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The number of regions undergoing water scarcity, where the quantity of available water is not enough to meet human demand, is expected to increase in the future. Water reuse measures have been widely implemented to face these situations as a means of increasing the supply of water resources. Thus, ‘water scarcity – water reuse’ (WS-WR) situations will likely become more common. In these cases, water resources management to secure enough water supply is key. Risk and sustainability concepts have been consolidated as guiding discourses that also support the management of water resources. In particular, in the case of WS-WR situations, they can guide decision-makers towards reducing the risk of water scarcity and striving for the implementation of sustainable water reuse measures. In particular, the use of risk and sustainability assessments helps to deal with various social, economic, and environmental requirements and constraints. However, there is still the call for a more comprehensive and integrated assessments. This dissertation aims at providing new ideas for the integration of risk and sustainability in the case of WS-WR situations. Three objectives guide this research: (A) to develop a conceptual assessment framework to support decision-making concerning sustainable water reuse in regions facing risk of water scarcity; (B) to advance the conceptual framework interrelating existing risk and sustainability assessment methodologies and indicators in the context of decision support; and (C) to test the conceptual and methodological framework using a case study in Latin America. Each objective is associated with a research question: (RQ1) How is decision-making regarding water reuse understood and supported towards reducing the risk of water scarcity sustainably – and how can it be represented in a conceptual assessment framework?; (RQ2) How can a conceptual framework for assessing water reuse as sustainable water scarcity risk reduction measures be operationalised through a methodological framework?; and (RQ3) What are the findings from testing the framework in a case study – and what can be incorporated into the framework? Each objective and its respective research question was addressed as a separate step of the research approach, comprising the development of an integrated Risk and Sustainability Assessment (RSA) Framework for WS-WR situations, its operationalisation and testing. The research approach followed a deductive to inductive rationale relying on qualitative and quantitative methods. The outputs of this research are three scientific publications that build this cumulative dissertation (two published and one submitted for revision). The development of the conceptual framework followed three steps: (i) defining the concepts of ‘water scarcity’, ‘water reuse’, ‘risk’ and ‘risk assessment’, ‘sustainability’ and ‘sustainability assessment’, and ‘decision-making’; (ii) integrating these concepts by interpreting water scarcity from a risk perspective and water reuse from a sustainability perspective, and relating assessments with decision-making; and (iii) structuring the RSA Framework, following a risk assessment and framing it by the social, economic, and environmental dimensions of sustainability. Results allowed defining decision-making in WS-WR situations as a four-step cyclic process that can be supported by an integrated RSA that comprises an analysis (descriptive and objective) and evaluation (subjective). The methodological aspects for the operationalisation of the RSA conceptual framework focused mainly on developing an analytical concept to support an adequate derivation of the information required in an integrated RSA for WS-WR situations. The resulting concept is based on (i) understanding the WS-WR situation as a Coupled Human and Natural System (CHANS) and identifying the main biophysical elements (endpoints); (ii) translating the CHANS endpoints into an information system via a Multi-Layer (ML) approach using generic descriptors and specific indicators; and (iii) identifying and characterising interlinkages between the indicators via a Lane-Based (LB) approach. Additional methodological aspects related to the evaluation include the use of indicator-based multi-criteria decision-making methods that include the weighting and aggregation of these indicators, as well as the selection of threshold values as evaluation criteria. The testing of the integrated RSA Framework was carried out in Cerrillos de Tamaya, Chile. It involved an ex-post RSA of a water reuse measure implemented in 2018 to face the local water scarcity