Widespread political and economic changes over the past several decades have influenced MENA insurance firms’ business environment fundamentally. This study investigates the influence of business environment, political risk, governance and Shariah compliance on efficiency in the insurance market from 2007 to 2017 using unbalanced panel data from 125 listed insurance firms across MENA countries. The study emphasises that a less favourable business environment exerts pressure on insurance firms and also identified an improvement in efficiency over the sample period, which may be attributed to the role played by challenging business conditions in increasing efficiency. Further, the results showed that variability in general economic conditions and influence of governance indicators explain efficiency, while solvency has a multifaceted effect on efficiency. Finally, the study found that Islamic insurance’s relative failure to enhance efficiency may be attributable to its failure to establish a distinct identity or draw a clear line between its mode of operation and that of conventional insurance, as well as the issue of customer confidence. Overall, the study emphasises the importance of controlling business environmental conditions in cross-country efficiency studies.