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The present paper provides an extensive literature review on water related health issues in Central Asia. Even though the per capita amount of available freshwater is substantial in all Central Asian states the uneven distribution in time and space creates problems for water availability. Due to this, the Central Asian economies are developing under increasing water deficiency. The degradation of water supply systems and sewage treatment plants is often severe leading to potentially high water loss rates and inadequate accessibility to safe water supply. In this context, rural areas are the most affected. Low tariffs in combination with absent metering and low collection rates for water fees mean that operation and maintenance costs for basic services of water supply and sanitation are not covered. Unsafe water supply contains both microbiological and non-microbiological contaminants. Helminthiasis and intestinal protozoa infections are of considerable public health importance in Central Asia. Agricultural and industrial pollution is especially affecting downstream areas of Amu Darya and Syr Darya rivers. In large areas copper, zinc, and chromium concentrations in water exceed maximum permissible concentration. Thus, there is an urgent need to strengthen the environmental monitoring system. Small-scale water supply and sanitation systems need to be developed in line with more efficient public spending on these.