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This Synthesis Paper is based on an Expert Meeting held in Rome 26 to 28 February 2008 as a preparation for the FAO High Level Conference (HLC) on World Food Security and the Challengesof Climate Change and Bioenergy in June 2008. The paper contains appraisal of the implications of the Fourth Assessment Report of the Intergovernmental Panel on Climate Change (AR4-IPCC) for agricultural water management and, based on that evidence, offers a more operationally focused diagnosis. It provides a summary analysis of a baseline, including projected trends without climate change and mitigation measures; the anticipated set of climate change impacts; a set of possible responses; main findings and recommendations; and a set of options for decision-makers.