Water shortages often create conflicts between neighbouring states, as in the case of the Middle East. In fact, in that region four elements determine the future development of the water issue: the chronic shortage, the cross-boundary nature of the resource, leading to interdependence in the amount and quality of the water available, the social and economic differences and consequent gaps, and the pattern of political relations often ranging from open to low intensity conflict.

Nevertheless, water may also serve as a key factor in enhancing cooperation. The 1991 Madrid process concluded that the water issue should be divided into two main components. The first one, establishing a base for bilateral relations, deals with the more problematic issues. The other one, dedicated to the multilateral track, identifies problems that could be tackled with through regional cooperation. Following this strategy of parallel tracks, a multilateral working group has been established with the ultimate goal of building up regional awareness and set up the appropriate regional solutions. As a result, some successful projects were developed that might well be applied to other conflictual frameworks.