With the rapid increase in the number of mega-infrastructure projects underway across East Africa, how the social, economic, political and environmental repercussions of these projects intersect with ongoing conflict dynamics is a poorly understood topic. Although recent interest in large-scale land acquisitions has led to a number of detailed investigations into specific projects and trends, there has not yet been a broad, systematic review of how large-scale infrastructure developments in East Africa interact with previous, ongoing and potential conflict in their areas of operation. The objective of this article is to report on an analysis of 26 mega-infrastructure projects across Kenya, Tanzania, Ethiopia and Uganda, with an explicit focus on the common tension points that contribute to security dynamics. The methodology used involved two composite indicators of risk—a conflict risk score and a project impact score. The study found seven common tensions across all projects: in-migration, population displacement and relocation, a negative history of community relations with previous or follow-on developments, land rights, securitisation, environmental degradation and expectations of the local population relative to benefits delivered by the project. The study recommends increased attention on prior assessments that focus on the broader and more interconnected impacts in addition to those confined to the immediate project location, as well as in-depth examination of possible mitigation measures.