The availability of clean drinking water impacts the quality of life of Arctic populations and is affected by climate change. We provide perceptions based on: (1) a study of the accessibility of the natural surface water to the nomadic and settled Indigenous inhabitants living in rural areas (in settlements and remote camps) in the Arctic zone of Western Siberia during climate change and industrial development; (2) an assessment of the impact of consuming different surface water resources on human health. We include primary data sources from medical examinations and surveys collected in the regions between the rivers of Ob, Nadym, Taz, and Yenisey in 2012, 2014–2019, and 2022 whereas the chemical analysis of the surface waters in the region was based on previous research. A total of 552 local residents from the Arctic zone of Western Siberia participated in the study. We discuss how the availability of high-quality drinking water is limited for them due to climatic and anthropogenic risks, despite the abundant water resources. The consumption of river water is associated with high health risks since it contains heavy metals (Pb, Cd, Mn, Fe), whereas the consumption of lake ice melt water likely affects health because of the low concentrations of beneficial ions.