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Faced with the growing need to find new viable water supply models for urban areas, this article studies and maps the strategies and identifies the key criteria of sustainable development present in pioneering water supply systems in the medieval period. The main aim is to determine which of its innovative principles could be applied in present-day cities.

From a methodological perspective, two types of cases were established, such as water supply models for human consumption and pre-industrial hydraulic systems, all of which are located in Italy. For the first group, the cases of Venice and Siena were analysed, while for the second, in the context of the cities along the Aemilian Way, the case of Bologna was selected.

Five key criteria resulted from the analysis of the cases: exploitation, self-sufficiency, maintenance, rationalisation and reuse. The said concepts were defined and contextualised within the framework of the Sustainable Development Goals.

The Middle Ages were a historic moment in technological reinvention, before the development of modern systems of sanitation. With very limited resources, these traditional systems focused on rational use and deep cultural and geographical knowledge. This is why its recognition is of great importance today, in a time full of instabilities, with a view to the work that needs to be done for the development of more sustainable communities.