The conference on ‘Health Service Delivery in Fragile States for US$ 5 per person per year: Myth or Reality?’ took place on the 24th and 25th October 2007. Merlin and London School of Hygiene and Tropical Medicine, jointly organised the conference to promote discussion dedicated to understanding better how health service delivery can be strengthened in fragile states to assure the right to health for all. Over 130 people attended the conference, representing non-governmental organisations (NGOs), academic institutions, bilateral donors and multi-lateral agencies. The main aim of the conference was to examine how realistic it is to expect that basic health services can be delivered for US$ 5/per day. Numerous themes were covered during these discussions, including an examination of evidence-base and cost of basic health packages, the amount of development aid for health (DAH) available, and the use of service delivery innovations such as contracting and performance based financing. Other mechanisms of working with non-state providers (social marketing, franchising, etc), and opportunities and constraints for scaling up basic service delivery in fragile states were then examined.