Deltas are a particular type of estuarine system in which the dependence on river flow (water, sediments and nutrients) is very strong, especially in river-dominated deltas such as the Mediterranean ones, but environmental flow (e-flow) proposals for deltaic systems are scarce. The Ebro Delta is one of the largest wetland areas in the western Mediterranean and one of the most important estuarine systems in Europe. The aim of this paper is to review the state of the art regarding e-flows and to carry out a critical analysis of the proposals for the lower Ebro River and Delta, in order to highlight the possible environmental and socioeconomic impacts arising from the e-flow regime currently approved. Additionally, based on existing scientific information, methods to establish an e-flow regime that allows the maintenance of the main socio-ecological functions and values are discussed; including those functions and values for which not enough information is available. The study concludes that the currently approved e-flows are not suitable for maintaining most functions and values, as they would not prevent the proliferation of alien fish species and macrophytes in the river, the intrusion of the salt wedge in the estuary, the deficit of sediment/nutrient transport and the degradation of riparian habitats or the decline of coastal fisheries. Socioeconomic consequences on coastal fisheries, river navigation, salt water intrusion, sediment deficit, biodiversity, water quality, aquaculture and hydropower are also considered. Other e-flow proposals such as the proposed by the Catalan government would be more suitable to maintain the main socioecological functions and values of the lower Ebro River and Delta. Nevertheless, additional studies are needed to validate e-flows in some relevant aspects such as the capacity of the river to transport sediments to the delta to avoid coastal regression and mitigate the effects of sea level rise and subsidence, as well as the capacity of floods to control the spread of macrophytes. The lower Ebro River and delta is among the case studies where more quantitative and qualitative criteria to set e-flows with a holistic approach have been established.