The Galápagos Islands face complex challenges at the intersection of freshwater ecosystems, sustainable water resources use, and public health. The growing population of residents and tourists strains freshwater resources, prompting a critical reassessment of water management and the adverse impacts on the environment. This chapter offers a comprehensive review of scientific literature to assess the current state and future prospects of freshwater ecosystems and wastewater management in the Galápagos Islands. Beyond summarizing existing evidence, it critically analyzes the social-ecological implications of prevailing water management strategies, addressing key knowledge gaps, ecological and institutional constraints, and the urgent need for actionable, science-based solutions. The chapter examines the drivers of freshwater vulnerability and evaluates the diverse responses—both positive and negative—that have shaped water governance in the Galápagos. A central theme is the concept of limits, emphasizing that freshwater resources in the Islands are not only scarce but finite, underscoring the need for careful management in a delicate, ecologically unique environment. Freshwater ecosystems are integral to the broader socio-ecological system, supporting endemic biodiversity, enhancing island resilience, and possessing inherent conservation value. This holistic view stresses their importance beyond merely serving human needs. Finally, the chapter underscores that addressing water-related challenges in the Galápagos Islands, from water scarcity to wastewater management, requires a multifaceted and multidisciplinary approach. This approach must integrate environmental science, biology, hydrology, engineering, and public health, guided by technical feasibility, scientific rigor, and ethical considerations, with a strong emphasis on environmental justice to ensure sustainable water governance for present and future generations in the Galápagos Islands.