Pacific Island states occupy the top categories in the World Risk Index for natural hazards, with Vanuatu consistently at the Number One spot. For some low-lying island states climate change poses an existential threat, and the region is increasingly recognized as the most immediately vulnerable area to potential mass migration and relocation due to climate change. This chapter aims to localise the global debate by focusing on the issue of Loss and Damage in Pacific SIDS. It also provides a commentary regarding the risk and options space in the Pacific SIDS context where many of the livelihood activities are subsistence-based, reliant on the current climate and its variability, and already seriously disrupted by extreme weather events.