Mediterranean region, especially the southern and eastern countries are facing major challenges related to water resources scarcity, accessibility, and environmental degradation. Treated and re-used sewage water is becoming a common source for additional water in some water scarce regions and many countries have included wastewater re-use in their water planning. Agricultural reuse of wastewater have to be integrated into comprehensive land, and water management plans taking into account water supply, wastewater collection, reclamation, and reuse. 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, the fulI utilization and re-use of sewage water is still far from our final goal, i.e. to be used as a water source, in spite of the vital role it could play in reducing the high pressure imposed on the limited available freshwater.