The western Makran subduction zone is capable of producing considerable tsunami run-up heights that penetrate up to 5 km inland. In this study, we show how climate change has affected urbanization along the tsunami-prone Makran coastline during the past 35 years. To address this issue, we have employed climate data, satellite altimeter radar, geomorphology and historical shoreline changes in order to shed light on the factors leading to a decline in access to freshwater resources and also rapid urbanization. We furthermore consider the interactions between environmental changes and human-induced coastal and catchment modifications in increasing socioeconomic vulnerabilities of littoral areas. The results of this study show that agricultural and freshwater management methods along the Chabahar coastal plain date back to at least 1808 CE, when wetter climate conditions characterized the area. Severe climate changes have been pronounced since 2000. Within this context, the majority of agricultural lands have been abandoned due to increasing drought intensity and duration. Decreasing cultivation and limited access to freshwater resources have led to extensive urbanization particularly for the two cities of Konarak and Chabahar. Enhanced soil erosion, increasing summer monsoon wind speed, sea-level rise and the growing number of strong storm events are some of the climate change-related hazards for high to very high socially vulnerable zones. In addition to environmental risks, poor urban planning has increased damage to coastal infrastructures such as ports and desalination plants. Furthermore, industrial and urban growth in the northwest of the Makran could further enhance socioeconomic damage by earthquakes and tsunamis.