The inequity of costly and low-quality fuel-based lighting is compounded by adverse health and safety risks including burns, indoor air pollution, poisoning due to accidental ingestion of kerosene fuel by children, compromised visual health, maternal health issues, and reduced service in health facilities illuminated solely or sporadically with fuel-based lighting. This article compiles and synthesizes information on the health and safety impacts of fuel-based lighting from 135 reports spanning 33 countries. Energy efficient, off-grid lighting solutions offer the most promising and scalable means to eliminate adverse health outcomes, while lowering lighting costs and reducing greenhouse-gas emissions. Deployments seeking the greatest possible health benefit should target the most impacted geographical and demographic user groups. Because women and children are disproportionately impacted, improved lighting technologies for use by these groups will yield particularly significant health benefits.