Traditional water distribution and irrigation systems have been used in the Middle East in agriculture for thousands of years. The main objectives of the study are to investigate positive and negative environmental and social impacts of such traditional methods in three countries of the Mediterranean (Sudan, Yemen, and Palestine). To achieve these objectives, field visits, observations, interviews, and questionnaires were used. The results showed the presence of five main traditional water distribution systems in the three areas. Differences in the existing systems were attributed to farmers' education level, experience, and degree of water scarcity in the area (50% of the educated farmers, more experienced farmers and water scarcity areas are adopting modern irrigation techniques, especially in Palestine). Preserving existing natural habitat and strengthening of social ties and relations between farmers were among the positive environmental impacts of such old methods. Water losses through high evaporation (about 40% water loss), seepage and water pollution were among the negative impacts. Proper planning and control, especially by public institutions, and programs for environmental awareness are some necessary actions to minimize the negative impacts in such traditional water societies. Such suggested measures are specifically important to be adopted whenever modern methods of water distribution (pipelines) and irrigation (drip irrigation) are intended to be applied.