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Desalination 218 (2008) 2433

Criteria for water recycling and reuse in the Mediterranean countries


F. Brissaud
Hydrosciences, Maison des Sciences de lEau, University of Montpellier II, 34095 Montpellier Cedex 05, France Tel. +33 (4) 67 14 42 74; Fax +33 (4) 67 14 47 74; email: brissaud@msem.univ-montp2.fr

Received 1 February 2006; accepted 27 July 2006

Abstract Though rapid changes are likely to occur, until recently most Mediterranean countries had neither water reuse regulations nor guidelines. Countries where reuse is developing within an organized institutional setting have elaborated and implemented their own regulations or guidelines. Some countries (France, Tunisia) and regions (Andalusia and Balearic Islands in Spain and Sicily in Italy) have adopted a set of water quality criteria based on the WHO guidelines, while other countries (Cyprus, Italy, Israel) elaborated regulations or guidelines close to the more conservative Californias Water Recycling Criteria. Though the need for sharing common regulations or, at least, a common rationale for developing water reuse standards on both sides of the Mediterranean has been acknowledged, this objective does not appear reachable in a near future. Among the factors that might be evoked to explain the dramatic discrepancies in the Mediterranean criteria, the lack of a clear rationale supported by scientifically established data as a solid basis for setting up water reuse guidelines has a major importance. A deterministic approach, such as the one adopted in the draft of Australian National Guidelines for Water Recycling may, despite several drawbacks and uncertainties, pave the way to reach a regional consensus. Keywords: Mediterranean; Regulations; Water reuse

1. Introduction In most countries of the Mediterranean region, wastewater is reused at different extents within planned or unplanned schemes. In many cases, application of raw or insufficiently treated wastewater is still a common practice. In other cases,

wastewater treatment plants are often not functioning or overloaded and thus discharge effluents that are not suitable for reuse applications. In several countries, water reuse is planned; wastewater is submitted to adequate reclamation systems and treated effluents are being reused without any evidence of risk for human health. The

Presented at AQUAREC 2006 Integrated Concepts for Reuse of Upgraded Wastewater, Barcelona, 13 February 2006 0011-9164/08/$ See front matter 2008 Published by Elsevier B.V.
doi:10.1016/j.desal.2006.07.016

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necessity for establishing water recycling and reuse criteria in Mediterranean countries has been reported years ago by Angelakis et al. [1]. Planning water reuse means that the conditions of reuse, including not only wastewater reclamation goals but also reuse practices, monitoring and control measures, have been defined. These conditions are usually stated in recommendations or regulations set up at the national or regional levels. Though rapid changes are likely to occur, until recently most Mediterranean countries (Albania, Algeria, Bosnia and Herzegovina, Croatia, Egypt, Greece, Lebanon, Libya, Malta, Monaco, Morocco, Slovenia and Syria) had neither water reuse regulations nor guidelines. Countries where reuse is developing within an organized institutional framework have elaborated and implemented their own regulations or guidelines. However the standards significantly differ between countries and even within a given country. Some countries (France, Tunisia) and regions (Andalusia, Catalonia and Balearic Islands in Spain and Sicily in Italy) have adopted a set of water quality criteria based on the WHO guidelines [2], while other countries (Cyprus, Italy, Israel) elaborated regulations or guidelines close to the more conservative Californias Water Recycling Criteria [3]. This has led to substantial discrepancies in the standards adopted by Mediterranean countries. Up to now, there are no regulations of water reuse at the European or Mediterranean levels. Nevertheless, as acknowledged in several meetings, there is a need for sharing common regulations or, at least, a common rationale for developing water reuse standards on both sides of the Mediterranean. This need is mainly based on the consideration that: (a) an agricultural Mediterranean market is developing with large amounts of agricultural products (vegetables, fruits, etc.) imported and exported among Europe and other Mediterranean countries; a growing concern of consumers about the food quality and the countries of

which fruits and vegetables come from can be observed; (b) cross-border tourism is an essential part of the economic activity of the region; its development might be jeopardized in the long term by disease outbreaks linked to wastewater mismanagement resulting in especially pollution of bathing water or food contamination. Overcoming the discrepancies between the water reuse standards existing in the region does not mean unifying the national regulations, which would be far too ambitious. Indeed every country is inclined to keep on its own approach, particularly those having already adopted stringent regulations. However, understanding the reasons of the discrepancies between the existing guidelines might clear the way for setting minimum accepted requirements that would guarantee safe water reuse on both banks.

