Flood disasters remain a serious development challenge in cities in developing countries. In many cities, the frequency and intensity of flood disasters have increased spatially and temporally and cause more casualties and economic losses than any other natural catastrophe. This study used multiple qualitative research approaches to explore the nature and causes of, as well as proposes options for addressing future disasters in Kumasi, the fastest growing city in Ghana. The findings show that disastrous floods now occurred on an annual basis with at least 4 per year, and are becoming increasingly severe. The floods now more regularly following moderate to high rainfall events as a consequence of uncontrolled occupation of inland water areas especially rivers and floodplains by urban physical developments. Despite a well-structured policy framework, interventions tended to be reactionary and failed to address the underlying causes of the floods. Indeed, they sometimes aggravated the impacts. The study suggests that it is critical for city managers and planners to enforce a “no development” zone along rivers and floodplains through integrated land use planning and relocation of settled encroachers. The enforcement could rely on participatory processes and institutional collaborations that focus on positive outcomes such as reducing and/or avoiding flood disasters and sustaining and/or improving liveability of the city.