Although Lebanon has the highest mean annual rainfall of all Middle Eastern countries, it is affected by water stress, negatively impacting agricultural food production, energy generation, and public health. The Bekaa Plain, where the Litani River Basin (LRB) is located, suffers serious water quality and quantity problems, which threaten agricultural productivity and public health. Most of the domestic and industrial water in the basin is left untreated. This study investigates prevailing water management issues in the basin. The analysis provides a critical reflection on the water quality and quantity indicators using Sustainable Development Goal 6 (SDG 6), to 'ensure availability and sustainable management of water and sanitation for all'. Results based on the author's observations and evidence from published reports and papers, since the early nineties, showed the existing management approaches are fall short to mitigate the negative impact of the environmental problems in the LRB, particularly low water quality (indicator 6.3) and inefficient water use (indicator 6.4). Progress on achieving sustainable water management (indicator 6.5) in the LRB is limited. Persistent environmental challenges remain due to weak governance, insufficient capacity, and law enforcement, which must be targeted by a public-private partnership.