Large Brazilian cities, such as Rio de Janeiro, suffer serious environmental problems caused by informal settlements (IS), such as advances in the degradation of surface waters involving anthropic pressures resulting from uncontrolled urban growth, lack of sanitation or disasters related to climate events, creating a gap in relevant information about environmental health in urban IS. Therefore, it is essential to assess the health conditions of IS and the local population's perception of their living conditions. This study aimed to evaluate, by online form and public data, the sanitary conditions of the third largest IS in Brazil, the Rio das Pedras community, which was located on the banks of the Jacarepaguá Lagoon complex. The analysis revealed that 35% of respondents reported releasing domestic sewage directly into the river near their homes. Furthermore, 83% of the participants reported that they disposed of urban solid waste inappropriately. About 21% of residents reported falling ill due to direct contact with unsafe water after flood events. Public managers, concerned with advancing sustainability agendas and mitigating the risks to environmental health related to the lack of adequate sanitation services, should invest in actions that reflect the perception of the local population, proposing more appropriate socio-environmental solutions.