The rapid failure of sewer schemes in the many Middle Eastern countries is mainly due to corrosion resulting from acid attack induced by the combination of severe climatic conditions with temperatures as high as 60 degrees C (140 degrees F) and septic sewage. As a result, the sewerage schemes in the region required an urgent and extensive renewal program to save the severely deteriorated underground infrastructure of these countries. This demands an unconventional approach for rapid and cost-effective solutions to the serious problems facing the countries in the Middle East. Therefore, utilization of trenchless techniques for the renewal of sewer lines is not a recent phenomenon, and the Middle East market was one of the first markets in the world to adopt trenchless techniques in the renewal of pipelines in a large scale in the late 1970s and early 1980s. This report will discuss the historical background of sewer networks in the region, the weather conditions, internal structural failure of cementitious pipe materials, and causes of failure of sewer schemes in general. Also, a case history of one of the largest sewer pipe renewal project will be discussed, including background of the project, scope of work, approach and methodology, availability of trenchless technologies in the region and costs.