Afghanistan fits the definition of a "failed state" with disintegration of the normal political, economic, and professional structures making restoration of health care a difficult and longterm task. Within this field there are few opportunities for clinically directed "quick impact" projects of significance. There are, however, many opportunities to proceed with quick impact projects in the areas of infrastructure and supply of consumables. Sustainable clinical projects will have to be deferred until improvements in estates and facilities create an appropriate environment into which clinical sustainable programs can be built. It is in the area of clinical and teaching support where medical schools in the United States and the United Kingdom have much to offer. However, a more secure and stable environment will be needed before expatriate medical educators may be safely deployed.