Nigeria represents one of the United States' most important relationships in Africa. Despite U.S. security sector and humanitarian assistance programs, ten years of violent insurgency in northeast Nigeria have led to massive humanitarian needs for more than seven million people, and the crisis shows no signs of abating. Ongoing restrictions by the government of Nigeria on humanitarian action threaten U.S. policy goals of improved humanitarian outcomes and a reduction in the presence of violent terrorist organizations. This report unpacks the challenges for humanitarian actors, the role of the United States and other donor institutions in meeting humanitarian needs, and the effectiveness of the Nigerian government's response. Jacob D. Kurtzer provides concrete recommendations for mitigating the civilian impact of the conflict in northeast Nigeria.