Operational research in fragile settings is not neat or linear, yet it remains critical to how we learn and evolve our treatment programmes. In May 2025, MSF held its annual Scientific Day conference, where selected pieces of operational research showcased evidence-based responses to some of the most pressing challenges in humanitarian settings. Critical evidence surfaced on diseases that global health systems routinely ignore. This breakthrough follows over a decade of effort to bring noma into the global health spotlight. It informed protocol adjustments, generated greater awareness of schistosomiasis among staff and communities, and shaped the direction of future MSF research on neglected tropical diseases.