<p>In coal mining areas, groundwater contamination from heavy metals is causing environmental and public health problems. This research investigated groundwater quality and related health hazards in three coal mining districts of Punjab, Pakistan. Sixty groundwater samples were obtained and were examined for physicochemical parameters, major ions and toxic metals (Cd, Cr, Cu, Fe, Ni, Pb) using standard methods including atomic absorption spectrophotometry. Spatial analysis showed variable metal concentrations with Khushab exhibiting elevated Ni (0.066 ± 0.018 mg/L) and Pb (0.064 ± 0.005 mg/L), Chakwal moderate ranges and Mianwali the highest Cd (0.126 ± 0.064 mg/L). Geogenic and human impacts were reflected in the variations of major ions and water quality indices. Principal component analysis and Spearman correlation revealed both localized pollutions especially for Cd and common geochemical sources. Health risk assessment revealed that Childrens are more vulnerable than adults. In Chakwal, children cumulative non-carcinogenic risk (HI) was 12.19, while adults was 7.76. HI was 13.15 for childrens and 8.05 for adults in Khushab. The highest HI was 16.19 for childrens and 9.03 for adults in Mianwali. All districts had probabilistic carcinogenic risk (TCR) over the USEPA tolerable threshold (1 × 10^–4), with Mianwali adults at 9.75 × 10^–3 and children at 4.54 × 10^–3. These findings underscore severe health risks from heavy metal exposure especially for children highlighting the urgent requirement for monitoring and mitigation strategies in coal mining zones.</p> Graphical Abstract <p></p>