This policy insight illustrates the challenges faced by many coastal cities in tackling the interwoven issues of demographic growth, climate change and waste management. With a focus on Mombasa, Kenya, it looks at how the priority climate hazards of flooding and sea-level rise interact with water and solid waste, and focuses on the potential for nature-based solutions. Treating grey water through constructed wetlands, revegetating urban zones to optimise the benefits residents receive from natural spaces, and investing in mangrove fringes for coastal protection, water treatment and blue carbon finance provide opportunities for multiple co-benefits to urban residents. The latest recommendations for restoring nature down to the smallest scale (to 1km2 areas), opportunities for generating income for informal groups, and the recognised value of building social capital at neighbourhood levels may provide a golden opportunity to reinforce ecological, economic and social resilience in responding to the multiple hazards facing East African coastal cities.