Water resources scarcity, accessibility, and environmental degradation are the major challenges facing most of the Mediterranean region and especially the southern and eastern Mediterranean countries. Treated and re-used sewage water is becoming a common source for additional water in some water scarce regions. Policies have been formulated but few have had the capacity to implement them in their water management practices in terms of actions to deal with water pollution control and waste disposal. In arid and semi-arid countries, particularly the developing ones, full utilization and re-use of sewage water is still far from the final goal of being used as a water source. Health and environmental problems are the major obstacles restricting the sustainable and safe re-use and recycle of wastewater, which requires concerted efforts supported by regional and international organizations, if real change and beneficial results are to be realized in the near future.