Fragility, conflict, and violence (FCV) in middle-income countries is one of today’s major development challenges. It is commonly assumed that low-income countries are more prone to FCV than middle-income ones. Yet over the past decade, more people have been killed from political violence and homicides in middle-income countries than low-income ones. This report outlines the extent of the issue, mapping patterns of violence and conflict in middle-income countries. Drawing on a series of case studies, it looks at how the World Bank has worked on FCV in middle-income countries, what the challenges have been, and what has worked. It puts forward ideas on how the World Bank and other development actors can work more effectively on FCV in middle-income countries.