For many decades, the Middle East has been troubled with numerous long-standing armed conflicts and wars. Children and adolescents were not spared the trauma and its consequences. Exposure to traumatic events can result in mental, behavioural and emotional problems in children and adolescents. To date, this is the first paper that aims to systematically review the literature on the mental health of children and adolescents living in areas of armed conflict in the Middle East, specifically Israel, Palestine, Lebanon and Iraq. It explores factors that mediate between exposure to armed conflict and mental, behavioural and emotional problems and places them in a cultural context. Pubmed was searched and papers were identified using specific inclusion criteria. Seventy-one eligible studies were included. The main findings are that children and adolescents living in these conflict zones are exposed to high levels of traumatic experiences. Number of conflict-related traumatic experiences correlates positively with prevalence of mental, behavioural and emotional problems. Prevalence of post-traumatic stress disorder in children and adolescents is estimated to be 5–8% in Israel, 23–70% in Palestine and 10–30% in Iraq (insufficient data for Lebanon). The main determining factors identified were level and type of exposure, age, gender, socio-economic adversity, social support and religiosity. These findings bring to light the pressing need to provide children and adolescents living in conflict areas with help. They are useful in designing new interventions to strengthen child and adolescent resilience in areas of conflict worldwide. Specific recommendations are included.