The global economy is in its third year of deceleration amidst declining inflation and oil prices. The MENA region grew at 1.9 percent in 2023 and is forecasted to grow at 2.7 percent in 2024. And for the first time since the pandemic, MENA oil exporters and importers will grow at similar rates. The tragedy of the conflict in the Middle East has increased uncertainty. Rising debt leaves many countries in the region exposed. This report unpacks the nature of debt in the region. Oil importers have been unable to either inflate or grow out of debt. Exchange rate fluctuations, and particularly stock flow adjustments (SFA) play a sizeable role. The report highlights the need to address debt transparency. Extrabudgetary items, especially for developing oil importers, need to be accounted for. Primary balances are key, but only to the extent that they capture the true state of government finances.