We synthesize the information available from the peer‐reviewed literature on the ecological status of lakes and rivers in the oil sands region (OSR) of Canada. The majority of the research from the OSR has been performed in or near the minable region and examines the concentrations, flux, or enrichment of contaminants of concern (CoCs). Proximity to oil sands facilities and the beginning of commercial activities tend to be associated with greater estimates of CoCs across studies. Research suggests the higher measurements of CoCs are typically associated with wind‐blown dust, but other sources also contribute. Exploratory analyses further suggest relationships with facility production and fuel use data. Exceedances of environmental quality guidelines for CoCs are also reported in lake sediments, but there are no indications of toxicity including those within the areas of the greatest atmospheric deposition. Instead, primary production has increased in most lakes over time. Spatial differences are observed in streams, but causal relationships with industrial activity are often confounded by substantial natural influences. Despite this, there may be signals associated with site preparation for new mines, potential persistent differences, and a potential effect of petroleum coke used as fuel on some indices of health in fish captured in the Steepbank River. There is also evidence of improvements in the ecological condition of some rivers. Despite the volume of material available, much of the work remains temporally, spatially, or technically isolated. Overcoming the isolation of studies would enhance the utility of information available for the region, but additional recommendations for improving monitoring can be made, such as a shift to site‐specific analyses in streams and further use of industry‐reported data. Integr Environ Assess Manag 2022;18:361–387. © 2021 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).