The world’s most fragile states contain 38% of the world’s population and are among the world’s poorest. In these states up to 10% of all deaths and 20% of deaths among young adults may be attributed to untreated surgical disease, and over 500 000 women die each year during childbirth. International aid organizations have a presence in fragile states notably the International Committee of the Red Cross (ICRC). The potential for long-term field missions to address disparities in access to acute trauma, surgical, and obstetric care is not to be underestimated. Every opportunity for training and support of local health care staff is to be valued. The success of long-term deployments rests on sound planning before the implementation of programs and honest appraisal of ongoing programs.