South African cities face unprecedented challenges due to climate change, including extreme weather events, water scarcity, and socio-economic disruptions. Rapid urbanization amplifies these vulnerabilities, straining infrastructure and resources. Coastal cities like Durban grapple with flooding and rising sea levels, while inland urban areas, such as Johannesburg, confront heatwaves and water shortages. The “Day Zero” drought in Cape Town exemplifies the dire consequences of these climate impacts. Policy frameworks, such as the National Climate Change Response Policy, emphasize adaptation and mitigation through sustainable urban planning, ecosystem-based approaches, and renewable energy transitions. Despite advancements, systemic issues hinder progress, necessitating collaborative international support. This paper highlights the urgent need for integrative strategies to enhance resilience, addressing the intertwined dimensions of water, energy, food, and health security for sustainable urban futures in South Africa.