The Nile is one of the longest rivers on the planet and an important freshwater source for the arid regions of Africa. It is also a river that is extensively affected by anthropogenic impact. This paper aims to provide an account of the social drivers that combine to cause extensive changes in the Nilotic environments. This paper is based on extensive review of literature backed up by field research. The main focus is on the lower Nile, where the effects of anthropogenic disturbances are most prominent. We argue that the Nile Basin is characterized by interrelated and compound problems of resource management, and managing this river system effectively requires shifting the focus from water related problems to a basin wide management agenda. We contend that knowledge of environmental history is important for this agenda shift, and the idea of benefit sharing can alleviate the growing stress on this extremely sensitive arid river basin.