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Economic development in the Mekong region has brought with it considerable environmental change, with more to follow. The river has already been highly modified by a plethora or perturbations including damming for hydropower and irrigation, disconnection of the flood plains for agriculture and growing urbanization. These have all impacted on the fish and fisheries and delivery of aquatic food products from the system, but the system has to date remained largely resilient, or has it? This paper explores the widespread degradation of the system and how fisheries have responded, looks at future prospects of the river and how the fisheries may be impacts and final examines opportunities which may help to mitigate future development scenarios, especially with respect to hydropower development.