The document identifies 22 issues that impact integrated water resources management in the Caribbean. Some of the key issues discussed include land use planning, comprehensive water resources assessment, water resources planning, abstraction licensing, designated water uses, ambient water quality standards, public water supply, agricultural water management, seasonal variation, flooding, watershed management, water-related ecology, climate change, wastewater management, and public participation. The document suggests that many of these issues pose major challenges to water management in Caribbean countries.