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The paper examines how best technical assistance (TA) for health might be implemented in post-conflict fragile states. It does so in the light of current development trends such as harmonization and alignment and moves towards aid instruments that favour country-led approaches. A number of key issues are addressed. The first of these considers which core principles for ethical TA might apply in post-conflict fragile states; the second reviews thematic challenges, such as the need to balance 'good enough governance' with effective attention to equity, rights and working with local health capacity. A third area for discussion is how best to plan for, and implement, long-term health TA inputs in often volatile and insecure environments, while a fourth topic is the engagement of civil society in rebuilding health systems and service delivery post-conflict. Attention to gender issues in post-conflict fragile states, including the importance of acknowledging and acting upon women's roles in peacekeeping and maintenance, the necessity to apply and sustain more gender equitable approaches to health in such contexts and how TA might facilitate such participation, represents the fifth issue for debate.

This paper considers the impacts of sexual violence perpetrated while the Eritrean town of Senafe was occupied by the Ethiopian military in 2000, during the second Ethiopia-Eritrea war. It discusses the aftermath for the survivors, all women and girls belonging to the Saho ethnic group, and the responses of other groups in the Saho community. An attempt is made to understand the reasons for the failure of one intervention that sought to provide support to these survivors of sexual violence. The potential repercussions of community denial of the sexual violence are addressed. These include lack of access by survivors to information on HIV, testing and care; refusal to face up to the possible infection of survivors, their husbands and unborn children, and to the psychological, social and economic impacts of HIV/AIDS.