This paper gives an overview of the human and social dimensions of Pakistan’s water policies to provide the basis for water-related policy interventions that contribute to the country’s human development, with special attention being given to the concerns of women and the poor. While Pakistan may not be a water-scarce country, water stress, poor water quality, and inequitable access to water adversely affect large portions of the population. Considerably less water is available in Balochistan and Sindh. This is also the case for people at the tail end of the irrigation distribution system, and for the poor. Though women have a distinct role in water management for domestic and productive purposes, they are hardly represented in user groups. This suggests that water management, rather than water availability, is at the core of Pakistan’s water crisis. The unequal distribution, coupled with population pressure, rapid urbanisation, and increasing industrialisation, poses a serious challenge to water management in Pakistan in the 21st century.