A new report from the Center for Public Health and Human Rights and the Center for Humanitarian Health, along with the International Rescue Committee and the Syrian American Medical Society, addresses some of the unique and difficult challenges humanitarian health organizations working in settings extreme violence.  The report, based on almost 100 interviews with organizational managers and front-line health workers, identifies these challenges and makes recommendations to humanitarian organizations to develop processes – now rarely in place – to address the questions in a structured and systematic way.