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This study investigates groundwater contamination by arsenic and iron and its health implications within the Sylhet district in Bangladesh. Utilizing geographic information system (GIS) and inverse distance weighting (IDW) methods, hazard maps have been developed to evaluate contamination risk across various upazilas. The findings show significant arsenic and iron pollution, particularly in the northwestern part of the district. In about 50% of the area, especially in Jaintiapur, Zakiganj, Companiganj, and Kanaighat where arsenic levels surpass 0.05 mg/L which is the standard limit of Bangladesh. Iron levels peak at 13.83 mg/L, severely impacting 45% of the region, especially in Gowainghat, northeastern Jaintiapur, Zakigonj, and Golabganj. The study employs USEPA health risk assessment methods to calculate the hazard quotient (HQ) and hazard index (HI) for both elements via oral and dermal exposure. Results indicate that children face greater noncarcinogenic and carcinogenic risks than adults, with oral HI showing significant risk in Balagonj and Bishwanath. Dermal adsorption pathways exhibit comparatively lower risks. Cancer risk assessments demonstrate high carcinogenic risks from oral arsenic intake in all areas. This comprehensive analysis highlights the urgent need for effective groundwater management and policy interventions in the Sylhet district to mitigate these health risks and ensure safe drinking water. HIGHLIGHTS Arsenic levels exceed 0.05 mg/L in 50% of Sylhet, posing severe health risks.; 45% of the area suffers from iron contamination (1.01–13.83 mg/L).; Children in Balagonj and Bishwanath upazilas are exposed to high health risks.; Carcinogenic risks from arsenic are high, especially orally.; Combined arsenic and iron levels in some areas are 2.74–4.75 mg/L, indicating severe contamination.;