What paradigms should take precedence during a humanitarian emergency when the needs may overwhelm the resources, particularly in the early phase ? Is it possible to resolve the tension between quality and quantity in a resource constrained situation ? How has a changing geopolitical climate affected humanitarian medical action ? Is there a rôle for a critical care specialist at all, when medical resources are simple and finite ? What are the particular challenges of living and working together with a group of colleagues in an unfamiliar and stressful remote environment ? What can be learned for critical care practice in resource rich settings from our colleagues working in resource constrained emergency situations ? These, amongst other complex questions will be explored.