Asylum-seeking children are one of the most vulnerable groups of displaced persons. The experience of being a detainee, with limited ways of communicating one's plight, shapes the expression of distress. Clinicians need to see the distress and symptoms of mental disorder as emerging in the context of the detention environment rather than within a traditional medical model. The use of diagnostic labels without elaboration does not provide an adequate account of the child's difficulties. The clinician has an important role in bearing witness to the harm done to detainees as well as trying to prevent harm in whatever way possible.