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Water is one of the major environmental concerns in the region as elsewhere. Significant water quality deterioration and water shortages are increasingly common in the Region. Insufficient policy measures in public water supply, over- abstraction and extremely high water loss in conveyance systems are some of the major common issues putting pressure on water resources and are becoming an indispensable part of regional political tension. Limited connection to waste water treatment – and low level of treatment efficiency in existing facilities – in addition to diffuse runoff from agriculture constitute key threats to water quality across the region. Almost all large basins in the Region are transboundary. However, lack of comparable and harmonised data and information, and insufficient expert and institutional capacity, are restricting the countries from undertaking assessments on the state of water resources, trends, pressures and drivers.