The management of the Global Navigation Satellite Systems (GNSS) and of the Medium Earth Orbit (MEO) region as a whole is a subject that cannot be deferred, due to the growing exploitation and launch rate in that orbital regime. The advent of the European Galileo and the Chinese Beidou constellations significantly added complexity to the system and calls for an adequate global view on the four constellations present in operation. The operation procedures, including maintenance and disposal practices, of the constellations currently deployed were analyzed in order to asses a proper reference simulation scenario. The complex dynamics of the MEO region with all the geopotential and lunisolar resonances was studied to better identify the proper...