So far, a limited number of studies have focused on the challenges that the unprecedented global spread of ELF poses to conference interpreting, and scarce resources and scholarly literature, if any, have addressed the peculiarities of ELF in interpreter-mediated encounters in humanitarian settings with vulnerable groups. Yet, in today’s globalized world, communication is increasingly taking place in a language, mainly English, other than the mother tongue of the participants in the conversation. This leads to the emergence of new “translationscapes” with multiple layers of vulnerability affecting both migrant clients and interpreters/mediators. Stemming from a qualitative research project on the role of cultural mediators employed by the Italian NGO Emergency ONG Onlus, which provides medical and social assistance to vulnerable groups in Italy, this case study investigates the role and practices of the cultural mediators employed at the NGO’s Castel Volturno outpatient clinic in a migration-intensive area characterized by urban decay and the well-rooted presence of organized crime, where communication to and/or through the NGO’s cultural mediators is often carried out in ELF. Drawing on semi-structured video-interviews with the cultural mediators, the contribution aims to identify the extent to which Emergency’s cultural mediators use ELF in their dyadic and triadic encounters with migrant patients and the NGO staff, as well as their challenges in using ELF and coping strategies. The study seeks to investigate if and to what extent ELF increases complexity and vulnerability for all participants in the encounter.