US sanctions have documented humanitarian impacts on domestic populations, resulting from restrictions on a country’s access to foreign currency and international trade, impeding its ability to recover from economic collapse and a weakening of civil society. In spite of efforts to carve out humanitarian exemptions, shipments of food and medicine have failed to materialize. This article explores the causes for the continuing gap between US policy intentions and real-world benefits for domestic populations of sanctioned countries and argues for specific enhancements to humanitarian exemptions and existing policy frameworks in order to bridge these gaps. The article recommends specific measures to mitigate the documented humanitarian impacts of sanctions and thereby strengthen US humanitarian policies and US policy positions globally.