This article asks whether institutions and processes for regional environmental governance can be introduced or, where they already exist, be strengthened to be more effective along three key dimensions: managing environmental stressors, coordinating the adaptation and mitigation strategies required at various scales of social organization, and establishing better early warning, response and recovery systems. These dimensions are analysed through an examination of the challenges facing the Hindu Kush-Himalaya region that affect all of the region of South Asia. In terms of both human and national security, regional environmental governance holds great promise, but effective governance institutions and processes (either hegemonic or democratic) would be extremely difficult to create.