The Middle East spans the transition between temperate Mediterranean climate in the Levant to hyper-arid sub-tropical deserts in the southern part of the Arabian Peninsula, with the complex alpine topography in the northeast feeding the Euphrates and Tigris rivers which support life in the southeastern Fertile Crescent (FC). Climate projections predict severe drying in major parts much of the ME in response to global warming, making it important to understand the controls of hydro-climate perturbations in the region. Here we discuss 23 ME speleothem stable oxygen isotope (δ18Occ) records from 16 sites from the SISAL_v1 database, which provide a record of past hydro-climatic variability. Sub-millennial changes in ME speleothem δ18Occ values primarily indicate changes in past precipitation amounts superimposed on variations of the main synoptic pattern in the region, specifically Mediterranean cyclones. The coherency (or lack thereof) between regional records is reviewed from Pleistocene to present, covering the Last Glacial Maximum (LGM), prominent events during deglaciation, and transition into the Holocene. The available speleothem δ18Occ time-series are investigated by binning and normalizing at 25-year and 200-year time windows over the Holocene. Important Holocene climatic oscillations are discussed, such as the 8.2 ka, 4.2 ka and 0.7 ka (the Little Ice Age) Before Present events. Common trends in the standardized anomalies are tested against different climate archives. Finally, recommendations for future speleothem-based research in the region are given along with comments on the utility and completeness of the SISAL database.