2. Setting up regulations in the Mediterranean Though important differences can be observed from one country to another, the methodologies adopted to set up water reuse standards and regulations share noticeable common features. Setting up health guidelines should be supported by a clear rationale based, whenever possible, on scientifically established data. In this respect, two approaches are essential: epidemiologic investigations and health risk assessment. Owing to the absence or the scarcity of such investigations, national water reuse regulations and guidelines, when they exist in the Mediterranean countries, have been derived from either the California Water Reuse Standards (1978) or the WHO guidelines (1989). These two benchmark standards result from different historical processes and do not have the same objectives [1,4]. California water reuse criteria, though very conservative, are neither based on epidemiological investigations nor on mathematical risk assessment modelling

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data [5], when the WHO guidelines, more liberal, are based on epidemiological and technological evidence available at the end of the eighties concerning health risks associated with wastewater irrigation. The dramatic discrepancies between the benchmark standards are often illustrated by the microbiological water quality requirements for irrigation of food crops eaten raw: when the California criteria stipulate a total coliform content of less than 2.2 CFU/100 mL, WHO recommends a faecal coliform content of less than 1000 CFU/ 100 mL. The option retained by each country, namely imitating the California criteria or the WHO guidelines, reflects its economic development but also its cultural links the place where its experts have been educated seems to have played an important part in the adopted approaches. Several countries, on both banks of the Mediterranean, have considered that guidelines must take the local conditions into account. If, taken as a whole, countries of the North bank are developed, industrialized, more and more equipped with wastewater treatment plants complying with the EU Directive on wastewater disposal [6], the economy of the South bank some countries excepted lags far behind, with poor wastewater management policy, slow wastewater treatment development and endemic diseases linked to the weaknesses of public hygiene. Moreover, farmers of both banks who are the main consumers of recycled water are not always used to pay for water; when they do, the fees cover only a small part of the costs and farmers are more than reluctant to pay more. Setting up water reuse guidelines raises the difficult question of how to share out the additional wastewater treatment costs. Treatment cost augmentation required by the very demanding California regulation seems to have led several countries to significantly relax the State of California Title 22 criteria when deriving their own standards from the Californias one. The choice between the benchmark standards has also depended on the balance between water

resources and needs and on the wastewater management institutional framework. Most groups of national experts have taken care of adapting or altering the chosen benchmark, either owing to the specificities of the national context and concerns, or to introduce some original input, or to take some new popular methodology into account or according to a more pragmatic and realistic approach. For instance, the absence of Salmonella has been introduced in the recent Italian regulation and the last draft of the French recommendations, the absence or a limit for Taenia eggs content in the last drafts of the French recommendations and the Spanish regulations. The criterion for Legionella spp. in the Spanish draft reflects the growing concerns related to this emergent pathogen in several countries. The introduction of pathogens in guidelines and regulations reveals that the experts are less and less confident in the traditional feacal indicators; however this distrust is not supported by scientific evidence obtained from water reuse monitoring. Setback distances included in several guidelines and regulations are variable, not always taking the water quality and the irrigation system into (proper) account. The impact of the economic conditions and the institutional framework has been already mentioned; as an example, the reluctance of the governmental National Office for Sanitation, which owns and operates all the wastewater treatment plants of Tunisia, to pay for more than secondary treatments explains the absence of regulation for unrestricted water reuse and the still enforced prohibition of the irrigation of vegetables with reclaimed water. The Israelian regulation, the result of a long experience of water reuse planned at the national level, appears as a masterpiece of pragmatism. As demonstrated by the heterogeneity of the criteria and the limits set for each criterion, the elaboration of water reuse guidelines and regulations in the Mediterranean has not, up to now, involved much science. The standards that have been proposed appear as the result of compromises

