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This paper synthesizes current knowledge on the impacts of the Gibe III dam and associated large-scale commercial farming in the Omo-Turkana Basin, based on an expert elicitation coupled with a scoping review and the collective knowledge of an multidisciplinary network of researchers with active data-collection programs in the Basin. We use social-ecological systems and political ecology frameworks to assess the impacts of these interventions on hydrology and ecosystem services in the Basin, and cascading effects on livelihoods, patterns of migration, and conflict dynamics for the people of the region. A landscape-scale transformation is occurring in which commodities, rather than staple foods for local consumption, are becoming the main output of the region. Mitigation measures initiated by the Ethiopian government—notably resettlement schemes—are not adequately buffering affected communities from food insecurity following disruption to indigenous livelihood systems. Therefore, while benefits are accruing to labor migrants, the costs of development are currently borne primarily by the agro–pastoralist indigenous people of the region. We consider measures that might maximize benefits from the changes underway and mitigate their negative outcomes, such as controlled floods, irrigating fodder crops, food aid, and benefit sharing.