<p>This study documents how salinity intrusion affects household water availability, livelihoods, and perceived health in southwestern coastal Bangladesh. This qualitative study was conducted between April and May 2025, comprising six focus group discussions (<i>n</i> = 67 community participants) and 16 key informant interviews with government, non‑governmental, and academic stakeholders across Satkhira, Khulna, and Bagerhat districts. Transcripts were analyzed using reflexive thematic analysis with data-source triangulation and iterative coding until thematic saturation. Key findings emerged: (1) extensive contamination of groundwater and surface water with many deep tube wells yielding saline water, forcing households to travel, purchase, or rely on stored rainwater (typically lasting 3–4 months); (2) strong seasonality, with monsoon months offering temporary relief while the dry season (Nov–May, peaking Mar–May) concentrates salts and coincides with increases in waterborne, dermatological, urinary, and heat-related complaints; (3) disproportionate socioeconomic and gendered vulnerability affecting women, children, the elderly, and low-income farming/fishing households; and (4) livelihood shifts toward shrimp aquaculture that provide income yet perpetuate salinization., creating a socio‑ecological feedback loop. This study emphasized community‑managed technologies, as depth alone is not a reliable technical fix, sustainable operation and maintenance financing, gender‑sensitive service design, and seasonally targeted health and water interventions. Study limitations include purposive sampling, reliance on self‑reported health outcomes without clinical or biomarker validation, and a short field window. Thus, mixed‑method longitudinal research linking environmental measurements and biomarkers to health outcomes, alongside implementation research to evaluate the acceptability, equity, and cost‑effectiveness of locally appropriate water and health interventions, was recommended.</p>