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The concept of the entrepreneurial ecosystem (EE) has recently attracted a lot of research attention. Despite the growing popularity, there is still a limited theoretical, empirical and conceptual understanding of the phenomenon. The purpose of this study is to explore the role of EE in the high growth SMEs’ internationalisation, specifically in the context of the health technology business in Finland. Due to the limited size of the domestic markets, internationalisation is often the only possibility for these companies to grow their business. In addition to the practical relevance, the topic is also important from the theoretical perspective, since internationalisation has not been addressed adequately in the existing research on EEs. Moreover, empirical studies on EEs are still scarce. This study aims to fill these research gaps by presenting an extensive qualitative explorative study. In total, 19 interviews with health-tech SME’s decision-makers comprising managing directors/chief executive officers and senior managers were conducted during autumn 2019. According to our findings, EE is crucial for high growth health-tech SMEs’ internationalisation, especially in the early phases, but there are also shortcomings in utilizing the EE. EE can enhance internationalisation by providing foreign market entry support, boosting collaboration within the ecosystem, offering various networking opportunities including access to resources and references, and increasing credibility for the high growth SMEs. Overall, this research makes valuable insights into both the theory and practice of EE research. It is among the first attempts to study the role of EE in the high growth SMEs’ internationalisation in the health-tech business and thus provides valuable implications to both academics and business managers.