Drought-driven humanitarian emergencies are becoming more frequent in the Horn of Africa where millions of people in this arid region face chronic water and food insecurity. Evidence from the region shows increasing reliance on groundwater supplies, infrastructure and institutional systems in response to decreasing rainfall. Drought emergencies can be mitigated by investing in resilience efforts that make safe water reliably available at strategic groundwater abstraction locations during cycles of water stress. A combination of early warning data, policy reform, asset management and improved rural water supplies and maintenance may enable rapid, responsive, and accountable water governance that is more cost effective than emergency relief and better positioned to absorb and adapt to shocks.