"This study assesses the state of a significant, albeit underserved, segment of the SME market, known as the "Missing Middle" to better understand their needs and the challenges they face. It addresses how governments and other stakeholders can help them reach their potential for growth and job creation to positively impact the MENA region. Missing Middle SMEs are formally registered firms that have passed the initial start-up stage. These SMEs typically have modest revenues of US$100,000-$5 million, employ an average of 6-150 employees and require between US$50,000 and $2 million in flexible growth finance, along with business development assistance, to survive and grow. This study shows that although there are a number of existing SME support programs in the region, they need to go beyond the provision of limited subsidized loans and pre-investment training to adequately support the Missing Middle SMEs throughout their business lifecycle."