A complex web of locally induced factors such as limited understanding of the geography and hydrology of the city by urban planning authorities, poor practice of informality, and changing weather patterns are responsible for flooding in Accra, Ghana. Limited understanding of these factors has contributed to the use of unworkable top-down general responses (such as evictions and demolitions). The case of Accra demonstrates that increased preparedness (involving individuals, households, and institutions) is required to enhance adaptation to flood events, rather than the current top-down response approach.