Under-five mortality in the Eastern Mediterranean Region fell to 72 per 1000 live births in 2009, a 31% reduction from the 1990 level, based on the World Health Statistics Report 2011. Three countries (Egypt, Lebanon and Oman) have already achieved a percentage reduction greater than the two third reduction set as the Millennium Development Goal (MDG) 4 for 2015; this is a remarkable accomplishment. Seven more countries have seen over a 50% reduction in the same period, substantially increasing the future chances of survival of their children. The causes of mortality have gradually been shifting pattern in this decade, with such traditional causes as infectious diseases (postneonatal pneumonia and diarrhoea, malaria and measles) decreasing to about 35% of all causes and newborn deaths increasing to 45%. Despite this progress, an estimated 1.150 million under-five children still died in the Region in 2009, with 83% of these deaths occurring in just five countries (Afghanistan, Pakistan, Somalia, Sudan and Yemen). An analysis of the under-five mortality rates and average annual rate of reduction (AARR) by five-year periods by country recently conducted by the Regional Office gives an indication about not only trends over time but also the level of effort required to achieve MDG 4 in the next five years and, thus, its feasibility at this stage. The analysis suggests that the five priority countries with very high under-five mortality rates (Afghanistan, Djibouti, Pakistan, Somalia and Sudan) are not on track to achieve MDG 4. These countries are mostly in complex emergencies and have an AARR of less than 2% per year (except for Pakistan which has a 2.1%), which is much lower than the 12%–18% required by them to achieve the Goal in the remaining next few years. The “Data and statistics” section on “Under-5 mortality and its causes” contains detailed information on mortality rates, trends and AARR by country.