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Located at the center of the Red River Delta, Hanoi is the consequence of the unstable balance between soil and water and has witnessed the amicable and adverse relationship between the two elements over a long history. Established as a small town in A.D. 210, Hanoi grew from a harbor on the bank of the Red River to a thriving city and was chosen to be the capital of Vietnam in 1010 as the site had advantageous physical, landscape, and geomancy characteristics. However, the capital had also been confronted with difficulties due to the alluvial process, which raises the level of the watercourse above its normal elevation forcing the inhabitants to take measures such as building a dyke to prevent floods. This chapter analyzes the natural and social conditions as well as several problems that have been affecting urban flood risk management in Hanoi. The chapter ends with practical options and policy measures to address the problems.