This paper provides a broad description of the current state of hydrological and geographical characteristics of the Shatt al Arab River (SAR), and analyses the severe decline in water quantity and escalating levels of salinity. The analyses cover SAR as well as all contributing rivers and Mesopotamian Marshlands, which is essential to present a holistic picture of the issues. The analyses are based on the most recent data, though limited, on water availability, water resources development and management infrastructure, and water quality status. The study shows that the water inflows have significantly reduced and the water quality status has deteriorated to alarmingly high levels, especially from Basra to the river mouth. The crisis can only be averted through the cooperative water management initiatives taken by all the riparian countries, which require a paradigm shift from the current approach of unilateral water management planning to international cooperation and management on the shared water resources. The crisis mitigation strategies should find ways of increasing inflows and improving water quality from the upstream source rivers. At the same time, local measures are required to avoid drainage of poor-quality domestic and industrial effluents and highly saline water from the marshes into the SAR. These efforts should be supported by sound scientific information, which is also limited at the moment.