The Mediterranean Region exhibits significant contrasts in its demographic and hydrologic features that have shaped the water management policies of the Mediterranean countries. Although awareness is raising with respect to sustainable water management, the extent to which it is applied in practice is debatable. Use conflicts and non-renewable water extraction in water scarce part of the region like the Southern and Eastern rim countries are exposed as overriding management issues. Furthermore climatic variations are superimposed on natural hydro-stress and water dependency on external resources in most of the cases. Decision-making process needs measurable, comparable and reliable tools in order to be able to make trade-offs when facing conflicting issues. Indicators are valuable tools for understanding the trends and challenges encountered in water resources management. The Contracting Parties to the Barcelona Convention adopted, in November 2005, the Mediterranean Strategy for Sustainable Development (MSSD). Integrated water resources and demand management constitute the first priority among the range of actions of the adopted strategy. Increasing efficiency by reducing losses and wasteful use is expected to help stabilise water demand in the Southern and Eastern part of the Mediterranean countries. In this paper, an assessment of the existing water management concepts and policies in Mediterranean countries will be presented based on sustainable development indicators related to water management.