The Metropolis of Toulouse and the Municipality of Ramallah initiated in 2017, a cooperation to improve the sanitation conditions in the city of Ramallah, in particular the optimization of the sludge process. A diagnostic and feasibility study led the partners to focus their efforts on increasing the skills of Ramallah’s technical services and the operator of the wastewater treatment plant and improving the performance of the current wastewater treatment plant by equipping it with adapted and modernized equipment and materials.