Pakistan is highly dependent on water resources originating in the mountain sources of the upper Indus for irrigated agriculture which is the mainstay of its economy. Hence any change in available resources through climate change or socio-economic factors could have a serious impact on food security and the environment. In terms of both ratio of withdrawals to runoff and per-capita water availability, Pakistan’s water resources are already highly stressed and will become increasingly so with projected population changes. Potential changes to supply through declining reservoir storage, the impact of waterlogging and salinity or over-abstraction of groundwater, or reallocations for environmental remediation of the Indus Delta or to meet domestic demands, will reduce water availability for irrigation. The impact of climate change on resources in the Upper Indus is considered in terms of three hydrological regimes – a nival regime dependent on melting of winter snow, a glacial regime, and a rainfall regime dependent on concurrent rainfall. On the basis of historic trends in climate, most notably the decline in summer temperatures, there is no strong evidence in favour of marked reductions in water resources from any of the three regimes. Evidence for changes in trans- Himalayan glacier mass balance is mixed. Sustainability of water resources appears more threatened by socio-economic changes than by climatic trends. Nevertheless, analysis and the understanding of the linkage of climate, glaciology and runoff is still far from complete; recent past climate experience may not provide a reliable guide to the future.