Biosand reactors (BSRs), alternatively known as slow or biological sand filters, are passive systems that are used to remove contaminants from domestic wastewater, industrial wastewater and drinking water. This review focuses specifically on their application for remediation of industrial effluent and sewage-containing municipal and household effluent. The relationships between the physicochemical characteristics of the sand grains (size, size distribution, shape, chemical composition) and the hydraulic conductivity of the sand employed in BSFs are critically discussed in relationship to the achievable loading rates and hydraulic retention times. The modes of operation and influence of the functional microbial biomass as well as biodegradable and recalcitrant particulates on these parameters is comprehensively reviewed. Finally, the bioremediation of sewage-based and industrial wastewater is examined. This includes an account of the biotic and abiotic removal mechanisms and the limitations of BSRs for removal of pollutants such as phosphorus/phosphate and nitrates/nitrites. The removal mechanisms and removal efficiencies of macronutrients, micropollutants, fecal indicators and other microorganisms such as antibiotic-resistant bacteria in BSRs are discussed.