The impact of detention People will get crazy in here. We have not killed anybody. We have not robbed anybody. Why are we kept in prison? I have been here for 10 days and I find life going backwards. I want my life to go forward. Here the only thing I can do is think and sleep. I do not want to think of my life. It upsets me and I might hurt myself or others. If I have to stay in here much longer I will do something bad to myself. Afghan adolescent, 16 years old Being detained was the single most important cause of stress and frustration for the majority of the migrants. Detention came as a shock to most them, as they had totally different expectations about their arrival in Europe and found it very difficult to cope with their time in detention. Being restricted in often overcrowded cells, with no or very limited time outside and no private space at all contributed to their psychological distress. Research has demonstrated that “the experience of detention is traumatic, regardless of the conditions.”51 Detention can induce fear, isolation, and hopelessness. Different stressors associated with detention (environmental, procedural, legal) may contribute to undermine the mental health of detainees, particularly those who have already suffered past trauma.52 Detention was the main problem for over one third (37%) of MSF patients. The unacceptable conditions of detention, the unknown length of detention and being treated like criminals, were some of the issues migrants raised during first consultations. Our patients used one or more of the following terms to describe their feelings while in detention: they felt “Insecure,” “in constant worry,” “afraid of police,” “anxious about the future,” “stressed,” “sad,” “lonely,” “depressed,” “desperate,” “angry towards authorities for being treated like animals,” “worthless for failing their families,” “guilty for being incarcerated.” The following accounts illustrate the feelings of MSF patients: I have never been in detention before. I feel very insecure and frightened. I am very upset. I would like to talk to a lawyer. Palestinian man, in his early twenties I am afraid of the police. They talk badly to us. I don’t know what to do. I don’t have shoes. My clothes are damaged because my journey was terrible. And I am afraid to ask anything from the police. Georgian woman, in her forties I cannot stand to stay for three months inside here. I am broken and afraid. Afghan man, in his early twenties The unpredictable nature of detention and especially the fear of deportation was the main concern for 7% of the migrants who sought the assistance of MSF psychologists. As many 21 of them come from unstable and war torn countries like Afghanistan, Iraq, the possible threat of deportation to their country of origin can be life-threatening. I cannot be deported. I face a death sentence in my country. I have been in prison for many months. I was tortured. I cannot stop worrying about being deported. I do not have a problem being in here. I have been through much worse. I am only afraid to be deported. Iranian man, in his early twenties The context of detention poses special challenges for migrants with a chronic medical condition, disability or mental health problem. Patients who were on treatment for a medical condition in their country of origin were concerned about not having their medication and/or adequate medical care. Migrants with physical disabilities had difficulties in their daily functioning in the detention setting. Such issues were discussed by 14% of patients in individual counselling sessions.