The Democratic People’s Republic of Korea (DPRK, or North Korea) has been a recipient of international humanitarian aid from international organisations (IOs) and non-governmental organisations (NGOs) since 1995. In recent years, multilateral and unilateral sanctions in response to the DPRK’s nuclear programme have created a new layer of difficulty for humanitarians looking to engage with the authoritarian state. This paper explores how sanctions are affecting humanitarian work in practice, utilising interviews with practitioners. The research first surveys documentation, particularly from IOs, to establish how humanitarians understand contemporary need inside the country. Next, this paper examines the impacts of sanctions on aid efforts, with a particular focus on multilateral United Nations Security Council (UNSC) sanctions and unilateral American measures. Unpacking humanitarian challenges and potential ways to navigate the sanctions regime provides a foundation for academics and humanitarian practitioners to better understand both the DPRK and possible avenues for principled, effective aid.