Future scenarios for water resources in the Mediterranean region suggest (1) a progressive decline in the average streamflow (already observed in many rivers since the 1980s), including a decline in the frequency and magnitude of the most frequent floods due to the expansion of forests; (2) changes in important river regime characteristics, including an earlier decline in high flows from snowmelt in spring, an intensification of low flows in summer, and more irregular discharges in winter; (3) changes in reservoir inputs and management, including lower available discharges from dams to meet the water demand from irrigated and urban areas. Most reservoirs in mountain areas will be subject to increasing water resource uncertainty, because of the reduced influence of snow accumulation and snowmelt processes. Besides, reservoir capacity is naturally reduced due to increasing sedimentation and, in some cases, is also decreased to improve the safety control of floods, leading to a reduction in efficiency for agriculture. And (4) hydrological and population changes in coastal areas, particularly in the delta zones, affected by water depletion, groundwater reduction and saline water intrusion. These scenarios enhance the necessity of improving water management, water prizing and water recycling policies, in order to ensure water supply and to reduce tensions among regions and countries.