The impact of more than 30 years of conflict, isolation and under-investment and the associated collapse of government, infrastructure and basic services such as health, education, water and sanitation have resulted in Afghanistan being one of the most fragile states in the world. Settled institutions have been destroyed, and instability and uncertainty rule in the country. The challenges are daunting, especially for children and women. The report outlines the factors of fragility in Afghanistan and the challenges NGOs face in attempting to reduce or mitigate the causes and consequences. Examples of management and programming approaches Save the Children has taken to overcome the constraints and respond to the opportunities that arise from fragility are documented and analysed. The report concludes by offering preliminary recommendations to donors and NGOs regarding issues that need to be considered and actions that could be taken to improve the effectiveness and impact of service delivery initiatives in fragile contexts.