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The underlying motivation for providing assistance to fragile states is often not humanitarian, but rather one of improving regional and even global security. This short paper by USAID outlines some more prominent issues that need to be considered by those involved in developing, financing, and implementing foreign assistance programmes. This applies especially to those posted in the field, who are often besieged by different, and sometimes contradictory, ideas emanating from their own or other donor headquarters. The paper argues that what these ideas have in common is that they frequently ignore the context in which they are supposed to be applied. The paper draws on case studies that have been conducted in a number of post-conflict states, showing how one lesson that has been learned many times is that every country is different.

The paper suggests that the principal causes of morbidity and mortality in post-conflict states specifically, and in fragile states more generally, may not be specific diseases that need to be controlled with programmes such as: the expanded programme on immunisation, integrated management of childhood illnesses, or even HIV/AIDS programmes. Control health programmes for illnesses such as Malaria may be important in the post-conflict setting not because they lower the burden of disease, but because they lower the level of tension within a society and reduce the high-risk reoccurence of conflict. If so, they can contribute to the creation of a more stable environment in which, at a somewhat later stage, disease control programmes can be implemented more effectively and on a larger scale than what might be possible in the immediate post-conflict period.

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