•Drivers behind sewage sludge incineration clearly demonstrated.•Technical detail on the incineration process and ash characteristics provided.•The 1st ever multi-disciplinary review of ISSA re-use is presented.•The optimum ISSA re-use routes are identified.•The first time acid insoluble ISSA residue has been considered as a resource. The drivers for increasing incineration of sewage sludge and the characteristics of the resulting incinerated sewage sludge ash (ISSA) are reviewed. It is estimated that approximately 1.7 milliontonnes of ISSA are produced annually world-wide and is likely to increase in the future. Although most ISSA is currently landfilled, various options have been investigated that allow recycling and beneficial resource recovery. These include the use of ISSA as a substitute for clay in sintered bricks, tiles and pavers, and as a raw material for the manufacture of lightweight aggregate. ISSA has also been used to form high density glass–ceramics. Significant research has investigated the potential use of ISSA in blended cements for use in mortars and concrete, and as a raw material for the production of Portland cement. However, all these applications represent a loss of the valuable phosphate content in ISSA, which is typically comparable to that of a low grade phosphate ore. ISSA has significant potential to be used as a secondary source of phosphate for the production of fertilisers and phosphoric acid. Resource efficient approaches to recycling will increasingly require phosphate recovery from ISSA, with the remaining residual fraction also considered a useful material, and therefore further research is required in this area.