The scale and complexity of global forced displacement has created enormous humanitarian, social, economic and political challenges across the globe. The Australian Government responded by putting in place a range of policies designed to deter people from seeking asylum in Australia through irregular maritime migration. A core feature of these policies is the highly contentious practice of offshore or ‘regional’ processing of asylum seekers in Nauru and Papua New Guinea. From August 2013 to October 2015, Save the Children was contracted by the Australian Government to provide welfare, education and recreation services to asylum seekers in Nauru. This paper explores the dilemmas facing organisations engaged in refugee issues using Save the Children’s experience in relation to Nauru as a case study. It argues that without a clearly articulated decision-making framework based on a realistic view about what can be achieved, and underpinned by a pragmatic, but ultimately principled, ethical position, the daunting humanitarian conundrums faced in such circumstances will overwhelm even the best intentioned humanitarian.