This paper provides an overview of topical issues and problems related to transboundary water resources in Central Asia and their management in the light of the Second Assessment carried out under the UNECE Water Convention (2009– 2011) as well as experiences from ongoing projects. The conflict between water use for hydropower and for agriculture, land degradation and negatively impacted ecosystems resulting from reduced flows and degraded water quality, poor condition of the hydraulic infrastructure, and the legacy of pollution all have implications for health, economy, and stability in the region. The outdated legal framework for regional cooperation on shared waters requires improvement to help find sustainable long-term solutions for reasonable and equitable use of shared water resources.