[Objective] The Beijing-Tianjin-Hebei region confronts critical challenges, including water resource scarcity and ecological degradation. Advancing the sophisticated development of the water resources system is pivotal for regional progress and aligns with national strategic objectives. [Methods] This study utilized the JRC global surface water dataset to identify surface water variations in Beijing, Tianjin, and Hebei from 2000 to 2021. We examined the spatial-temporal trends of surface water and the morphological evolution within Baiyangdian and Qilihai wetlands using the Morphological Spatial Pattern Analysis (MSPA). Correlation analyses, incorporating climate and anthropogenic factors, elucidated the drivers behind these spatial-temporal changes. [Results] Temporally, the region’s permanent water bodies diminished, whereas seasonal water bodies expanded over the past 22 years. Spatially, urban centers like Beijing, Tianjin, and Langfang saw a decline in surface water, in contrast to cities along the South-to-North Water Transfer project, which experienced growth. Baiyangdian's core wetland area fluctuated, decreasing initially then rising post-2005, while its periphery steadily increased. Qilihai wetlands saw a decline until 2010, followed by recovery. A positive correlation exists between maximum water area and precipitation in the south, and a negative one in eastern coastal cities, highlighting the natural replenishment and human activity imbalance. Significant correlations between water usage and surface water area in Beijing, Chengde, and Tangshan indicate the positive impact of water transfers and ecological replenishment, whereas negative correlations in Qinhuangdao and Tianjin suggest adverse effects of groundwater over-extraction. [Conclusion] This analysis uncovers the two-decade dynamics of surface water in the Beijing-Tianjin-Hebei region, offering insights for sustainable water resource management.