Water scarcity in the Arab region is intensifying due to population growth, economic development, and the impacts of climate change. It is manifested in groundwater depletion, freshwater ecosystem degradation, deteriorating water quality, low levels of water storage per capita, and added pressures on transboundary water resources. High-income Arab countries have sought to circumvent the ever-present challenges of water scarcity through agricultural imports (virtual water trade), desalination, and, increasingly, wastewater reuse. In this review article, we argue that the narrative of water scarcity and supply-side technological fixes masks more systemic issues that threaten sustainable water management, including underperforming water utilities, protracted armed conflict and displacement, agricultural policies aimed at self-sufficiency, evolving food consumption behaviors, the future of energy markets, and educational policy. Water management challenges, particularly on the demand side, and responses in the Arab region cannot be understood in isolation from these broader regional and international political and socioeconomic trends. Recognizing the complex and interdependent challenges of water management is the first step in reforming approaches and shifting to more sustainable development outcomes and stability in the Arab region and beyond.