The climate system of the Third Pole region, including the (TP) and its surroundings, is highly sensitive to global warming. Mesoscale convective systems (MCSs) are understood to be a vital component of this climate system. Driven by the monsoon circulation, surface heating, and large-scale and local moisture supply, they frequently occur during summer and mostly over the central and eastern TP as well as in the downstream regions. Further, MCSs have been highlighted as important contributors to total precipitation as they are efficient rain producers affecting water availability (seasonal precipitation) and potential flood risk (extreme precipitation) in the densely populated downstream regions. The availability of multi-decadal satellite observations and high-resolution climate model datasets has made it possible to study the role of MCSs in the under-observed TP water balance. However, the usage of different methods for MCS identification and the different focuses on specific subregions currently hamper a systematic and consistent assessment of the role played by MCSs and their impact on precipitation over the TP headwaters and its downstream regions. Here, we review observational and model studies of MCSs in the TP region within a common framework to elucidate their main characteristics, underlying mechanisms, and impact on seasonal and extreme precipitation. We also identify major knowledge gaps and provide suggestions on how these can be addressed using recently published high-resolution model datasets. Three important identified knowledge gaps are 1) the feedback of MCSs to other components of the TP climate system, 2) the impact of the changing climate on future MCS characteristics, and 3) the basin-scale assessment of flood and drought risks associated with changes in MCS frequency and intensity. A particularly promising tool to address these knowledge gaps are convection-permitting climate simulations. Therefore, the systematic evaluation of existing historical convection-permitting climate simulations over the TP is an urgent requirement for reliable future climate change assessments.