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This paper examines the hydroclimate history of the Eastern Mediterranean (EM) region during the 10th to 14th centuries C.E., a period known as the Medieval Climate Anomaly (MCA), a time of significant historical turmoil and change in the region. The study assembles several regional hydroclimatic archives, primarily the Dead Sea reconstructed lake level curve together with the recently extracted deep-lake sediment record, the Soreq Cave speleothem record and its counterpart, the EM marine sediment record and the Cairo Nilometer record of annual maximum summer flood levels in lower Egypt. The Dead Sea record is a primary indicator of the intensity of the EM cold-season storm activity while the Nilometer reflects the intensity of the late summer monsoon rains over Ethiopia. These two climate systems control the annual rainfall amounts and water availability in the two regional breadbaskets of old, in Mesopotamia and Egypt. The paleoclimate archives portray a variable MCA in both the Levant and the Ethiopian Highlands with an overall dry, early-medieval climate that turned wetter in the 12th century C.E. However, the paleoclimatic records are markedly punctuated by episodes of extreme aridity. In particular, the Dead Sea displays extreme low lake levels and significant salt deposits starting as early as the 9th century C.E. and ending in the late 11th century. The Nile summer flood levels were particularly low during the 10th and 11th centuries, as is also recorded in a large number of historical chronicles that described a large cluster of droughts that led to dire human strife associated with famine, pestilence and conflict. During that time droughts and cold spells also affected the northeastern Middle East, in Persia and Mesopotamia. Seeking an explanation for the pronounced aridity and human consequences across the entire EM, we note that the 10th-11th century events coincide with the medieval Oort Grand Solar Minimum, which came at the height of an interval of relatively high solar irradiance. Bringing together other tropical and Northern Hemisphere paleoclimatic evidence, we argue for the role of long-term variations in solar irradiance in shaping the early MCA in the EM and highlight their relevance to the present and near-term future.