BACKGROUND: As a result of more than 20 years of war in Afghanistan, its blood supply system has been damaged. We carried out an assessment of that blood supply system to determine the type and extent of assistance needed to increase blood availability and safety. STUDY DESIGN AND METHODS: An assessment tool was developed, daily activities in Afghanistan were observed, and key personnel were interviewed. RESULTS: Because there was no donor recruitment organization, most blood was obtained by the family replacement system. There was an inadequate supply of stored blood, which led to use of blood before screening test results for transfusion-transmitted disease were complete. Whole blood was provided but blood components were not produced. Blood was tested intermittently for human immunodeficiency virus Types 1 and 2, hepatitis B surface antigen, hepatitis C virus, and syphilis using agglutination-based screening methods. CONCLUSIONS: A dedicated staff is in place but to strengthen the blood supply system in Afghanistan, it will be important to address infrastructure and facilities, organization, standard operating methods, supplies and equipment, training, quality assurance, and transfusion medicine education.