The Regional Organization for the Protection of the Marine Environment (ROPME) Sea Area (RSA) in the northern Indian Ocean, which comprises the Gulf, the Gulf of Oman and the northern Arabian Sea, already experiences naturally extreme environmental conditions and incorporates one of the world’s warmest seas. There is growing evidence that climate change is already affecting the environmental conditions of the RSA, in areas including sea temperature, salinity, dissolved oxygen, pH, and sea level, which are set to continue changing over time. The cumulative impacts of these changes on coastal and marine ecosystems and dependent societies are less well documented, but are likely to be significant, especially in the context of other human stressors. This review represents the first regional synthesis of observed and predicted climate change impacts on marine and coastal ecosystems across the ROPME Sea Area and their implications for dependent societies. Climate-driven ecological changes include loss of coral reefs due to bleaching and the decline of fish populations, while socio-economic impacts include physical impacts from sea-level rise and cyclones, risk to commercial wild capture fisheries, disruption to desalination systems and loss of tourism. The compilation of this review is aimed to support the development of targeted adaptation actions and to direct future research within the RSA.