In recent years, many countries throughout the Middle East - in particular the more prosperous states - have made great progress in education, higher education, and scientific research. However, this has not often been matched by equivalent progress in astronomy and its related fields, despite the fact that many nations in the region consider astronomy a fundamental part of their cultural and scientific heritage. The current status of astronomy in the individual countries of the Middle East will be reviewed. The positive decision of the International Astronomical Union (IAU) (Commission 46) to take a proactive role through visits and consultancy in the region will also be discussed, including the founding of MEARIM - the Middle East and Africa Regional IAU Meeting (first meeting held in Cairo 2008). The challenges and proposals to move forward teaching and research in astronomy in the Middle East will be considered, with comments relating North African countries and new trends, including space research along with astronomical activities.