Groundwater pollution has attracted widespread attention as a threat to human health and aquatic ecosystems. However, the mechanisms of pollutant enrichment and migration are unclear, and the spatiotemporal distributions of human health risks are poorly understood, indicating insufficient groundwater management and monitoring. This study assessed groundwater quality, human health risks, and pollutant sources in the Fen River Basin(FRB). Groundwater quality in the FRB is good, with approximately 87 % of groundwater samples rated as “excellent” or “good” in both the dry and rainy seasons. Significant precipitation elevates groundwater levels, making it more susceptible to human activities during the rainy season, slightly deteriorating water quality. Some sampling points in the southern of Taiyuan Basin are severely contaminated by mine drainage, with water quality index values up to 533.80, over twice the limit. Human health risks are mainly from As, F, NO3−, and Cr. Drinking water is the primary pathway of risk. From 2019 to 2020, the average non-carcinogenic risk of As, F, and NO3− increased by approximately 28 %, 170 % and 8.5 %, respectively. The average carcinogenic risk of As and Cr increased by 28 % and 786 %, the overall trend of human health risks is increasing. Source tracing indicates As and F mainly originate from geological factors, while NO3− and Cr are significantly influenced by human activities. Various natural factors, such as hydrogeochemical conditions and aquifer environments, and processes like evaporation, cation exchange, and nitrification/denitrification, affect pollutant concentrations. A multi-tracer approach, integrating hydrochemical and isotopic tracers, was employed to identify the groundwater pollution in the FRB, and the response of groundwater environment to pollutant enrichment. This study provides a scientific basis for the effective control of groundwater pollution at the watershed scale, which is very important in the Loess Plateau.