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Support for the use of treated gray water as an alternative water resource in the Middle East and North Africa is high, especially given the lack of religious restrictions against its use, but several obstacles have kept application of treated gray water near 1 % in some areas. The largest of obstacles include the cost of treatment and the ambiguity surrounding the health safety of gray water and treated gray water. This paper aims to provide an overview of current gray water practices globally, with specific focus on household-level gray water practices in the Middle East and North Africa region, and highlight the need for cost reduction strategies and epidemiological evidence on the use of household-level gray water and treated gray water. Such actions are likely to increase the application of treated gray water in water-deprived areas of the Middle East and North Africa.