This contribution discusses the ethical dilemmas faced by clinicians coming into contact with and treating refugees and asylum seekers. Such people may have endured multiple traumatic events in fleeing their country of origin and face a number of difficulties in a host country, including poverty, homelessness, language difficulties and so on. They present with a range of mental health problems, with particularly high rates of post-traumatic stress disorder, depression, anxiety and self-harm. Their mental health problems are expressed within the context of their particular cultural background and experiences. Clinicians can feel deskilled when faced with their needs. This is compounded by the limitations of using interpreters, and respecting confidentiality. They may be confused about the entitlements of this group to healthcare. Specialist teams need to be developed to cater for their needs and/or the skills of generic services enhanced in order to deal with them. Access to services is complicated by the stigma around mental illness and distorted perceptions from refugee communities about what services can provide. The provision of medicolegal reports, the management of detained asylum seekers and the issues around hunger strike pose particular dilemmas. Clinicians may also face a tension between their professional role and the call to advocate for this group in a wider context, but these two functions are not mutually exclusive. Better training and guidance from professional organizations is called for. Dialogue with service users would also enhance training as well as improve practice in the areas of service provision/evaluation and research.