situation. The testing included (i) describing the case study location and adapting the RSA Framework to fit the local context; (ii) translating the case study’s CHANS via the ML approach and identifying and characterising interlinkages via the LB approach; and (iii) evaluating the degree of risk of water scarcity and sustainability of water reuse via the distance-based method TOPSIS. The results of the testing provided feedback for the RSA Framework. These mainly referred to the influence of the conceptualisation behind the indicators and their use, and the methodological challenges for integrating risk and sustainability evaluation. Further recommendations to the RSA framework are: the inclusion of interlinkage directionality; the use of existing system dynamics modelling approaches (e.g., CLD, SFD); the development of an established database of indicators; the automation of the interlinkages analysis (LB approach); and advance the use of scenarios for sustainability evaluation for better coupling with risk evaluation methods. Overall this research provides evidence of (a) the conceptual integration of risk and sustainability discourses under one decision support framework for the case of WS-WR situations; (b) the use of a system thinking approach for interpreting the WS-WR situation; (c) the relevance of indicators as a means of representing the situation; (d) the interlinkage of social, economic, environmental information; (e) the benefits of the use of conceptual maps; (f) gaps in the process of measuring the effect of water reuse on water scarcity levels via indicators; (g) the gap between a simulation-based risk assessment and a snapshot-focused sustainability assessment that hinders an operational integration; (h) the possibility of the RSA framework to bridge a system thinking view with a traditional assessment-based decision-making view.:Acknowledgements Abstract Contents List of Figures List of Tables Acronyms and Abbreviations Symbols Chapter 1 - Introduction 1.1 Background and problem statement 1.1.1 Water resources for water security 1.1.2 Risk and sustainability discourses for water-related decision-making 1.1.3 Problem statement and research focus 1.2 Objectives and research questions 1.3 Research approach and structure of the document 1.3.1 Research approach 1.3.2 Structure of the document 1.4 Chapter references Chapter 2 - Conceptual Framework 2.1 Introduction 2.2 Developing the conceptual framework 2.2.1 Definition and interpretation of the subject at stake 2.2.2 Identification and definition of key concepts 2.2.3 Construction of the conceptual framework 2.3 Results and discussion 2.3.1 Defining and interpreting the ‘water scarcity – water reuse’ situation 2.3.2 Identifying and defining key concepts 2.3.3 Construction of the integrated RSA Framework 2.4 Conclusions and outlook 2.5 Acknowledgements 2.6 Chapter references Chapter 3 - Methodological Aspects 3.1 Introduction 3.2 RSA Framework for a WS-WR situation 3.3 Systems thinking in a WS-WR situation 3.3.1 Identifying elements of a WS-WR situation and its interpretation as a system 3.3.2 Translation of the CHANS into an information system 3.4 Characterisation and interlinkage of indicators 3.4.1 Type and number of indicators 3.4.2 Type and number of interlinkages 3.4.3 Indicator connectivity 3.4.4 Structuring via a lane-based approach 3.5 RSA analytical concept and exemplification 3.5.1 RSA analytical concept 3.5.2 Exemplification of the analyitical concept 3.6 Discussion 3.6.1 Translating the CHANS into an information system 3.6.2 Supporting decision-making via the analytical concept 3.7 Conclusions 3.8 Acknowledgements 3.9 Chapter references Chapter 4 - Framework Testing 4.1 Introduction 4.2 Approach 4.2.1 RSA Framework 4.2.2 Case study site 4.3 Results 4.3.1 Analysis 4.3.2 Evaluation 4.3.3 General results for the case 4.4 Discussion 4.4.1 Analysis 4.4.2 Evaluation 4.4.3 Overall discussion on the testing of the RSA Framework 4.5 Conclusions 4.6 Acknowledgements 4.7 Chapter References Chapter 5 - Synthesis 5.1 Conceptual aspects 5.2 Methodological aspects 5.3 Testing aspects 5.4 Placing the RSA Framework in a broader context 5.5 Chapter References Chapter 6 - Conclusions and Outlook Annexes Annex A - Literature review: Found records Annex B - Example list of endpoints, descriptors, indicators, and attributes Annex C - Technique for Order Preference by Similarly to Ideal Solution (TOPSIS) Annex D - Translation into the Information System (from endpoints to attributes) Annex E - Interlinkages Identification Matrix Annex F - List of Most Interlinked Indicators (MII) Annex G - List of indicators, scores, and thresholds