Donors and implementing organizations are alarmed by the gap between humanitarian needs in today's most acute crises and the apparently diminishing access to populations in need. The total number of attacks against humanitarian aid workers has risen starkly over the past decade, and humanitarians face myriad barriers when trying to deliver assistance. These trends, however, have to be seen against the background of the rapid growth of the humanitarian sector as a whole. With more means at their disposal, humanitarian organizations have deployed more staff on the ground who are providing more assistance than ever before. While alarmist claims about diminishing access need to be viewed with some caution, the challenges that humanitarian organizations face in the countries visited for this evaluation and review (Somalia, Sudan, Afghanistan, Pakistan and Myanmar) are real. Based on a literature review and 388 interviews with representatives of donors, implementing organizations, governments and local authorities, this study analyzes what the most relevant access constraints are, what strategies humanitarian actors apply to overcome them and what trade-offs these strategies entail. It also addresses the questions of what compromises humanitarian actors should and should not accept when programming under limited access, as well as explores what DG ECHO needs to do to ensure that urgent humanitarian needs are met while the humanitarian principles are upheld in the most challenging environments.