Globally, the demand for water is increasing, driven by a rising global population, rapid urbanization, rapid industrialization, agriculture, climate change, changing diets and economic growth. According to [
1] this demand is expected to grow by more than 50% by 2050. The preservation of this resource has been a key concern around the world; it is a requirement for Sustainable Development Goals (SDG) such as SDG 2 (zero hunger), 3 (good health and well-being), 6 (clean water and sanitation), 11 (sustainable cities and communities), 13 (combating climate change and its impacts),14 (life below water) and 16 (Peace, justice and strong institutions). Most of these goals are interlinked by water [
2,
3]. The rate of freshwater deterioration caused by anthropogenic activities is increasing in tandem with the ever-increasing demand for water resources. River water quality is decreasing as a result of the addition of industrial effluents comprising organic contaminants and heavy metals. Metal contamination in aquatic ecosystems, both natural and manmade, needs to characterize its environmental impact [
4,
5]. In this context, Water quality is significant in the water-agricultural and human health sectors, where the use of poor-quality water in agriculture is the main pathway to food quality and security is impacted since irrigation with contaminated water affects crop yields and poses a risk to human health. Surveying water contaminated by heavy metals (HM) has been one of the most serious topics for environmental experts in recent years [
6,
7]. Heavy metal contamination of surface water can degrade the quality of drinking and irrigation water supplies [
8]. Although some heavy metals play an important role in human beings such as Iron (haemoglobin in the blood, healing, immune function and synthesis of DNA), Fluoride (reduces the incidence of tooth decay) Copper (production of energy from carbohydrates and protein, formation of bone), Zinc (formation of enzymes, helps clot blood, maintains a sense of taste and smell), Chromium (functioning of the thyroid gland) and Manganese (helps grow bones and heals wounds by boosting collagen production) [
9,
10], their accumulation in water resources may cause hazards to human nutrition and health [
11,
12]. High intake of concentrations above the required amounts (Cr, Zn, F, As, Mn) of these heavy metals and other hazardous substances can create negative health effects such as cancer, lung diseases, renal diseases, hypertension, gastrointestinal bleeding, neurological disorder, dental enamel degradation, skeletal fluorosis, respiratory tract diseases, sensitive and fragile skin, reproductive effects [
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13,
14,
15,
16,
17]. Thus, several researchers in South Africa and all throughout the world focused on the potential human health risks assessments created from trace elements in contaminated waters [
18,
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23,
24]. Despite the contamination of water with heavy metals, bacterial proliferation can be observed as well in drinking water. This phenomenon has been described for faecal indicators such as coliform bacteria, especially Escherichia coli, and poses the problem of respecting sanitary regulations regarding water quality [
25,
26]. Escherichia coli (E. coli) is a pathogen that causes illnesses in people. This is most often caused by the spread of gut flora when the patient has another deficiency or condition. Some E. coli strains, however, can cause diarrhoea. All of these infections are the result of direct or indirect faecal-oral transmission from other humans or animals [
27]. Water contamination is a serious problem today in South Africa. The water resources in the Vaalharts irrigation scheme are relatively more contaminated than other areas in South Africa due to the higher population and, therefore, intense agriculture and industrial activities in this region [
28,
29].The quality of water in the Vaalharts area is determined by several parameters such as lithostratigraphy formation, recharging water, mineralogy, and the impact of anthropogenic activities [
30,
31,
32]. Moreover, the chemical composition of surface and groundwater is influenced by various hydrogeochemical processes such as precipitation, dissolution, desorption, sorption and residence time during water-rock interaction [
33]. This can be prejudicial to the Vaalharts area where water resources are limited due to a semi-arid region. Surface water researchers have used several methods to assess water quality depending on the various uses of water (drinking, irrigation etc). Some of these methods using different mathematical approaches include water quality indices, such as Sodium adsorption ratio (SAR), Residual sodium carbonate (RSC), Magnesium Hazard (MH), Kelley’s ratio (KR), Sodium percentage (Na%), and Potential salinity (PS), Permeability Index (PI) [
34,
35,
36,
37,
38,
39,
40,
41] to investigate the suitability for irrigation purposes. Furthermore, several numerical models have been used to analyze water quality for drinking purposes. The water quality index (WQI) is a numerical model to evaluate water quality using several water quality parameters (Physico-chemical parameters, major ions and heavy metals) [
12,
42]. Similarly, Heavy Metal Pollution Index (HMPI) and the Heavy Metal Evaluation Index (HMEI) measure and delimit the suitability of drinking water based on trace element concentrations [
43,
44,
45]. The Risk Assessment is defined as the process of estimating the nature and probability of adverse health effects in individuals of various ages (infants, children, and adults) who may be exposed to chemicals in polluted environmental media over a specified time period [
46,
47,
48,
49,
50,
51]. Researchers have performed health risk evaluations through three steps, namely: Average Daily Dose (ADD), Hazard Quotient (HQ), Hazard Index (HI) and Cancer Risk (CR). These steps assist in the determination of the impact of contaminant toxicity on humans. The purpose of this article is to demonstrate the importance of water quality for drinking and irrigation purposes and its impact on health (i) to evaluate surface water suitability for irrigation usages, (ii) to assess drinking water quality using different approaches to water quality indices and indexes, and (iii) to estimate the carcinogenic and non-carcinogenic human health risks from ingesting and cutaneous absorption of different heavy metals found in surface water.