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elaborated between experts of the concerned ministries, the academic institutions and the water industry. The lack of scientific support, together with the dramatic discrepancies between the benchmark standards, explains that, in several countries, drafted regulations have not been officially approved many years after their elaboration. The concerns raised by any new emergent pathogen seem to be able to call these drafts into question. Examples of regulations and guidelines officially approved or not, are given here below, mainly referring to their microbiological standards. Though this distinction is not always fully consistent, they are classified as conservative or liberal, owing to the benchmark from which they have been originally derived. 3. Conservative standards The earliest and most conservative regulation as regarded the microbiological requirements of water reuse for irrigation in Europe was issued in 1977 in Italy. It stated that the total coliform content should not exceed 2 and 20 CFU/ 100 mL for respectively unrestricted and restricted irrigation, which reflected the requirements of the State of California Title 22 Water Recycling Criteria. Even with such a high quality water, a buffer strip of 80 m between the irrigated area and roads and houses was imposed. On June 12th, 2003, a new set of regulations was published (Ministry Decree, D.M. n. 185/03). Microbiological targets, though alleviated, are still stringent, with an E. coli content of less than 10 UFC/100 mL whatever the plants irrigated and the irrigation system. This limit is relaxed at 50 and 100 UFC/100 mL when the reclaimed water is supplied from respectively constructed wetlands and stabilization ponds. In every case, no Salmonella should be found in the irrigation water. Moreover, a long series of physical and chemical parameters should be monitored, the criteria for many of them being similar to the requirements for potable water.

Though providing adjustments to take a diversity of uses into account, several requirements of Cyprus regulations may also be regarded as conservative (Table 1). The irrigation with reclaimed water of vegetables to be eaten uncooked and of ornamental plants for trade is not allowed. For cooked vegetables and amenities of unlimited public access, the microbiological criterion is: faecal coliforms 50 CFU/100 mL, which is less restrictive than the total coliform content 2.2 CFU/ 100 mL of the State of California Title 22 but more stringent than the WHO guidelines. Other microbiological criteria, ranging from faecal coliform content of 200 CFU/100 mL to 3000 CFU/100 mL, reflect a risk hierarchy perception and an attempt to bring the regulation closer to the technical and economical context of the island. However, as for other countries, these standards are not based on risk assessment investigation. On another hand, they do not take the irrigation system into account. The Israelian regulation, as established by the Halperin committee for the Ministry of Health in 1999, is based on the multiple barrier concept. Barriers are measures or crop characteristics that allow diminishing health risks. The types of barriers taken into consideration are sand filtration, long retention times in ponds and reservoirs, effluent ratio limited to 10% of the irrigation water, effluent disinfection, distance of the harvested part of the crop from drip irrigation, plastic mulching, subsurface irrigation, inedible pill or shell and vegetables only eaten cooked. Each type of barrier account for 13 barriers, depending on the crop considered. The number of barriers required depends on the quality of the irrigation water. Four qualities are considered: (a) Irrigating with very high quality effluent does not require any barrier. Very high quality effluent should contain less than 10 E. coli /100 mL and more than 1 mg/L of residual chlorine. (b) High quality effluents require 2 barriers. These effluents are produced by biological-mechanical treatment works or equal value treatment

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Table 1 Quality criteria for irrigation with reclaimed water in Cyprus (1989)
Irrigated crops All crops (*) BOD5 (mg/L) A 10(a) 10(a) 15(b) 20(a) 30(b) 20(a) 30(b) 50(a) 70(b) SS (mg/L) 10(a) 10(a) 15(b 30(a) 45(b) 30(a) 45(b) Faecal coliforms Treatment required (MPN/100 mL) 5(a) 15(b) 50(a) 100(b) 200(a) 1000(b) 200(a) 1000(b) 1000(a) 5000(b) 1000(a) 3000(a) 10000(b) 3000(a) 10000(b) Secondary, tertiary and disinfection Secondary, tertiary and disinfection Secondary, storage >1 week and disinfection or tertiary and disinfection Stabilization-maturation ponds total retention time >30 days or secondary and storage >30 days Secondary and storage >1 week or tertiary and disinfection Stabilization-maturation ponds total retention time >30 days or secondary and storage >30 days Secondary and disinfection Stabilization-maturation ponds with total retention time >30 days or secondary and storage >30 days

Vegetables eaten cooked (**) A Amenity areas of unlimited public access Crops for human consumption. A Amenity areas of limited public access B Fodder crops A B Industrial crops A B

A: Mechanized methods of treatment. B: stabilization ponds. (a) These values must not be exceeded in 80% of samples per month, minimum number of samples 5. (b) Maximum value allowed. (*) Irrigation of leaved vegetables, bulbs and crops eaten uncooked is not allowed. (**) Potatoes, beetroots, colocasia.

