lack of adequate medical assistance. Respiratory and dermatological infections, gastrointestinal, and musculoskeletal problems were the most frequently diagnosed conditions, which were clearly linked to overcrowding, unhygienic conditions, insufficient ventilation, restricted access to the outdoors, limited physical activity, and poor diet. In the words of one MSF doctor who worked in a Greek immigration detention centre, [M]ost of the diseases I treat are connected to the detention circumstances. For example, it is too humid – I have seen patients who sleep on completely wet mattresses. People also face problems related to their psychological condition [. . .] they have sleep disorders and psychosomatic issues.33 Incarceration is in itself – notwithstanding the detention conditions – detrimental to migrants’ well-being. Being detained was the single most important cause of stress and frustration for MSF patients. Lack of privacy, inactivity, dependence on others’ decisions, strict security rules, maltreatment by security personnel, lack of communication with the outside world, and uncertainty about the future can all contribute to the psychological distress experienced by detainees. Many were also tormented by feelings of injustice for being deprived of their liberty without having committed any crime. As Mary Bosworth has previously pointed out in relation to her own research in UK detention facilities: “men and women [have] commonly asserted that their 32 Standard Minimum Rules for the Treatment of Prisoners, adopted by the First United Nations Congress on the Prevention of Crime and the Treatment of Offenders, held at Geneva in 1955, and approved by the Economic and Social Council Resolution 663 C (XXIV), 31 Jul. 1957, and 2076 (LXII), 13 May 1977. 33 MSF doctor working in a Greek immigration detention centre, interviewed in Feb. 2014. MSF, Invisible Suffering, 9.