Source: The Conversation – Canada – By Jamaica Cass, Director, Queen’s-Weeneebayko Health Education Partnership, Queen’s University, Ontario
When 200 people evacuated from Kashechewan First Nation arrived in Kingston, Ont. on a Sunday afternoon in January 2026 — many Elders, children and medically complex family members — the urgency was immediately clear. By the next afternoon, my colleagues from the Indigenous Interprofessional Primary Care Team and I had brought our mobile clinic to the evacuees’ hotel and were seeing patients who had been abruptly displaced by yet another failure of their community’s drinking water system.
At the same time, Kingston’s Indigenous friendship centre was organizing volunteers to lead cultural programming and create supports to help families maintain connection and dignity during displacement.
This matters because Kashechewan is not an exception. Research across Canada shows that unsafe drinking water continues to drive preventable illness, mental distress and evacuations in First Nations communities.
These events are often described as isolated emergencies or technical breakdowns. But decades of public health, engineering and Indigenous-led scholarship demonstrate that they are the predictable outcome of how water systems for First Nations have been governed, funded and maintained.
I am an Indigenous primary care physician who works with Indigenous communities, including those affected by long-standing water insecurity. What I see in Kingston closely reflects patterns documented in Canadian research.
A widespread problem in a water-rich country
Canada has one of the largest supplies of fresh water in the world, yet many First Nations communities have lived under “boil-water” or “do-not-consume” advisories for years — some for more than a decade. National analyses and community-based studies show that Indigenous households are far more likely than non-Indigenous households to lack reliable running water, particularly in remote or northern communities.
In many of these settings, water is delivered by truck and stored in household cisterns, drums or buckets. Studies led by Canadian researchers, including work in Manitoba First Nations, have shown that these systems are difficult to disinfect consistently and are far more vulnerable to bacterial contamination than piped, continuously supplied systems.
In plain terms, the way water is delivered and stored in many homes increases the risk that it becomes unsafe before it’s ever used.
What unsafe water looks like in the clinic
The health impacts of water insecurity are well documented. Reviews of Canadian studies consistently identify gastrointestinal illness — such as diarrhea and vomiting — as the most frequently reported outcome in communities with unsafe drinking water. Skin infections are also common when regular bathing and hand-washing are limited.
Research from First Nations communities in Manitoba has found that people living in homes without indoor plumbing are significantly more likely to report illness overall. That same body of work shows strong associations between indoor water access and mental health: households with reliable in-home water and sanitation report lower rates of depression and stress-related symptoms.
Mental health effects are increasingly recognized in the literature. Researchers describe “water anxiety” — the chronic stress of worrying about whether water is safe to drink, cook with or bathe in.
Qualitative and survey-based studies show this burden falls disproportionately on women, who are more likely to manage household water and caregiving responsibilities. Carrying water, hauling heavy bottles and cleaning storage containers have also been linked to back and shoulder injuries.
Among the evacuees I see in Kingston, these physical and mental health burdens are compounded by displacement itself: being far from home, separated from land and trying to manage chronic illness, educate their children and maintain professional responsibilities in crowded conditions in an unfamiliar environment.
Why these failures persist
If unsafe drinking water in First Nations communities has been so thoroughly studied, why does it continue?
One reason, consistently identified in Canadian policy and academic literature, is that water problems are framed primarily as technical failures rather than as governance failures. Responsibility for drinking water on reserves is fragmented across federal departments, leading to regulatory gaps, unclear accountability and slow responses.
Infrastructure design is another factor. Studies show that water systems in First Nations are often modelled on urban technologies that are poorly suited to remote or low-capacity settings. Even when new systems are built, chronic underfunding of operations, maintenance and operator training leaves communities vulnerable to repeated breakdowns.
Housing plays a critical role as well. Research clearly demonstrates that the absence of indoor plumbing — not just treatment plant performance — is strongly associated with illness. Yet housing and water infrastructure are frequently planned and funded separately, despite their intertwined health impacts.
Evacuation as a recurring health risk
When water systems fail, evacuation becomes the default response. For remote communities, this can involve flying hundreds of people to southern cities on short notice.
Canadian studies show that these disruptions affect schooling, employment, access to cultural practices, and family cohesion.
From a health perspective, evacuation trades one risk for another. While it may reduce immediate exposure to contaminated water, it introduces stress, disrupts continuity of care and worsens mental health outcomes, particularly for Elders, children and people with chronic disease.
What the evidence points to
Across disciplines, Canadian research converges on several findings. Long-term water safety improves when First Nations have meaningful authority over water governance and source-water protection.
Infrastructure is more reliable when systems are designed for local conditions and paired with stable funding for maintenance, training and housing upgrades, not just construction.
Importantly, Indigenous-led approaches that integrate community knowledge with engineering and public-health expertise have been shown to strengthen environmental protection and improve trust in water systems.
Back to that hotel clinic
The patients I see in Kingston are living with the downstream effects of problems that Canadian researchers and Indigenous leaders have been documenting for decades. Their illnesses were not random. They were shaped by unsafe distribution systems, chronic under-investment and governance structures that leave communities reacting to crises rather than preventing them.
Canada’s drinking water crisis reflects systemic design and governance failures, not a lack of fresh water. In a country with the capacity to ensure safe water for all, persistent water insecurity in Indigenous communities represents a preventable policy failure.
The evidence is clear: Chronic water insecurity is a manufactured driver of illness and displacement. Treating its consequences in a makeshift hotel clinic should not be routine. Ensuring safe, reliable, Indigenous-governed water should be.
Jamaica Cass works for Queen’s University. She receives funding from the National Circle on Indigenous Medical Education, the CPFC and the CMA. She is a board member of the Indigenous Physicians’ Association of Canada and the Medical Council of Canada.
– ref. What treating Kashechewan evacuees reveals about Canada’s drinking water crisis: Policy failure is an Indigenous health issue – https://theconversation.com/what-treating-kashechewan-evacuees-reveals-about-canadas-drinking-water-crisis-policy-failure-is-an-indigenous-health-issue-274402
