The Medog dam's location in a geologically unstable area poses risks to downstream regions, including India's Arunachal Pradesh and Assam, as well as Bangladesh. Potential hazards include landslides, glacial lake outbursts, and sudden water releases, which could disrupt river-dependent livelihoods and exacerbate flooding. The lack of a comprehensive transboundary governance framework increases the vulnerability of downstream countries to the consequences of China's upstream infrastructure decisions.