<p>Precipitation variability in North Africa, one of the most water-scarce and climate-sensitive regions globally, exhibits pronounced spatial and temporal changes driven by both natural variability and anthropogenic climate forcing. This review synthesizes current knowledge on precipitation variability across North Africa from the early Holocene to future climate scenarios. We identify key atmospheric drivers, including synoptic-scale weather systems and large-scale teleconnections, as central controls on precipitation variability and extremes. Contrasting trends between the Mediterranean and Saharan regions, coupled with strong interannual variability, influence the frequency and severity of hydrological extremes, with implications for agriculture, water resources, hydropower production, and ecosystems. Future projections consistently indicate drying along the Mediterranean coast, whereas parts of the Sahara may experience relative precipitation increases that may permit localized increases in vegetation activity, although uncertainties remain substantial. We highlight persistent knowledge gaps, particularly regarding dust–precipitation interactions, and emphasize the need for integrated observational, modelling, and process-based approaches to improve future assessments and support climate adaptation.</p>