p. 213-255 | Food security and water security in the Mediterranean are intrinsically linked and are facing similar challenges. Food security is threatened mainly by the high dependency of Mediterranean countries on food imports, making them vulnerable to external pressures such as volatile food prices. From a nutritional standpoint, the number of overweight and obese people has increased as a result of the traditional Mediterranean diet being abandoned. Water security has degenerated due to the deterioration of internal freshwater resources, both in terms of water quantity and quality, with a high dependency on external water resources, higher regional water footprints than the global average, increasing scarcity of renewable water resources, an increased number and capacity of dams exerting pressure on freshwater ecosystems, and a growing risk of conflicts between water users and countries. Access to water and sanitation remains a major challenge in the region. Territorial divisions separating coastal urban and remote rural areas are growing stronger, making isolated populations such as smallholder farmers particularly at risk of food and water insecurity. With climate change, precipitation is expected to decrease and temperatures to rise in the region, which will affect water supply (and thereby energy and food supply). It will also directly affect soil moisture and crop growth, thereby further increasing irrigation water needs. There are clear but difficult to measure interactions between the water, energy and agricultural sectors, as they are all interdependent, which calls for integrated policies and management. Agriculture being the largest water user in the region, further efforts need to be made to promote the use of non-conventional water resources. The conservation and restoration of Mediterranean agroecosystems is key to ensuring sustainable development. This requires better management of continuing arable land loss, land use intensification, and soil erosion and salinization. Integrated Water Resources Management and Water Demand Management (WDM) provide guidelines for achieving better water efficiency and reducing conflicts between users.