This chapter covers much ground by looking into the black box of ICRC decision making. The subject is rarely covered by outsiders, given the difficulty of obtaining reliable information. Facts and interpretations are presented about the role and influence of the Assembly (governing board), Assembly Council, presidents, directors-general, and Directorate. There is a comparative evaluation of the roles and legacies of the three most recent presidents as well as the often ignored subject of the different directors-general (who are the CEOs of the organization or are supposed to be – if the presidents do not pre-empt that role). On the one hand, bringing in outside presidents from Bern with differing styles and values does make a difference both internally and externally for the ICRC. On the other hand, a Swiss cultural tradition of collective consultation and accommodation is at work, as presidents rarely take decisions entirely on their own. It is extremely rare to have public spats or resignations at the top of the ICRC over policy disagreements.