The thalassemias, together with sickle cell anemia and its variants, are by far the most common monogenic diseases. They occur at their highest frequency in countries of the developing world where their control and management is hampered by a lack of knowledge of their true prevalence, adequate services for their management and control, and support by their governments and international health agencies. However, there has been some progress recently in addressing these problems and there are several ways in which the lot of children with thalassemia in poor countries could be improved in the future. Over the last 20 years there has been considerable improvement in the control and management of the thalassemias in the richer countries of the world. Unfortunately, however, this is not the case for many of the developing countries, where there have been few improvements in the control of the numbers of births of babies with thalassemia or in the care of thalassemic children since the frequency of the problem started to become evident in the 1960s. Here, I will try to assess the current situation in these countries and examine some of the potential approaches for improving the current situation.