Arsenic occurs across the world in freshwater and marine environments, menacing the survival of aquatic organisms. Organic and inorganic forms of this substance can be found, in which the inorganic form is more hazardous than the organic form. Most aquatic bodies contain inorganic arsenic species, but organic species are believed to be the dominant form of arsenic in the majority of fish. Natural and anthropogenic both are the sources of water contamination with arsenic. Its bioaccumulation and transfer from one trophic level to another in the aquatic food chain make arsenic a vital environmental issue. Continuous exposure to low concentrations of arsenic in aquatic organisms including fish leads to its bioaccumulation, which may affect organisms of higher trophic levels including large fishes or humans. Humans can be exposed to arsenic through the consumption of fish contaminated with arsenic. Hence, the present review facilitates our understanding about sources of arsenic, its bioaccumulation, food chain transfer, and its effect on the fish health. Also, "Poison in the Water: Arsenic's Silent Assault on Fish Health" serves as a wake-up call to recognize the pressing need to address arsenic contamination in water bodies. By understanding its devastating impact on fish health, we can strive to implement sustainable practices and policies that safeguard our precious aquatic environments and ensure the well-being of both wildlife and human communities that depend on them.