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The status of treated wastewater reuse as experienced in some Mediterranean Basin countries such as Greece, Israel, Italy and Cyprus is examined. General background information is given for each of these Mediterranean countries, including natural water resources, climatic conditions (temperature, rainfall), generated wastewater, crops cultivated and irrigated with effluent, and related aspects of reuse. The examined parameters include treatment strategies, wastewater reuse standards applied in each country, effluent reuse research in progress in the above target countries related to the treatment technologies, water quality, regulations, economics, public acceptance, risk assessment, benefits, keys for potential success and main constraints. Emphasis has been given to the benefits of treated wastewater reuse in integrated water resources management systems and its role for water cycle management, solving water scarcity issues mainly in arid and semi-arid regions of the Mediterranean basin. The experience presented can be implemented in other water scarce regions around the world.