Over the past ten years, Médecins Sans Frontières (MSF) has provided medical care to almost 118,000 victims of sexual violence. Integrating related care into MSF general assistance to populations affected by crisis and conflicts has presented a considerable institutional struggle and continues to be a challenge. Tensions regarding the role of MSF in providing care to victims of sexual violence and when facing the multiple challenges inherent in dealing with this crime persist. An overview of MSF’s experience and related reflection aims to share with the reader, on the one hand,the complexity of the issue, and on the other, the need to continue fighting for the provision of adequate medical care for victims of sexual violence,which despite the limitations is feasible.