This synthesis report summarizes findings from a participatory assessment of socio-economic drivers, conditions, and climatic and environmental stresses leading to different levels of vulnerabilities in the Hindu Kush Himalayan (HKH) region. The study sites included high mountain, mid-hill, and downstream regions of the Indus, Upper Ganga, Gandaki, and Teesta– a tributary of the Brahmaputra River – basins. An integrated and multidimensional approach was adopted to understand social drivers, conditions, climate stresses, and multiple causes of vulnerability. Community perceptions about major socio-economic drivers and conditions were collected in geographical contexts. Upstream regions are characterized by an abrupt rise in topography, extremely rugged terrain, steep slopes, and deeply cut valleys. Midstream characteristics include hills with large areas of dense broad-leaved and mixed forest and extensive agriculture, often on terraced slopes. Downstream areas are mostly flat and characterized by vast floodplains that are prone to flood and river erosion.