Our knowledge about prisoners’ health in developing countries is patchy. Even in affluent societies the state of prisoners’ health leaves a lot to be desired. Significant progress in health care provision has been made in a small number of states or regions that entrust, instead of the detaining authority, the health authority with providing health care for prisoners. The Swiss canton of Geneva was a pioneer in making prison health completely independent from the prison administration in a process that started in the mid1980s. Norway, France, England, Wales and parts of Australia are recent examples that are best documented. Overlooked so far is the recent very similar experience in one of the world’s poorest and most war-affected countries: Afghanistan. This article describes the progress reform has made and the challenges it is facing in that particular context. The article is the result of two visits to Afghanistan: an external evaluation commissioned by the European Union (EU) was conducted between 13 and 25 October 2012; the methodology consisted of a literature and document study, three prison visits and interviews (n1⁄4 49) with representatives