[Objective] The spatiotemporal trends of surface water areas, evolution of surface water spatial patterns in typical wetlands, and imaging factors in the cities of the Beijing-Tianjin-Hebei region from 2000 to 2021 were analysed in order to provide scientific references for the protection, rational development, and utilisation of water resources in the region. [Methods] This study utilised the JRC global surface water dataset to identify surface water variations in Beijing-Tianjin-Hebei region from 2000 to 2021. We examined the spatiotemporal trends in surface water and morphological evolution within the Baiyangdian and Qilihai wetlands using morphological spatial pattern analysis (MSPA). Correlation analyses incorporating climatic and anthropogenic factors had identified the drivers of these spatiotemporal changes. [Results] ① During 2000—2021, from a temporal perspective, a notable decline occurred in the area of permanent water bodies across the Beijing-Tianjin-Hebei region, which was contrasted by a consistent increase in seasonal water bodies. In terms of spatial distribution, the reduction in surface water area was primarily concentrated in the metropolitan areas of Beijing, Tianjin, and Langfang City. Conversely, cities along the South-North Water Diversion central route, such as Handan, Xingtai, and Shijiazhuang City, experienced an increasing trend in surface water area, indicating a directional shift towards increased water resource availability. ② The surface water area of the core wetland of Baiyangdian gradually decreased from 2000 to 2005 and began to gradually increase after 2005. The core wetland area of Qilihai gradually decreased from 2000 to 2010 and gradually increased after 2010. ③ The maximum water body area in the southern cities of Beijing-Tianjin-Hebei was positively correlated with precipitation, whereas the eastern coastal cities were negatively correlated. This indicated an imbalance between human activities and natural recharge. A significant positive correlation was observed between water consumption and maximum surface water area in Beijing, Chengde, and Tangshan City, indicating a greater influence of cross-basin water transfer and ecological recharge. In contrast, Qinhuangdao and Tianjin City showed highly significant negative correlations, indicating that the over-exploitation of groundwater had a negative impact on surface water resources. [Conclusion] Changes in surface water area are significantly affected by climate and human activities. In the future, the Beijing-Tianjin-Hebei region should effectively protect surface water resources through inter-basin water transfers, water conservation campaigns, ecological restoration, and reduction of groundwater extraction to cope with the impacts of climate and human activities.