Canada is considered a freshwater-rich country, despite this, several Indigenous reserves struggle with household water insecurity. In fact, some of these communities have lacked access to safe water for almost 30 years. Water quality in Canadian Indigenous reserves is influenced by several factors including source water quality, drinking water treatments applied, water distribution systems, and water storage tanks when piped water is unavailable. The objective of this multifaceted review is to spot the challenges and consequences of inadequate drinking water systems (DWS) and the available technical and microbiological alternatives to address water sanitation coverage in Indigenous reserves of Canada, North America (also known as Turtle Island). A comprehensive literature review was conducted using national web portals from both federal and provincial governments, as well as academic databases to identify the following topics: The status of water insecurity in Indigenous communities across Canada; Microbiological, chemical, and natural causes contributing to water insecurity; Limitations of applying urban-style drinking water systems in Indigenous reserves in Canada and the management of DWS for Indigenous communities in other high-income countries; and the importance of determining the microbiome inhabiting drinking water systems along with the cutting-edge technology available for its analysis. A total of 169 scientific articles matched the inclusion criteria. The major themes discussed include: The status of water insecurity and water advisories in Canada; the risks of pathogenic microorganisms (i.e., Escherichia coli and total coliforms) and other chemicals (i.e., disinfection by-products) found in water storage tanks; the most common technologies available for water treatment including coagulation, high- and low-pressure membrane filtration procedures, ozone, ion exchange, and biological ion exchange and their limitations when applying them in remote Indigenous communities. Furthermore, we reviewed the benefits and drawbacks that high throughput tools such as metagenomics (the study of genomes of microbial communities), culturomics (a high-efficiency culture approach), and microfluidics devices (microminiaturized instruments) and what they could represent for water monitoring in Indigenous reserves. This multifaceted review demonstrates that water insecurity in Canada is a reflection of the institutional structures of marginalization that persist in the country and other parts of Turtle Island. DWS on Indigenous reserves are in urgent need of upgrades. Source water protection, and drinking water monitoring plus a comprehensive design of culturally adapted, and sustainable water services are required. Collaborative efforts between First Nations authorities and federal, provincial, and territorial governments are imperative to ensure equitable access to safe drinking water in Indigenous reserves.