Commonalities can be recognized between people living in North Africa and the Middle East in terms of water resources management in urban and rural settings. They all had to adapt to a difficult natural environment and, throughout time, scientific exchanges and migration of populations have facilitated the exchange and adaptation of ideas in this domain. Within this vast area of the world, both for cultural but also for climatic reasons, some similar and also diverse examples of water management systems can be found. This chapter reviews the indigenous water management practices that have therefore emerged from a mixed heritage, following the influences of Greeks and Romans, Arabs and Muslims, Andalusians and Berbers. It shows the multidimensional aspects of indigenous water management practices and their connection to architecture, health, cities, agriculture, spirituality, and ways of interacting with nature.