How do states manage water stress? What are the experiences in Southern Africa and the Middle East? How can decision makers be supported in the future? These are some of the questions covered in this study, the outcome of ESCOR Small Grants Research Project R7647. Compiled by a team of researchers from both north and south, the study provides a route through the complex decision-making that is required to manage adjustments to water scarcity in uncertain, risk-prone environments. The answers are not always obvious—and invariably complex. Solutions may have to be found outside the water sector in the form of 'virtual water' imports, yet still have to balance the national and local concerns of livelihoods sustainability and poverty reduction. To achieve more effective, systematic decisions in these environments, FoRWaRD—a decision support model—is presented by the authors.