ABSTRACT Fluvial environments represent complex human-water systems, as floodplains have always been among the most suitable environments for human subsistence. In this paper, we present one of the first attempts to investigate human adaptation to fluvial environments in the past using spatial statistics (Point Pattern Analysis). In particular, the paper addresses the influence of alluvial geomorphology on the settlement strategies in the Po plain (Northern Italy) during the Roman and the Medieval Period. The transition from Roman to the Middle Ages represented a crucial phase for the reorganisation of human settlement strategies in the Po Valley. The collapse of Roman hydrological systems in association with a cooling climate phase triggered waterlogging process in a large portion of the farmland: swamps became the typical features of the Medieval landscape. This paper aims to assess if the different water management strategies in the Roman and Medieval periods influenced the spatial distribution of sites, and to evaluate the relative importance of agricultural suitability over flood risks in the two historical phases. This research contributes to quantifying how the socio-political factors of past societies played a key role in human resilience to geomorphological hazards related to alluvial contexts and exceptional floods triggered by climate changes.