The purpose of the Mekong River Basin agreement is to support the sustainable development and management of basin's water and related resources; addresses institutional, financial and management issues and thereby enhance coordination between the member countries. The overriding importance of climate change as a driver of environmental change makes it crucial to address disaster-reduction and water-management concerns in a holistic manner at the river basin level. It has been suggested recently that regional cooperation on water management and water-related hazards can be facilitated by developing a broader perspective on regional economic cooperation that goes beyond the focus on water alone. The chapter looks at these issues under three sections covering conflict and cooperation, climate change impact and regional cooperation on water-related hazards and basin-wide regional economic cooperation. It presents an overview of the fundamental factors behind cross-border water-related conflicts and likely avenues for cooperation, and discusses them using examples drawn from the greater Himalayan region.