Amidst climate change, coastal cities in Africa will face serious water and sanitation problems owing to the predicted flooding of coastal land and saltwater intrusion into freshwater aquifers. For cities such as Mombasa, the problems will be further compounded by high prevalence of informal economies and settlements superimposed on western style governance systems. Yet, right from colonisation to the present day, the water supply and sewage systems have been characterised by a series of inequalities in access. This review paper, discusses the water and sanitation backlogs in the coastal city of Mombasa, tracing them from the colonial times to the post-colonial period. Against this background, we overview the current situation of the water and sanitation sector in the city and discuss possible sustainable interventions. We argue that any analysis of the water and sanitation challenges must consider the motive of the development of the infrastructure during the colonial times. We conclude that sustainable water and sanitation services are likely to remain a mirage unless the issues of funding, cost recovery, data availability and overall governance are fully addressed. A good understanding of both historical inadequacies and current investments would help in designing sustainable interventions going forward.