Oxfam and MSF clashed over the meaning of ethical humanitarian action and the relevance of human rights to their work during the Cold War. To understand why, this book compares how the NGOs’ identities were forged within specific political cultures in Britain and France. While MSF gave voice to the anti-totalitarian convictions of disillusioned ex-communists, Oxfam’s members had a less ideologically charged background and gravitated towards criticism of Western realpolitik, leading the NGO to engage differently with leftist actors in negotiating access to suffering populations in the Global South. Across three case-studies – post-Khmer Rouge Cambodia and displacement in Thailand, the Salvadoran civil war and refugees in Honduras, and the Ethiopian famine – this book demonstrates that the NGOs’ interactions with refugees, civilians and states are best understood when contextualised within the national civil societies and social movements they emerged from.