Over the centuries, societies, farmers and communities have developed sustainable practices to cope with insufficient and unpredictable rains and with limited ground water resources. Ingenious solutions have been developed to better conserve and allocate water resources. The Near East and North Africa (NENA) region, one of the most arid areas of the world, has been grappling with water scarcity for thousands of years. It is here, in this region, that irrigation techniques were first introduced, and it is in this region that some of the most fundamental crops for humanity were cultivated for the first time. For a long time, Egypt, for example, was the world's breadbasket for wheat and a major exporter of staple grains. Times have changed. Demographic growth, environmental degradation and climate change — all occurring amid complex geopolitical and economic dynamics — are adding further stress to water resources. At the same time, rapid urbanisation, paired with rising incomes and changing lifestyles, means that the demand for food, and the water to produce this food, will continue to grow. By 2050, the region's population is expected to double and reach nearly 668 million people, of which about 400 million will live in growing cities. These high rates of population growth — about two per cent annually compared to a world average of 1.1 per cent — are putting pressure on already scarce arable land and water resources. The impacts of climate change, such as higher temperatures, changing evapotranspiration patterns and increasing crop water requirements, are already contributing to the deterioration of water availability in the region. In fact, renewable fresh water availability per capita has been fast decreasing over the last five decades, putting considerable pressure on agricultural production and turning the region into one of the largest importers of food, particularly wheat and other cereals. Projections show that the frequency of drought could increase by 20 to 60 per cent by the end of the century compared to current levels. In fact, no other region has been as severely affected by desertification as the NENA region, mostly caused by unsustainable land use patterns, soil erosion, sand and dust storms, deforestation and the overgrazing and rapid degradation of rangelands. Unless action is taken, the region may face heavy economic losses due to climate change-induced water scarcity. All of this is happening in a context where conflicts and instability are taking a heavy toll on the societies and economies in the region. Hunger and poverty are on the rise again. Household food insecurity and undernourishment are concentrated in the poorest and most conflict-stricken nations, with stunting affecting over one-fifth of the region's under-five population. There is an urgent need to act now on the triple challenge of sustainable water management, climate change, and food security and nutrition. A range of solutions, when implemented together, can deliver on these three fronts. The first imperative is to end conflicts so that attention and resources can be concentrated on the 2030 Agenda for Sustainable Development. The second imperative is to achieve greater alignment between the region's food security, water and agriculture, energy and environment policies and make them work more complementarily. The third imperative is to build productive and resilient food systems that generate employment and protect natural resources simultaneously. It is important to move from costly and unsustainable self-sufficiency policies to self-reliance policies, taking advantage of the region's comparative advantages to boost production of nutritious food, such as vegetables and fruit and fish and poultry. It is also important to reduce food losses and waste. It is unacceptable that a region so water scarce and so dependent on food imports loses more than 30 per cent of its food each year. We need to implement and massively scale up tools — which already exist — to improve water use efficiency, increase the availability of water, and allow for strategic planning. Despite its wealth of human and other resources, the region should increase the use of existing technologies in treated wastewater, in water harvesting, in irrigation, and in the monitoring of water consumption. We also need policies and mechanisms that reward farmers who make a more efficient and sustainable use of water. Incentives can be crafted to accelerate the broad adoption of climate-smart agriculture technologies and practices that increase agricultural productivity and improve water efficiency and soils management. The Near East and North Africa Land and Water Days Conference, held from 31 March to 4 April 2019, reviewed the progress made in addressing water scarcity in the region, fostered exchange of knowledge and experience among countries and partners, and charted the way forward taking into account the lessons learned. The countries of the region cannot do this alone. They will need support from partners, including the United Nations system. The UN Food and Agriculture Organisation (FAO) stands ready to support the needed transformation in agriculture and food security policies.