This includes 31 million people in Sudan, more than 14 million in war-torn Yemen and 9.9 million in Egypt, a UN report said.
"While it has been agreed worldwide that hand-washing with soap and water is the best prevention against COVID-19 contagion, this simple act proves to be difficult in a region where 74 million people lack access to a basic hand-washing facility," the UN's Economic and Social Commission for Western Asia(ESCWA) said.
"Refugees and people living in conflict areas or under occupation bear an additional burden," it added.
An estimated 26 million refugees and displaced people are at greater risk of contracting the illness region-wide, as they lack adequate access to water and hygiene services, ESCWA said.
"It is urgent to ensure access to clean water and sanitation services to everyone everywhere, at no cost for those who cannot afford it, in order to avoid further spread of the coronavirus," ESCWA Executive Secretary Rola Dashti said.
About 87 million people in the region also lack access to drinking water at home, forcing them to collect it from a public source and similarly threatening their health, the UN agency warned.
In a region where 10 out of 22 countries have insufficient piped water supply, more hand-washing was likely to increase household demand by four million to 5 million cubic metres, it said.