Nevertheless, the construction works began in 2010 despite the disapproval of local residents and other supporters, affected municipalities of Ribnik and Mrkonjić Grad and even the negative expert opinion of the Institute for Protection of Cultural, Historical and Natural Heritage of RS. Upon reviewing the plans for the construction, the Institute submitted 10 reasons not to build the HPP. Also, in the above mentioned lawsuit initiated by the Coalition, the Banja Luka District Court decided the studies of EIA contain false information. Despite these facts, investor LSB Elektrane commenced preliminary works - construction of the road and deforestation of the land next to the river bank. The company conducted the work without the necessary environmental and construction permit. Unfortunately, the Inspectorate of the RS, the authority responsible for ensuring compliance with environmental and construction regulations, has thus far failed to react and stop the continued illegal destruction of the source of the river Sana.

The company also ignored the will of citizens and did not respect the decision of Banja Luka District Court and that of the RS Institute for the Protection of Cultural and Natural Heritage that disputed the construction of the plant. The Coalition for the Protection of Sana River gathers more than 20 organisations; they organized several mass protests, and launched a petition against the hydro-power plant which was signed by 8000 citizens.

In 2013 LSB Elektrane sold the concession permit to the Slovenian company Intgerenergo.

In September 2014, it was announced that the laying of the foundation stone of Medna HPP was to be attended by the President of RS Milorad Dodik. The Coalition has sent an open letter inviting him not to take part in the event, reminding the public dissent and the fact that the case is now at the Supreme Court. The letter stressed the commencement of construction; before a judicial decision is reached on the matter is both illegal and irresponsible. In the end, the President of RS did not attend the event, although he has never answered the letter.

In 2015 construction is ongoing although five lawsuits are still on the court. Local community is already facing problems with lack of drinking water and with problems due to mining for the tunnel.