Urbanisation and population growth are concentrated on the coast with approximately 40% of the human population living within 100 km of the ocean. The freshwater systems on which coastal urban areas rely are vulnerable to bidirectional pressures including coastal processes such as sea-level rise and coastal erosion coupled with land use changes and pollution occurring in inland catchment areas. These threats are likely to be amplified in the future under climate change conditions and more frequent and severe drought periods are expected to jeopardise already constrained water supply systems. Groundwater is used as a freshwater resource globally and is especially important as a conjunctive supply during drought periods due to perceived buffer capabilities. However, several threats impact coastal aquifers due to over-abstraction, such as salinisation, land subsidence and groundwater flooding and often these subterranean resources are “out of sight and out of mind” when it comes to management strategies. Here, we present an assessment of current issues and management options relevant to coastal aquifers using recent literature. These insights provide knowledge on global issues relevant to groundwater resources, especially regarding water use during droughts. This is exemplified using a South African case study of two metropolitan municipalities that have experienced or are experiencing severe multi-year droughts. Both municipalities have grappled with the depletion of surface water resources, which constitutes the bulk of the local water supply systems. Consequently, groundwater resources have been explored as an augmentation strategy. Although groundwater resources may be useful in alleviating drought effects, it is crucial that a local understanding of the aquifers is developed through baseline hydrological studies and long-term monitoring. Furthermore, unregistered groundwater use needs to be quantified. Finally, a holistic groundwater management view, and the communication thereof, is required to ensure the sustainable management of coastal aquifers.

We present evidence that international trade may exacerbate the initial unequal distribution of hydric resources. This result is driven by the fact that countries exporting agricultural goods are relatively abundant (with respect to capital) in the combined availability of water and arable land but, in absolute terms, scarce in capital and not richer in water in comparison to more developed ones. Due to both the scarcity of capital and the lower relative price of natural resources with respect to capital, the total value of production in these developing countries is modest, implying that international trade can lead to a less even distribution of the water content of consumption. Policies sustaining water prices and, more generally, those of natural resources (or lower capital costs) may contribute to offsetting this effect and allow for trade to play a positive role in reducing the uneven distribution of water endowments.

Early on August 2, 2014, in the city of Toledo, Ohio, a media alert informed the public that traces of microcystin, a hazardous toxin, had been detected in the drinking water. The warning stated that residents should not drink, boil, or even touch the contaminated water. A water crisis of this magnitude was recognized to pose a potentially serious and significant impact on patient care and safety in health care environments. ProMedica Toledo Hospital’s Emergency Operation Plan addressed 3 critical issues: safe water availability, alternate cleaning solutions, and preparations for a prolonged crisis. This report details some of the lessons learned throughout the response to the crisis: particularly, because the impact was county-wide which affected other hospitals who used the same vendors, alternate water sources should have been secured in advance; the courier service was vital to delivery of supplies and moving equipment to alternate areas for sterilization processes; and finally, communication with staff and patients was jeopardized by external media outlets. Changes to the emergency plan considering these unanticipated aspects proved useful in a later incident and should be considered by all health care facilities as water emergency policies and procedures are created and reviewed. (Disaster Med Public Health Preparedness. 2018;12:666–668)