This article examines the medieval (Islamic) cities in India from an environmental and technological perspective. The main objectives of this article are (a) to identify and evalu- ate characteristic features of the cities that were closely linked with the natural environ- ment, (b) to examine the environmental conservation measures, sustainable practices and eco-friendly technologies adopted in these cities, (c) to assess the environmental impact of these cities and (d) to explore those eco-friendly measures and technologies that are relevant even at present. This is a first of its kind review of the Islamic cities in India that flourished from the thirteenth to eighteenth century. Some of the important findings are the following: (a) water had a dominant role in the establishment of these cities, (b) gardens, canals, water-harvesting structures and sanitation were important characteristics of these cities that were profoundly integrated with the natural environ- ment, (c) despite numerous environmental conservation measures adopted, several of these cities declined or were abandoned ironically due to environmental factors and (4) in response to natural environment, some exemplary eco-friendly technologies were introduced, particularly the karez technology for water-supply, which is worth consider- ing to make contemporary Indian cities ecologically sustainable.