The human rights aspects of water and sanitation management have become increasingly salient in recent years. The 2010 recognition by the UN General Assembly and Human Rights Council of a human right to safe drinking water and sanitation, and the 2015 recognition of sanitation as an independent right, galvanized political will and strengthened the legal interpretation of the International Covenant of Economic, Social and Cultural Rights by the Committee on Economic, Social and Cultural Rights in its General Comment 15. The human rights to water and sanitation influenced the 2030 Development Agenda and the indicators for Sustainable Development Goal 6 on water. However, tensions exist between human rights and development paradigms. This chapter explores these conflicts through an examination of hot-button issues, including: privatization and commodification debates; the extraterritorial application of the rights to water and sanitation; emerging norms on business and human rights; and controversies over large dams. The human rights to water and sanitation present an important case study for understanding the challenges of reconciling human rights and development goals.