This report examines the relationship between water governance and food insecurity in Small Island Developing States (SIDS). It starts by profiling the socio-economic and biophysical diversity in the SIDS, traces water flows on the islands in terms of volume and quality and identifies the factors that exert pressure on water resources. The report analyses 23 case studies to determine the factors for the success and failure of water policy interventions. It appraises the findings of a survey of water professionals and presents detailed findings of two case studies. Finally, the report provides a road map and action plan for an approach to water governance that can support the food security and nutrition of SIDS.