Reuse of treated wastewater is not only environmentally and financially sound, it is becoming indispensable for meeting the staggering water demand in certain regions, especially under conditions of alarming water scarcity. Reusing treated wastewater will help in reducing the pressure on expensive desalinated water production and depleting groundwater withdrawal, thereby reducing associated harmful environmental impacts. Reuse of wastewater in general and in the countries of the Gulf Cooperation Council (GCC) in particular has been a priority research area and has been in the media spotlight for some time, especially the use of tertiary quality water resources for agricultural purposes. However, reuse of treated wastewater is still in its primitive stage in terms of implementation in GCC. In addition, the overall volume of tertiary treated water that outflows unutilized to the sea is much greater than the volume reused. This paper provides a general review of and statistics on current practices of treatment of domestic wastewater in the GCC. The review highlights water resources, sanitation service coverage, wastewater treatment, effluent types, treated and reuse quantities, costs, and tariffs. The paper provides recommendations to improve wastewater treatment in the GCC to alleviate the stress on the scarce groundwater resources, provide a relatively inexpensive alternative to desalination, reduce the environmentally adverse impacts and externalities of desalination plants, and eliminate the discharge of untreated wastewater in coastal areas or terrestrial landfills.