works; the criteria to be met by these treatments are BOD5 20 mg/L and SS 30 mg/L. (c) Medium quality effluents require 3 barriers and are not suitable to irrigate vegetables. These effluents are produced by treatment works such as aerated ponds and overloaded biologicalmechanical treatment works which do not meet the BOD5 20 mg/L and SS 30 mg/L criteria; however, BOD5 and SS should not exceed respectively 60 and 90 mg/L. (d) Oxidation pond effluents: irrigation of fruits, or crops with the same (or lower) sensitivity, with effluents from an oxidation pond that accepts only domestic wastewater, with at least 15 days of retention time, would be possible

with two barriers. When the retention time is at least 10 days, 3 barriers are required to irrigate fruits. The microbiological criterion for unrestricted irrigation is the same as in the Italian regulation: E. coli content 10 CFU/100 mL. However, relying on the multiple barriers concept offers much more opportunities of reusing reclaimed water at affordable costs. Several types of barriers long retention times in ponds and reservoirs, drip irrigation, plastic mulching, subsurface irrigation are measures that are also required for saving water resource in arid or semi-arid countries.

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4. Liberal standards Following the publication of the WHO guidelines, several countries or regions have adopted regulations or recommendations that can be classified as liberal. In Tunisia, wastewater reuse in agriculture is regulated by a 1975 Water Law and a 1989 decree [7]. The Water Law prohibits the use of raw wastewater in agriculture, which is consistent with the development of wastewater treatment works in the country. It also prohibits the irrigation of any vegetable to be eaten raw with reclaimed water, whatever its quality. Thus the 1989 decree specifically regulates restricted reuse of wastewater in agriculture. The use of secondary treated effluents is allowed for growing all types of crops except vegetables, whether eaten raw or cooked. This prohibition was not driven by a conservative approach; it was the consequence of the reluctance of public authorities to afford for tertiary treatments that would allow unrestricted irrigation. The reclaimed water quality criteria for agricultural reuse were developed using the FAO guidelines [8], the WHO guideline [2] for restricted irrigation (<1 helminth ova per litre), and other Tunisian standards related to irrigation or water supply. As happens in many Mediterranean countries, EU countries included, water reuse is not yet officially regulated in France. However, Recommendations about the use, after treatment, of municipal wastewater for the irrigation of crops and landscape areas have been drawn up by the National Council for Public Health (CSHPF) in 1991. Representatives of the Ministry of Health currently used these recommendations to authorize water reuse projects. These recommendations refer to the A (nematode egg content <1/L, faecal coliform content <1000 cfu/100 mL), B (nematode egg content <1/L, no bacteriological criterion) and C (no microbiological criterion) categories of water reuse defined by the World Health Organisation guidelines [2]. But, as stressed by Bontoux and Courtois [9], additional requirements on irriga-

tion management and the prevention of health risks related to human exposure made the first French recommendations more stringent than the WHOs guidelines. For instance, irrigation of vegetables to be eaten raw with quality A water is allowed, but methods that reduce the direct contact of irrigation water with vegetables and fruits are highly recommended. Irrigation of public green spaces with the same quality of water is tolerated, provided it is done by short range sprinklers outside opening hours. Also, sprinklers should be more than 100 m apart from houses, sports and recreational areas. This last requirement applies also to aspersion of cereal, fodder crops, nurseries, with B quality water. The most prominent restrictions added to the WHOs guidelines apply to aspersion. Reuse of C quality water by drip or underground irrigation is limited to areas closed to public access. Though no detrimental health impact resulting from the implementation of the projects authorized according to the recommendations of the CSHPF was ever detected, these recommendations are under revision. According to the last draft, worked out in 2000, the new regulation is likely to be more stringent than the 1991s guidelines. The main changes are as follows: performing a secondary treatment before any irrigation reuse will be mandatory; four water reuse categories will be introduced, instead of three in the WHOs guidelines: (a) A (E. coli content <103 CFU/100 mL, no Salmonella, no Taenia egg): irrigation of vegetables and small fruits to be eaten raw, irrigation of pastures, aspersion of fruit trees, public parks, sports areas and golf courses, (b) B (E. coli content <103 CFU/100 mL): irrigation of vegetables and small fruits to be cooked or pasteurized, aspersion of flowers, nurseries, cereals and fodder crops, (c) C (E. coli content <104 CFU/100 mL): irrigation with the exception of aspersion

