Climate change and human interventions over the past few decades have significantly affected the groundwater resources in Ladakh Himalaya. Sparse or lack of suitable data and knowledge gaps are a major challenge in evaluating these impacts. Here, we synthesize the available data to assess the status of groundwater quantity, quality, withdrawal, and contamination in the Leh district of India. The study shows that glacier area has decreased by 40% whereas its volume has reduced by 25% since the Little Ice Age (similar to 1650 AD). The glacier melt, which influences the recharge, has reduced significantly. The growth of population by 15% per year, expansion of build-up area by 50%, and changes in the socio-ecology have further stressed the groundwater. The bore wells and groundwater draft have increased at similar to 115 wells/year and similar to 7 MCM/year, respectively. The increase of groundwater development by similar to 26 times has reduced the reserves. Hence, for the sustainability of the resource, modeling and managing the impacts is imperatively required. In this direction, this paper provides guidelines for researchers, policymakers, and water users to develop an integrative consortium management strategy for the sustainable utilization of the groundwater. HIGHLIGHTS center dot Rise of temperature, high variability of precipitation, and change in its pattern have reduced the groundwater reserves of Ladakh Himalaya. center dot Population expansion, the tourism industry, urbanization, changes in land use, and water demands have also affected the groundwater and quality. center dot The need arises to model and manage the resources keeping the current and future scenario of the affecting factors in view.