The number of sickle cell patients in Europe is steadily increasing due to continuing immigration and increase of average life expectancy. In 2005 probably up to 1,000 sickle cell patients were living in Germany, most of them in former West-Germany. Precise figures are not available as registration of sickle cell patients into a German surveillance study register that was initiated 1987 is on a voluntary basis. In December 2005 the register included a total of 514 patients, with 273 patients (208 children, 65 adults) still actively participating in the study. They were followed at 92 different institutions all over the country. We report on data regarding the origin of these patients, their genotypes, disease manifestations, social integration, therapy and causes of death. We discuss difficulties in the delivery of care and make suggestions for improvement.