In the past decades, the provision of vital assistance to ‘strangers’ caught up in disasters has significantly expanded in scope and in scale. But to what extent does the aid provided to persons whose lives have been endangered and upended by war, natural catastrophes or other major crises meet their critical needs and aspirations? While the ideal of universal needs-based humanitarian aid remains elusive, efforts to improve the quality and standards of assistance and to increase ‘downward accountability’ towards affected persons by involving them more effectively in the management of the response are underway. Yet humanitarian aid’s ‘externality’, the large power asymmetry between providers and recipients and enforcement deficits all set inherent limits to what these ‘self-improvement’ processes can achieve. Ultimately, despite its shortcomings, humanitarian aid’s most significant limitation from the point of view of affected persons is when it is either absent or terribly insufficient, in part because access and acceptance are especially difficult to negotiate in politically-charged crises.