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This report presents the GIWA assessment of the Mekong River region which comprises parts of Cambodia, China, Lao PDR, Myanmar, Thailand and Vietnam. Rapid economic development and population growth are increasing the demand for water, energy and food, necessitating more hydro-dams, the intensification of agricultural and fisheries production, and higher rates of deforestation. The resultant transboundary environmental changes, particularly to the fluxes of water and sediments, are leading to severe habitat and community modification. The past and present status and future prospects of water-related problems in the Mekong River Basin are discussed and traced back to their root causes. Policy relevant conclusions are provided so that appropriate solutions can be developed to address the emerging challenges to the management of the region's aquatic environment.