Hyderabad’s River Musi, once the city’s lifeline, has transformed from a vital resource to a neglected, polluted channel due to rapid urbanization and encroachments. Post-1908 flood initiatives gave rise to landmarks like the High Court and Osmania Hospital, but unplanned growth has disrupted its character. Restoring the river’s significance requires cohesive urban planning to reconnect its banks and revitalize its surroundings.