International debt relief continues to be a highly controversial subject. Although many heavily indebted poor countries have received large amounts of debt relief over the past quarter of a century, it doesn't appear to be enough. This book examines the impact of international debt relief efforts since 1990. It assesses whether the various debt relief modalities have enhanced economic growth in eight highly indebted countries in Latin America and Africa. Dijkstra argues that fundamental changes of the international aid and debt architecture are necessary to stop the flow of new multilateral loans and the possible perverse effects of conditionality.