Livestock plays an important role in food security and nutrition as well as the economies of countries in the Near East and North Africa (NENA) region, supporting rural livelihoods and employment, and ensuring access to animal source foods (ASFs). Between 1993 and 2013, while global livestock numbers expanded by 16 percent, the NENA region numbers expanded by 25 percent, from 77 million livestock units to 96 million. Diverse livestock production systems exist in the region and are rapidly evolving in the face of a sustained growing demand for ASFs. One of the key challenges is maintaining a balance between the intensification of livestock systems and ensuring livelihoods of the livestock-dependent poor householders. A growing dependence on imported ASFs is prompting several countries in the region to seek innovative and affordable options for the future, including best practices and options for better and more sustainable management of adapted livestock which make use of scarce feed resources in predominantly semiarid environments. Meanwhile, ensuring access of urban populations to affordable ASFs through the intensification of poultry and dairy operations is important, not only for national food security but for job creation and economic growth. Building on a comprehensive regional analysis of livestock systems in the region in addition to a technical consultation with regional experts in January 2016, the Sustainable Development Goals (SDGs: 1, 2, 12 and 15), sustainable food and agriculture (SFA: 1, 2, 3, 4 and 5) and COP21, this paper discusses the evolution of demand for ASFs and the challenges on the supply side, which include the control of animal diseases, management of animal genetic resources, ensuring feed accessibility both through sustainable natural ranges and forage production, ensuring food and feed safety, promoting innovative ways to adapt to the changing climate and reducing food losses and waste along the chain.