In a humanitarian response, leaders are often tasked with making large numbers of decisions, many of which have significant consequences, in situations of urgency and uncertainty. These conditions have an impact on the decision-maker (causing stress, for example) and subsequently on how decisions get made. Evaluations of humanitarian action suggest that decision-making is an area of weakness in many operations. There are examples of important decisions being missed and of decision-making processes that are slow and ad hoc. As part of a research process to address these challenges, this article considers literature from the humanitarian and emergency management sectors that relates to decision-making. It outlines what the literature tells us about the nature of the decisions that leaders at the country level are taking during humanitarian operations, and the circumstances under which these decisions are taken. It then considers the potential application of two different types of decision-making process in these contexts: rational/analytical decision-making and naturalistic decisionmaking. The article concludes with broad hypotheses that can be drawn from the literature and with the recommendation that these be further tested by academics with an interest in the topic.