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The Mekong River Delta is Vietnam’s most important and largest region with respect to agricultural and aquacultural production systems. The city Can Tho, also referred to as the economic centre of the Mekong Delta, and with that in most parts only about two meters above sea level, is at high risk of flooding. The combination of three different flood regimes comprising of tidal floods from the South Chinese Sea, increased precipitation and the Mekong River’s flow variation create a challenging situation for the city and its increasing trend of urbanization. Already existing pressure on the water supply, sewage and drainage situation is thus increasing through growing intensity and frequency of flooding, inundation and tidal surges due to climatic developments. The traditional coping and adaptation mechanisms of ‘living with the floods’ are not enough anymore to prevent the increases in losses.