ABSTRACT The Nile River is one of the longest rivers in the world, serving as the lifeline of many countries. The river is subjected to significant anthropogenic pressures, and thus, understanding the magnitude of contamination and its possible consequences is needed. This research aimed to evaluate the presence of heavy metals in the surface water of an understudied region within the Nile River. The distribution and level of 18 elements along the Damietta branch were assessed, and their potential sources were estimated. Additionally, pollution indices and health risks were calculated. The results showed that most metals were within the acceptable levels of USEPA and WHO. However, Na, Mg, and Ca were higher than the permissible level of WHO, and K was higher than the permissible levels for irrigation. Furthermore, heavy metal pollution indicators, degree of contamination indices, heavy metal evaluation indices, Nemerow pollution indices, and water quality indices all pointed to very high standards for water quality. Also, the noncarcinogenic health risk index indicated a safe limit for dermal and oral exposure for adults and children. Overall, this study recommends management focus on anthropogenic activities in the Damietta branch of the Nile River.