This article examines the relationship between Médecins Sans Frontières (MSF) and the Sphere Project. Prior to revisiting the concerns MSF had with the project, it looks at factors that give rise to differences between NGOs and cites some reasons for why an organisation such as MSF would not embrace such a project and clarifies some key elements of MSF-style humanitarianism. The author revisits the original concerns and arguments presented by MSF when it decided not to participate beyond assisting with the establishment of technical standards and key indicators for the handbook. This is followed by a critical discussion examining these concerns and counter-criticism with reference to experiences a few years after the inception of Sphere. It concludes with MSF's perceptions and stance regarding Sphere and accountability in 2003.