The rules and regulations stipulated by the WHO Framework Convention on Tobacco Control apply to all tobacco products. This will therefore include tobacco consumed through use of the water pipe, or shisha, a traditional form of smoking common to the WHO Eastern Mediterranean Region. The regulation of tobacco products includes health warnings, information about contents and emissions, as well as packaging and labeling. This publication comprises a series of studies conducted by the Egyptian Smoking Prevention Research Institute (ESPRI). For decades use of the water pipe, or shisha, was considered to be less harmful than cigarette consumption; worse, in the eyes of many users it is not even considered to be a form of tobacco smoking. Traditionally the water pipe has been regarded as less harmful and less addictive than cigarettes. These studies show the reality behind this false premise. The water pipe is as harmful and as addictive as cigarettes. The WHO Regional Office for the Eastern Mediterranean hopes, through the publication of these studies, to convey the message to decision-makers, health professionals and the public in the Region that use of the water pipe is indeed harmful. It is just another of the many disguised forms of tobacco consumption and not a safe alternative to cigarettes.