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The South Saskatchewan River Central sub-watershed extends north of Medicine Hat and encompasses an area roughly bounded by Highway 524 to the south, Highway 884 to the west and Highway 41 to the east. At its northern edge it aligns with the Red Deer River Sub-basin, south of Highway 555. It is also one three sub-watersheds that straddles the border between Alberta and Saskatchewan. Within this sub-watershed, the river runs north, and then northeast until it crosses into Saskatchewan and joins with the Red Deer River near Estuary, Saskatchewan. The sub-watershed lies almost entirely within Cypress County, but the City of Medicine Hat lies along the southern edge, and a small portion at the northern edge lies within Special Areas No.2.

While the ecology and landscape are similar to others within the SSRSB, there are some notable exceptions. Like other sub-watersheds, the gently rolling plain is blanketed with a layer of coarse glacial till or fine-textured ancient glacial lake deposits, and is carved by coulees formed by glacial meltwater, but the rare, desert-like, active and stabilized sand dunes of the Middle Sand Hills are unique to this area.

The region has the lowest level of precipitation in Alberta and the climate is classified as sub-arid to semi-arid due to strong winds, high summer temperatures and minimal precipitation. There are many small closed drainage systems collecting water in seasonal marshes or sloughs, but only a few small surface water bodies. These include: Dishpan Lake; White Horse Lake; Red Deer Lake; Easy Lake; and a small oxbow lake north of Medicine Hat called Old Channel Lake.

The South Saskatchewan River Central sub-watershed reflects the second most monitored region of all the six SEAWA sub-watersheds.