The Sarno River trend analysis during the last 60years was traced focusing on the socio-economic and environmental issues. The river, originally worshiped as a god by Romans, is affected by an extreme level of environmental degradation, being sadly reputed as the most polluted river in Europe. This is the "not to be followed" example of the worst way a European river can be managed. Data about water, sediment, soil, biota and air contamination were collected from scientific papers, monitoring surveys, and technical reports depicting a sick river. Originally, the river was reputed as a source of livelihood, now it is considered a direct threat for human health. Wastewater can still flow through the river partially or completely untreated, waste production associated with the manufacture of metal products and leather tanning continues to suffer from the historical inadequacy of regional wastewater treatment plants (WWTPs), associated with the partial or no reuse of effluents. All efforts should be devoted to solving the lack of wastewater and waste management, the gap in land planning, improving the capacity of existing WWTPs also via the construction of new sewer sections, restoring Sarno River minimum vital-flow, keeping to a minimum uncontrolled discharges as well as supporting river contracts. The 2015 goal stated by the Water Framework Directive (2000/60/EC) is still far to be reached. The lesson has not been learnt yet.
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