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. An increasing number of countries are now approaching full utilization of their surface and ground freshwater and that most of the economically viable development of these resources has been already implemented. 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. 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 full 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. Health and environmental problems are the major obstacles restricting the sustainable and safe re-use and recycle of wastewaters which require concerted efforts supported by regional and international organizations, if real change and beneficial results are to be realized in the near future.