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of flowers, nurseries, cereals and fodder crops, (d) D (no microbiological criterion): irrigation with the exception of aspersion of forests with public restricted access. Restrictions on aspersion will be maintained, diversified and adjusted, to some extent, to the water quality. Another example of standards inspired by the WHOs guidelines are the quality guidelines for water reuse adopted in Andalusia which reflect the acute and recurrent water scarcity experienced in this Spanish region (Table 2). The Spanish last draft, which addresses a wide range of applications, is one of the most comprehensive proposals of water reuse regulations elaborated in Europe (Table 3). Indeed, due to severe water shortage, planned water reuse is developing rapidly in Spain with an increasing diversity of applications and competing with seawater desalination to augment the available water resources. Very strict criteria are proposed for residential uses while more liberal standards, close to the WHO unrestricted guideline, would apply for urban reuses and facilities, greenhouse irrigation, irrigation of vegetables and water supply to ponds for recreational purposes where public contact with the water is allowed. Requirements for
Table 2 Quality guidelines for water reuse in Andalusia

the fodder irrigation, with an E. coli content 1000 CFU/100 mL, are much more stringent than the corresponding WHO guideline though more liberal than the 23 total coliform/100 mL of the California title 22. Aquifer recharge, direct and indirect, and aquaculture are also taken into account. The most innovative side of this proposal is the introduction of pathogens, Taenia saginata, Taenia solium and Legionella spp. in the criteria. Owing to recent severe outbreaks, monitoring Legionella spp. is likely to be required for urban applications in France. As a whole, this draft conveys the risk hierarchy as it is perceived by the Ministry of the Environment, with the ambition to provide affordable opportunities of saving water resources. The proposal elaborated by Tsagarakis et al. [10] and the Spanish draft are converging in many aspects (Table 4). This means that both countries may converge towards a common perception of the risks related to water reuse and the criteria allowing minimizing these risks to an acceptable level. 5. Conclusion Several factors that explain the dramatic discrepancies in the Mediterranean regulations of water reuse have been found in their elaboration

Type of application Irrigation of sport fields and parks with public access Vegetables to be consumed raw Production of biomass intended for human consumption and refrigeration in open circuits Recreational lakes Refrigeration in semi-closed circuits Industrial crops, cereals, dry fodder seeds, forests and conserved or cooked vegetables Irrigation of green areas with no public access, production of biomass not intended for human consumption and impoundments with access prohibited

Faecal coliforms/100mL <200 <1000 <1000 <2000 <10,000 None None

Nematode egg/L <1 <1 None <1 None <1 None

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Table 3 Planned Spanish standards for the reuse of treated effluent (Associacin Espaola de Abastecimiento de Agua y Saneamiento, 2005)
Uses of reclaimed wastewater Residential uses Urban uses and facilities Greenhouse irrigation Irrigation of vegetables Irrigation of fodder Watering of crops eaten cooked Irrigation of industrial crops Irrigation of wooden areas Industrial cooling Ponds, etc. for recreational purposes (public contact allowed) Ponds, etc. for recreational purposes (public contact is not allowed) Aquifer recharge: localized percolation Aquifer recharge: direct injection <1/L <1,000 <35 No limit set Taenia saginata and T. solium <1 egg/L Nematode eggs1 <1/10 L <1/L E. coli (cfu/100 mL) 0 <200 SS (mg/L) <10 <20 Turbidity (NTU) <2 <10 Legionella spp. 100 cfu/100 mL Other criteria

<1/L <1/L No limit set <1/L No limit set <1/L <1/L

<10,000 No limit set <10,000 <200 <10,000 <1,000 0

<35 <35 <35 <35 <35 <35 <10

No limit set No limit set 15 No limit set No limit set No limit set <2

Legionella spp. <10 cfu/100mL

Total nitrogen <50 mg/L Total nitrogen <15 mg/L

process and, particularly in the reference to the benchmark standards, i.e. the State of California Title 22 criteria and WHO guidelines. Beyond these factors, the lack of a clear rationale supported by scientifically established data as a solid basis for setting up or adapting water reuse guidelines explains the heterogeneity of the Mediterranean guidelines and regulations. Most guidelines and regulations reflect more a perception of a risk hierarchy which differs from one country to another than scientifically based risk assessments. Therefore, some doubts might be introduced on the consistency of the reuse criteria and their ability to provide an efficient protection to the public

health and the environment. As a result, governments may be tempted to turn towards the most conservative and costly regulations or to prioritize other resources, such as seawater desalination. Two conditions should be fulfilled to increase the credibility of water reuse guidelines and regulations and, at the same time, facilitate the reduction of the discrepancies between the regulations adopted by Mediterranean countries. (a) The first one is the harmonization of healthbased guidelines related to different water uses. Water reuse guidelines should be part of a set of consistent water regulations applying to drinking water, bathing water, irrigation and

