The eastern South Asia region (Bangladesh, Bhutan, India, and Nepal) has extensive networks of all the main modes of surface transport for the movement of goods, both within and between countries. However, goods transport in the region is heavily dependent on a single mode—road transportation—which accounts for about three-quarters of the market in India and Bangladesh and over 90 percent in Bhutan and Nepal. The regional road transportation system faces significant structural challenges that undermine its effectiveness, notably severe congestion and poor reliability. Multimodal transport is increasingly recognized in the region as a way of achieving seamless movement of freight. When combined with measures that synchronize and optimize the entire transportation chain, it can relieve congestion and decrease transit times by 40-50 percent. Many regional trade routes within eastern South Asia are long, exceeding 250 kilometers—a distance where rail and Inland Waterway Transport (IWT) have a competitive edge over road transport due to their lower costs and higher capacity for bulk shipments. This is particularly relevant given that mineral transportation, which is well-suited to these modes due to its bulk nature, constitutes a significant 67 percent of total cross-border trade flow in eastern South Asia. To better understand the economic benefits of improving multimodal transportation in eastern South Asia, the World Bank developed a detailed trade and transport model. The findings indicate that while both soft and hard measures are essential for creating a more efficient multimodal transport network, dismantling critical regulatory and policy barriers is three times more effective in enhancing the region’s trade potential. This paper focuses on the various dimensions of a multimodal freight transport system for eastern South Asia, examining the challenges that must be overcome to fully realize its potential.