Water in the Middle East and North Africa region is a source of major social and economic problems stemming from scarcity, variability, unreliable services, and environmental damage. The situation is likely to become even worse in the future, unless current practices change: by 2050 per capita availability will fall by half, water quality will deteriorate further, and more aquifers will become depleted. Climate change is predicted to worsen the problems by increasing temperatures and causing more droughts and floods. While water professionals have been advocating comprehensive water reforms for years and many countries have improved their water policies and institutions, some of the most politically sensitive elements of reform remain untouched. This report suggests that a series of factors are now emerging that represent a potential opportunity to break this impasse. Turning the potential into reality will depend upon three things: - Adopting reforms that respond to the dynamics of the political economy; - Recognizing that water policies cannot act alone, but that water outcomes are often determined by other sectors, such as trade, agriculture, finance, and energy; and - Choosing policies and practices that make government institutions and service providers more accountable to the public. 'Making the Most of Scarcity' will be of interest to readers working in the areas of agribusiness and markets, agriculture, urban and rural development, water supply, and water resources, as well as those responsible for setting policies in the areas of environment, economics, and social protection.