BACKGROUND: Climate change is increasing temperatures, frequency of heatwaves, and erratic rainfall, which threatens human biology and health, particularly in already extreme environments. Therefore, it is important to understand how environmental heat stress measures are tied to human water needs and thermoregulation under increasingly hot conditions. AIM: To test how ambient temperature, heat index, and wet bulb globe temperature (WBGT) relate to hydration status and thermal heat perception in a hot, semi-arid environment. SUBJECTS AND METHODS: Urine samples, perceived heat stress, and anthropometrics were collected among Daasanach semi-nomadic pastoralists ( RESULTS: Multiple linear and logistic regressions indicate that all environmental heat stress measures were associated with USG, odds of dehydration, and heat perception. Ambient temperature performed marginally better than WBGT, and both performed better than heat index. These associations were stronger among children than adults. CONCLUSION: In a hot, semi-arid climate, ambient temperature and WBGT accurately predict human water needs and heat stress, with children more vulnerable to dehydration. To mitigate consequences of extreme heat, local bioculturally-appropriate hydration (e.g. tea) and cooling (e.g. shade) strategies should be encouraged.