This publication provides a detailed account of the status of the Kathmandu Valley environment. The report highlights the five key environmental issues of air quality, settlement, drinking water, waste management, and natural disaster preparedness, reviews their status, and recommends measures to prevent or minimise the negative impacts. It provides direct options for management by various levels of government, civil society, the public-private sector and residents. These include improved planning and zoning, land pooling, solid waste management, rainwater harvesting, a variety of infrastructural and technical measures and vastly improved coordination and enforcement. Community mobilisation is critical to achieving these goals. With the potential for catastrophic disaster from earthquakes, many of these measures are not only important for human health, tourism development and the quality of life but also essential to the preservation of life when the inevitable earthquakes occur.