Sea turtle by-catch data in the Mediterranean were reviewed and analysed with fishing effort. The results indicate over 132 000 captures per year, with probably over 44 000 incidental deaths per year, while many others are killed intentionally. Small vessels using set net, demersal longline or pelagic longline represent most of the Mediterranean fleet and likely cause more incidental or intentional deaths than large vessels typically using bottom trawl or pelagic longline. When interactions, mortality, intentional killing, size (a proxy for reproductive value) and turtle populations are considered, results indicate that Mediterranean green (Chelonia mydas) and loggerhead turtles (Caretta caretta) are more affected (i) by fishing gears such as bottom trawlers, demersal longlines and set nets, (ii) by small-scale fisheries, and (iii) by fishing in the eastern basin. Although small-scale fisheries should be the priority target, available measures are easier to implement on the fewer large vessels. Moreover, these measures are few, and they are not implemented yet, while others should still be tested for the Mediterranean fisheries. Thus, measures for reducing captures or mortality through changing gear-specific characteristics may help, but probably a more holistic conservation strategy aimed to an ecosystem-based fishery management for a sustainable fishing would be the only solution for the long-term survival of Mediterranean Sea turtle populations and their habitats. Small-scale fisheries should manage marine resources, including turtles, in a responsible and sustainable way. Turtles may not only benefit from but can also help this process if their non-consumptive value is fully recognized.