Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)Diaconu, KarinWitter, SophieDakessian, ArekLoffreda, GiuliaAger, Alastair2023-06-072023-06-072023-06-28Diaconu, K., Witter, S., Dakessian, A., Loffreda, G. and Ager, A. (2023) ‘Fragile, handle with care: refining a key concept for global health and development’, BMJ Global Health, 8(6), p. e012956. Available at: https://doi.org/10.1136/bmjgh-2023-012956.2059-7908https://doi.org/10.1136/bmjgh-2023-012956Karin Diaconu - ORCID: 0000-0002-5810-9725 https://orcid.org/0000-0002-5810-9725Sophie Witter - ORCID: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Arek Dakessian - ORCID: 0000-0001-7792-6862 https://orcid.org/0000-0001-7792-6862Giulia Loffreda - ORCID: 0000-0003-4895-1051 https://orcid.org/0000-0003-4895-1051Alastair Ager - ORCID: 0000-0002-9474-3563 https://orcid.org/0000-0002-9474-3563AM replaced by VoR 29/06/2023Summary box In the development sphere, the term ‘fragile’ has generally been used as a pejorative label to represent ‘fragile and conflict-affected states’ with chronic governance challenges. Beginning with the formulation of the OECD’s multidimensional framing of fragility, a broader use of the term is emerging, which is of potential utility in the field of global health. Evidence from a series of studies addressing non-communicable disease and mental health provision—both of which require continuity of care and long-term investments into health service delivery and capacity—informs a ‘fragility for health’ framework consistent with this evolving understanding of fragility. This framework identifies two domains that warrant more intense, politically sensitive study: political economy and financing for health services delivery and community engagement in shaping systems for health. Consideration of these domains will critically inform health interventions in contexts of fragility.en© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.http://creativecommons.org/licenses/by-nc/4.0/Article