A total of 3,368 athletes (2,183 men and 1,185 women) from 23 National Olympic Committees (NOCs) participated in the Games.

The Games "were designed specifically to bring together the Muslim and European countries surrounding the Mediterranean basin" to promote understanding through sporting competition.

[1][2] The first edition of the Mediterranean Games was held in the Egyptian city of Alexandria in 1951, attracting 734 competitors from 10 nations.

[3] Pescara was elected as the host city for the 2009 Mediterranean Games on 18 October 2003 in Almeria, Spain, defeating bids from Rijeka and Patras.

Former Prime Minister of Croatia and the president of the Croatian Olympic Committee Zlatko Mateša expressed his disappointment: "It just shows, once again, that small countries have no chance of competing with the big ones".

The Croatian bid was supported by the president and CEO of Formula One Management and Formula One Administration Bernie Ecclestone, 1992 Olympic bronze medallist in tennis Goran Ivanišević and 1998 FIFA World Cup Golden Shoe Award winner Davor Šuker.

[6] The committee's board of directors consisted of politicians, IOC members from Italy, and presidents of the various Italian sports governing bodies.

[8] A few weeks before the Games on 18 May, Sabatino Aracu resigned from his post of the president of the organising committee in order to allow its dissolution, which according to him was "incapable of taking urgent measures".

[11] The official logo of this edition of the Mediterranean Games featured simple graphical illustrations of mountains and sea of the Abruzzo region.

The official mascot was a Marsican brown bear, called Aua', wearing a diving mask and flip-flops with swimfins in his hands.

The obverse features the Games logo, stylised shape of an athlete posed to plunge into the waves, with the inscription "Pescara 2009" and XVI Jeux méditerranéens in French and the ICMG logo at bottom—three interlocking rings, representing Africa, Asia and Europe.

[19][20] The village was designed according to modern architecture and was said to have adopted green features like solar water heating.

Key facilities such as a restaurant, medical centre, and a conference hall with a seating capacity of 800 people were hosted there.

[19][20] In the following calendar for the 2009 Mediterranean Games, each blue box represents an event competition, such as a qualification round, on that day.

[56] Opening ceremony was held on 26 June, and on the same day Tunisian weightlifter Khalil El-Maaoui won the first gold medal of the Games in the men's 56 kg event.

[57][58] The opening ceremony officially began at 9:00 pm Central European Summer Time (UTC+02:00) on 26 June in the Stadio Adriatico.

[63][64][65][66] The cultures of Abruzzi Region and Mediterranean were highlighted in the two-and-a-half hours long opening ceremony.

[64] Italian musician and singer-songwriter Eros Ramazzotti sang "L'orizzonte" from his 2009 studio album Ali e radici.

The Mayor of Pescara, Luigi Albore Mascia, then handed the Mediterranean Games flag to the president of the International Committee for the Mediterranean Games, Amar Addadi, who in turn passed it to Aleksandros Voulgaris, the Mayor of Volos.

[103] The closing act of the ceremony was the romanza of Mario Cavaradossi "E lucevan le stelle", performed by local pop singer Piero Mazzocchetti, who was specially chosen for this purpose by the president of the organising committee Sabatino Aracu.

Spanish swimmer Aschwin Wildeboer set a new world record in 100 metres backstroke.

All but one of the 24 National Olympic Committees that were member of the ICMG, as of 2009, participated in the Pescara Games, the exception being Republic of Macedonia.