The latest row between the International Committee of the Red Cross (ICRC) and the government of Burma is a sharp reminder of the very real limits the organisation faces in attempting to work with rogue regimes.
The ICRC took the rare step last week of publicly denouncing Burma's military junta for serious and repeated abuses of both civilians and political prisoners.
The junta, which has been in power since the 1960s, has cracked down hard on political opposition and ethnic minorities, and is accused of pushing thousands of villagers into forced labour on government construction projects.
Now the government is hitting back, accusing the Geneva-based humanitarian agency of secret ties with guerrillas.
It may not have been the most dramatic of exchanges, but the ICRC's decision to denounce will not have been taken lightly in Geneva.
The organisation has no police function, and although it supports the International Criminal Court (ICC), it has no power to prosecute abuses of International Humanitarian Law. A public denouncement is about the most serious sanction it is capable of delivering - a last resort to be exploited once all other avenues have been exhausted.
But in the case of Burma, the government appears unmoved by the official protest, highlighting an operational dilemma that goes to the heart of the ICRC's way of working.
Now that is has fired its ultimate broadside, it is left with a stalemate that will do little to improve the lot of Burma's long-suffering population.
RARE OUTBURST
"We are an organisation that relies on bilateral, confidential dialogue," said ICRC spokesman Florian Westphal. "It is important to underline that this statement was quite exceptional."
To get an idea of just how exceptional it was, think about how infrequently the agency makes such statements.
The last denouncement was issued in 2004, when Geneva released a statement describing the barrier that Israel is constructing around the West Bank as illegal under International Humanitarian Law. We have to go back to the Rwandan genocide in 1994 and then even further to Bosnia-Herzegovina in 1992 to find previous public criticisms.
The ICRC refuses to speak out about what it sees in exchange for the holy grail of humanitarian work: access. Mandated by the Geneva Conventions - including the third convention on the treatment of prisoners - it reaches areas that other aid agencies can only dream about. This is because it negotiates privately with the authorities concerned on the understanding that the content of those talks will not be spoken about publicly.
In the case of Burma, which signed the Geneva Conventions in 1992, this meant access to prisons and the estimated 1,100 political detainees inside them.
The ICRC detention programme in the country began in 1999. But there were problems from the start with public statements from ruling party members that appeared to make propaganda capital out of the fact they had allowed the ICRC into their prisons.
The agency continued to remain silent, choosing to restrict itself to its usual confidential exchanges with the authorities.
In an age of media-driven advocacy, it can be hard to grasp a way of working that shies away from the limelight, but that is what the ICRC has always preferred to do, believing that you get closer to the abused if you're prepared to negotiate with the abuser.
It is, of course, an ethical trade-off. In its bid for continuing and meaningful access, it talks to some very nasty people, Burma's military rulers among them.
Former ICRC president Cornelius Sommaruga said he would shake hands with the devil if it gave him access to the victims of humanitarian crises. Crucially, he never said he would then discuss the conversation on the evening news.
Not everyone agrees with this approach. The organisation was widely criticised for not speaking out about conditions after delegate visits to Guantanamo Bay. An ICRC report on alleged torture tactics in the facility was eventually leaked to the media in early 2005.
FRUSTRATING LIMITS
For all its reticence, the Red Cross has now run out of patience in Burma.
The detention programme collapsed in late 2005 when Burma's authorities refused to allow ICRC delegates to interview detainees without any government officials present. (The Geneva Conventions are specific about the right of prisoners to speak with Red Cross visitors in private.)
In May of this year, the ICRC closed two field offices in the face of what it described as "drastic" government-imposed restrictions.
"The ICRC's humanitarian work in Myanmar has now reached near-paralysis," director of operations Pierre Krähenbuehl said at the time. "A recent meeting with the Ministry of Home Affairs made no headway," he added.
Given the intransigence of the authorities, the ICRC has now resorted to the only option left open to it.
"Yes, absolutely there are limits," said Westphal, asked if a public denouncement can really be expected to change things. "We've said we're ready to resume substantial and meaningful dialogue."
But that's about it.
He refutes the allegations of "clandestine relations with insurgent groups", pointing out that the ICRC will as a neutral organisation openly seek contact with all sides of any given conflict. "We make no political value judgement between one side and another".
But for the time being, its humanitarian operations remain severely constrained. All it can do is continue to offer to talk with the government.
"I don't want to speculate on what happens next," said Westphal, ruling out any thought of a complete ICRC withdrawal from the country.
But for as long as Burma's military junta refuses to allow the Red Cross to do its work, the organisation's hands will remain tied and it will be up to other organisations to campaign for an effective international response to one of the world's most brutal regimes.