This document summarizes Gerard A.M. de Fraiture's contribution to an international seminar on sustainable domestic wastewater treatment in urban areas. Conventional wastewater treatment systems in western countries are not very sustainable. Research shows that anaerobic treatment, which mimics natural biological processes, is more sustainable as it recovers energy and nutrients in a decentralized manner. Promising technologies like upflow anaerobic sludge blanket reactors and recent algae technologies follow principles of separating solids from liquids and minimizing water use for transport. Simple, robust, affordable technologies at small scale can create jobs and economic opportunities while achieving sustainability goals.