The objective of this report is to provide an overview of current knowledge related to the water sector1 across Small Island Developing States (SIDS) of the Pacific region. SIDS face a specific set of water, sanitation, and hygiene (WASH) challenges related to the extreme fragility of their water resources to anthropogenic impacts and climate change, the unique features of their water cycles, lack of scale, and isolation. Many of the modern water management paradigms applied elsewhere need careful reconsideration in that context. Consolidating a review of current knowledge, approaches, and best practices across the region can, therefore, be of high value to stimulate new thinking and prevent duplication of efforts. The reader will find captured in this report the findings and recommendations of development practitioners, researchers, policymakers who have left their mark over the past decades on the water, sanitation and hygiene sector in the Pacific region. Those can in turn help inform the design of future water, sanitation and hygiene development projects and programs, and the scoping of academic work.