Settlement patterns and social structures have been shaped by access to water since the onset of human societies. This review covers historical and recent examples from Cambodia, Central Asia, India, Latin America and the Arabian Peninsula to analyze the role of water resources in determining the rise and collapse of civilizations. Over recent decades increasing globalization and concomitant possibilities to externalize water needs as virtual water have obscured global dependence on water resources via telecoupling, but rapid urbanization brings it now back to the political agenda. It is foremost in the urban arena of poorer countries where competing claims for water increasingly lead to scale-transcendent conflicts about ecosystem services. Solutions to the dilemma will require broad stakeholder-based agreements on water use taking into account the available data on water resources, their current and potential use efficiency, recycling of water after effective treatment, and social-ecological approaches of improved governance and conflict resolution.