<p>This study investigates the dual challenges of water scarcity and declining water quality in Islamabad, Pakistan, through an integrated assessment combining household-level survey data with physicochemical and microbiological analyses of drinking water sources. The survey revealed that a significant proportion of households relying on municipal water supply experience frequent shortages, while those using alternative sources such as private boreholes are comparatively less affected. Notably, households facing water shortages reported a higher prevalence of waterborne diseases, including dermatological and gastrointestinal ailments. Laboratory analysis of water samples from various zones of Islamabad indicated elevated concentrations of ions such as calcium (Ca²⁺), magnesium (Mg²⁺), nitrate (NO₃⁻), and chloride (Cl⁻), suggesting substantial deterioration in water quality. The application of a Drinking Water Quality Index (WQI), based on WHO and national standards, classified most samples as poor to unsafe for human consumption. Furthermore, microbial testing confirmed the presence of Total Coliform bacteria in all samples, with Escherichia coli detected in several cases, indicating fecal contamination and posing serious public health risks. The findings highlight the region's multidimensional nature of water scarcity, demonstrating that it encompasses both quantitative insufficiencies and qualitative degradation. This underscores the need for a comprehensive water management strategy that integrates infrastructure improvement, groundwater regulation, and routine water quality monitoring to ensure safe and equitable access to water. The study provides a scientific basis for policy interventions to mitigate the health and environmental impacts of water insecurity in urban Pakistan.</p>