Pakistan generates 34,370 tones of excreta per day in wet condition. Karachi alone discharges sewage approximately 300 million gallons per day. The discharged organic load measured in terms of Biological Oxygen Demand (BOD) for Pakistan is 2,265 tones per day. It has been reported that pollution of the Ravi River into which Lahore discharges its untreated waste water has resulted into 5,000 tones of less fish production per year. Effect of sewage on plants and pH range in waste effluents and distribution of plant communities is demonstrated. Pathogenic organisms, which were found in sewage such as viruses, bacteria, fungi, protozoa and metazoa, are listed. The use of sewage in agriculture and their control measures are also discussed.