The water crisis in the Greater Himalayas constitutes an enormous challenge for the region and a growing, if still under-reported, concern in the West. Elements of the crisis include floods and droughts, unpredictable changes in the timing of water flows, hydropower rivalries and persistently unsafe drinking water. Population growth, urbanisation, and consumption and dietary changes are key drivers of the growing demand for irrigation, hydropower and industrial water use. But blame for scarcity and pollution problems often lies in extremely poor water and ecosystem management practices across the region. For domestic change to take place, greater transparency and public awareness are essential, yet difficult to achieve. Climate change will increasingly exacerbate these already observable problems and add new ones in the form of sealevel rise, changing monsoon patterns and the shrinking of glaciers. Pakistan’s massive 2010 floods provided an unwelcome preview of a global warming-dominated future. This report looks at a variety of approaches to this critical problem. Specific actions that can be taken vary across the region and include the following: land reform, a reconsideration of subsidy policies, better maintenance and repair of water infrastructure, investments in wastewater treatment, rainwater harvesting and general water conservation technologies, and crop diversification, substituting less water-intensive crops. Transboundary dialogues need to reinforce commonalities of needs across the region. Opportunities for cooperation are found in environmental monitoring and data-sharing, water conservation, ecosystem stewardship, “peace parks”, and disaster diplomacy. A key question is whether existing initiatives can be sustained, scaled up and broadened. For instance, monitoring activities eventually need to transition toward international watershed management agreements. The efforts discussed in this report can generate fresh perspectives, but a string of disparate, shortlived efforts are unlikely to build momentum. Furthermore, contrary to the responses championed by the region’s powerful water bureaucracies, the solution lies not in grandiose engineering works such as dams or river diversion schemes. Meaningful local capacity-building is essential and requires sustained commitment. While civil society initiatives are welcome, governments eventually need to be brought on board. Developing the necessary political will and reforming established mindsets are essential prerequisites and fundamental hurdles to surmount, and there is no blueprint for how to do this successfully. Ultimately, given the staying power of orthodox views and vested interests, it is incumbent upon us to continue to ask inconvenient questions and challenge established mindsets.