52  Ioanna Kotsioni j Detention of Migrants and Asylum-Seekers were there to support migrants endure the incarceration experience – thus becoming unintentionally complicit with the detention system. Based on these grounds, the MSF field team decided to discontinue its activities in detention centres in the North of Greece and speak out in the spring of 2010. This was a case of MSF’s “ethic of refusal” where it was felt that compromise – always essential to a certain extent for action – had crossed the threshold and become a “surrender of principle”.46 It is interesting to note that this was a bottom-up decision taken from aid workers on the ground, but it informed future MSF interventions in immigration detention centres in Greece. In practice, it meant that subsequent work was planned as a series of short-term interventions from the outset, with a view to reducing the risk of “institutionalisation”. The strategy was also to include other types of support, for example, relief assistance (e.g. personal hygiene items) – making the intervention more relevant to the needs of detained migrants and thus increasing the acceptance of the action and its “legitimacy”. However, the toll on the mental health of humanitarian workers was significant, as demonstrated by high rates of burnout.47 In addition to the ethical concerns and dilemmas, aid workers also had to manage serious obstacles in their daily work – most importantly the constraints on their autonomous action. Indeed, in a detention setting operated and controlled by security personnel, access to the beneficiaries can be critically compromised. In the case of the immigration detention centres in Greece, it was challenging for MSF teams to work in prison-like facilities, where daily operations were fully dependent on the consent of security personnel. In many settings, direct access to the beneficiaries had to be negotiated on a daily basis, even when framework agreements had been signed with the authorities. MSF workers would have to negotiate daily with detention staff for them to unlock patients and accompany them to the medical room or for MSF staff to be allowed to enter the migrants’ living area (cells). This was particularly difficult during the first months of MSF’s intervention in the North of Greece, where detention staff had no previous experience and interaction with humanitarian or non-governmental actors. The insistence of MSF staff during those daily negotiations to ensure the maximum possible independent access was instrumental for improving beneficiaries’ acceptance and for MSF workers to feel that they were able to meet – to some extent – the humanitarian principle of autonomy. In this context, it was also useful for field staff to admit MSF’s limitations to beneficiaries and to detention staff. To establish a trusting relationship with the beneficiaries, it was essential to explain what MSF could provide and could not provide, which helped to manage expectations and distinguish MSF’s role from that of the authorities. Part of this process involved explaining why the organisation had chosen this course of action – a form of accountability towards the beneficiaries, which was particularly crucial because beneficiaries did not have much of a choice whether or not to use the services MSF provided. Such accountability involved explaining to beneficiaries why MSF chose to work in the detention centres, why the organisation 46 Brauman, “Médecins Sans Frontières and the ICRC”. 47 T. G. Sicard Gleason, Correctional Nurses and Secondary Trauma, PhD Dissertation, Minneapolis, Capella University, 2007.