The climatic condition in Ethiopia is semi-arid and this has implications especially for rural communities in the country that are largely dependent on surface water. In water scarce areas across four districts in the Tigray region, a survey of 595 households was carried out, and two shared dialogue workshops was held. In this study, the following issues were examined: (i) Access to water in relation to sources, distances covered, gender and time taken; (ii) Local perceptions on current (2014-2017) and future (2018-2021) access to water, and (iii) The types of water conflicts encountered and their causes. Results indicate 50.8% of the surveyed households collected water from dugout ponds and 24% from rivers. Chi-square test showed a statistical significance at the 1 and 5% level, respectively for distance covered and time taken to water sources. Although gender was not significant statistically, females (N=440) were more involved than males (N=155) in fetching water. Immediate problems arise for householders and specifically women and girls that travelled more than 2 km to collect water. Climate change was mentioned as the key driver that reduced access to water resources whereas tanks with water brought in truck by the government was reported as reason for current increase in access to water. However, future access to water was perceived as unpredictable due to the impacts of climate change. At least 40% of households reported that a member had encountered conflict while accessing water, conflict that manifested itself as verbal accusation and physical fighting. The majority of such instances of conflict resulted from water shortage, followed by pollution from livestock droppings. Project interventions that promote watershed rehabilitation through different ecosystem-based adaptation approaches should be supported locally to restore nearby degraded water sources while improving the functionality of boreholes and existing taps to ensure access and sustainability of water infrastructures.