This paper analyses the dispute that emerged in 1878 between Romania and the European Commission of the Danube, a techno-political organisation composed of delegates from Europe’s Great Powers, over which side had the right to enforce sanitary policies at Sulina. On the one hand, since Sulina was part of the territory granted in 1878 to Romania, whose independence had been recognised by the Great Powers through the Berlin Treaty, the government in Bucharest claimed that it had the legal and moral rights to extend its public health policies to its newly acquired territories. As an independent state, part of the European community of civilised nations, Romania believed that it possessed all the necessary institutions, knowledge and expertise to fight epidemic diseases threatening its own citizens and those of Europe. On the other hand, since Sulina was the operational headquarters of the Commission, an organisation that enjoyed the status of operating ‘in complete independence’ of Romania’s territorial authority, the commissioners representing the Great Powers of Europe and their governments demanded full control over the sanitary administration of the region. The dispute lasted until 1884, after a functional compromise was reached in several stages.