Video anomaly understanding (VAU) aims to automatically comprehend unusual occurrences in videos, thereby enabling various applications such as traffic surveillance and industrial manufacturing. While existing VAU benchmarks primarily concentrate on anomaly detection and localization, our focus is on more practicality, prompting us to raise the following crucial questions: “what anomaly occurred?”, “why did it happen?”, and “how severe is this abnormal event?”. In pursuit of these answers, we present a comprehensive benchmark for Causation Understanding of Video Anomaly (CUVA). Specifically, each instance of the proposed benchmark involves three sets of human annotations to indicate the “what”, “why” and “how” of an anomaly, including 1) anomaly type, start and end times, and event descriptions, 2) natural language explanations for the cause of an anomaly, and 3) free text reflecting the effect of the abnormality. In addition, we also introduce MMEval, a novel evaluation metric designed to better align with human preferences for CUVA, facilitating the measurement of existing LLMs in comprehending the underlying cause and corresponding effect of video anomalies. Finally, we propose a novel prompt-based method that can serve as a baseline approach for the challenging CUVA. We conduct extensive experiments to show the superiority of our evaluation metric and the prompt-based approach.