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Table 4 Proposed minimal criteria for reuse of reclaimed wastewater in Greece [10]
Water quality criteria I.N. 0.1 eggs/L FC 10 cfu/100mL SS 10 mg/L Tb 2 NTU I.N. 1 egg/L FC l00 cfu/100mL SS 20 mg/L 1 NTU I.N. 1 egg/L FC 1000 cfu/100mL SS 35 mg/L I.N. 1 eggs/L FC 10,000 cfu/100 mL SS 35mg/L
c d

Recommended uses (a) Residential areas with high public contact (b) Toilet flushing and air conditioning (c) Car washing (d) Direct injection to the groundwater (a) Ponds, bodies of water, and streams with high public contactc,d (b) Fountains and other recreation places (c) Streets cleaning and fighting (d) Irrigation of vegetables to be eaten uncooked (a) Irrigation of fodder crops for livestocke, crops for canning, vegetables to be eaten cooked, plant nurseries, etc. (b) Aquaculture (c) Groundwater recharge (by surface spreading)g (a) Irrigation of wooden areas, industrial wooden areas, greenbelts, and areas where the public is not allowed to enter (b) Industrial use (except for food industry)h (c) Ponds, bodies of water and streams where the public contact is not allowed

Limits for T are not applicable Limits for NO3 should be required e Limits for Taenia sp. (< 1 egg/L) should be required g Minimal depth of 5 m is required h Limits for Legionella pneumophila should be required for industrial cooling.

discharge in the environment. Guidelines on water reuse and other water exposures (e.g. drinking water and recreational water contact) should assure equivalent protections. (b) The second is that setting up health guidelines should be supported by a methodology based on epidemiologic investigations and quantitative microbiological health risk assessment (QMRA). In this respect, the deterministic approach adopted in the draft of Australian National Guidelines for Water Recycling and Reuse [11] is, despite some methodology limitations, a major breakthrough in the methods implemented for the elaboration of reuse guidelines. Its mathematic formulation should allow a more efficient dialogue between the countries and significant progress in the adop-

tion of common policies. In the same time, it makes easier pointing out the uncertainties attached to the relationships between the microbial quality of the reused water and heath risks and, by the way, stressing the research needed to reinforce the scientific basis of reuse guidelines. The WHO guidelines for the safe use of wastewater in agriculture have been recently revised according to the same principles; this work was also based on an updated and comprehensive review of epidemiological investigations and QMRA results [12,13]. This revision should help revitalize the dialogue between European and Mediterranean countries and pave the way towards a regional consensus.

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cree No. 89-1047 regulating the use of reclaimed water for agricultural purposes, 1989, (in French). R.S. Ayers and W. Westcot, Water quality for agriculture, Food and Agriculture Organization of the United Nations, FAO Irrigation and Drainage, Paper 29, Rome, Italy, 1985. J. Bontoux and G. Courtois, Wastewater reuse for irrigation in France. Wat. Sci. Tech., 33(1011) (1996) 4549. K.P. Tsagarakis, G.E. Dialynas and A.N. Angelakis, Water resources management in Crete (Greece) including water recycling and reuse and proposed quality criteria. Agr. Water Manag., 66(1) (2004) 3547. Natural Resource Management Ministerial Council and Environment Protection and Heritage Council, Australia. National Guidelines for Water Recycling. Managing Health and Environmental Risks, 2005. L. Fewtrell and J. Bartram, eds., Water Quality Guidelines, Standards and Health: Assessment of Risk and Risk Management for Water-Related Infectious Disease. IWA Publishing, 2001. World Health Organization. Guidelines for the safe use of the wastewater, excreta and grey water; vol. 2: Wastewater use in agriculture. WHO, Geneva, Switzerland, 2006.