One-third of the world's population burn organic material such as wood, dung or charcoal (biomass fuel) for cooking, heating and lighting. This form of energy usage is associated with high levels of indoor air pollution and an increase in the incidence of respiratory infections, including pneumonia, tuberculosis and chronic obstructive pulmonary disease, low birthweight, cataracts, cardiovascular events and all-cause mortality both in adults and children. The mechanisms behind these associations are not fully understood. This review summarises the available information on biomass fuel use and health, highlighting the current gaps in knowledge.