The Mediterranean region, encompassing both southern Europe and North Africa, is facing significant changes in water resources due to climate and land use alterations. Climate models predict an increase in temperature and a decrease in precipitation by the end of the 21st century, leading to increased stress on natural forests and shrubs, higher water consumption, and altered evapotranspiration and interception processes. These changes will impact surface water balance and the partitioning of precipitation between evapotranspiration, runoff, and groundwater flow. Soil moisture content is expected to decline, and snow accumulation and melting patterns will change, particularly in mid-mountain areas. Land management will see forest and shrub expansion in most Mediterranean mountain areas due to farmland abandonment and grazing reduction, while urbanization and industrial expansion in lowlands will increase water demand. Future scenarios suggest a progressive decline in average streamflow, changes in river regimes, and reduced reservoir inputs and management. These changes highlight the need for improved water management, pricing, and recycling policies to ensure water supply and reduce tensions among regions and countries. The paper reviews the effects of climate fluctuations and land use changes on water resources, emphasizing the importance of understanding these changes for sustainable water management in the Mediterranean region.The Mediterranean region, encompassing both southern Europe and North Africa, is facing significant changes in water resources due to climate and land use alterations. Climate models predict an increase in temperature and a decrease in precipitation by the end of the 21st century, leading to increased stress on natural forests and shrubs, higher water consumption, and altered evapotranspiration and interception processes. These changes will impact surface water balance and the partitioning of precipitation between evapotranspiration, runoff, and groundwater flow. Soil moisture content is expected to decline, and snow accumulation and melting patterns will change, particularly in mid-mountain areas. Land management will see forest and shrub expansion in most Mediterranean mountain areas due to farmland abandonment and grazing reduction, while urbanization and industrial expansion in lowlands will increase water demand. Future scenarios suggest a progressive decline in average streamflow, changes in river regimes, and reduced reservoir inputs and management. These changes highlight the need for improved water management, pricing, and recycling policies to ensure water supply and reduce tensions among regions and countries. The paper reviews the effects of climate fluctuations and land use changes on water resources, emphasizing the importance of understanding these changes for sustainable water management in the Mediterranean region.