BACKGROUND AND OBJECTIVES: Trace elements and pesticide residues are among the crucial problems in the river Watershed ecosystem. The current study sought to evaluate the health risks associated with trace elements and organochlorines from fish consumption for the local population in the Citarum Watershed, Indonesia. This study is important as the rapid development of population and industrial activities along Citarum Watershed has contributed to domestic waste production, agricultural run-off, and industrial emissions that could leak into the river watershed. METHODS: This risk assessment was conducted based on the framework according to the Codex Alimentarius Commission. The concentrations of selected trace elements and organochlorines in fish species from Citarum Watershed were obtained from fish farms in 3 reservoirs (Saguling, Cirata, and Jatiluhur). Data pertaining to food consumption, which was employed to evaluate contaminant exposure, was gathered from individual food consumption surveys conducted by the Ministry of Health as part of the National Total Diet Study. A deterministic approach was used to estimate the dietary exposure to trace elements and organochlorine pesticides from fish consumption related to the Citarum Watershed in different age groups of the local population. The health risk assessment is categorized into chronic/non-carcinogenic health risks (hazard quotient) as well as carcinogenic risk. FINDINGS: The study found that trace elements and organochlorine pesticides were detected in freshwater fish from Citarum Watershed with concentration orders of copper > chrome > lead > mercury > cadmium. The concentrations are fall below the maximum permitted limit in accordance with Indonesian and global standards. Additionally, organochlorine levels in fish samples were also relatively low compared to the official threshold, with concentration order of heptachlor > lindane > dichloro-diphenyl-trichloroethane > endosulfan > aldrin > endrin > dieldrin, respectively. Chrome and lead showed the highest contributors for non-carcinogenic and carcinogenic risks from trace element exposure, respectively. Moreover, aldrin and heptachlor are the key contributors for non-carcinogenic and carcinogenic risks stemming from organochlorine exposure, respectively. CONCLUSION: The present study revealed that trace elements and organochlorines are unlikely to pose non-carcinogenic and carcinogenic risks to the local populations in Citarum Watershed. However, the worst estimation of cumulative exposure revealed that children are particularly vulnerable to the highest level of risk. The result of the present study is considered as the lowest risk scenario. Additionally, if there is no improved mitigation program to reduce contamination to Citarum Watershed, there is a possible increased health risks to the local population. There may be an increased risk from various contaminants and dietary sources, along with the potential for synergistic toxicity among the compounds. To provide a more reliable health risk, further research is required to identify the contamination in wild fish and other dietary sources, as well as to include emerging contaminants. Furthermore, it is essential for the associated governmental organizations to create a routine monitoring system and to keep track of the biota samples. Identification of contaminant sources is important to develop a mitigation strategy and law enforcement for minimizing the use and leakage of the contaminants in the ecosystem and reducing the hazards to public health. © 2025 The author(s). This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes are made. The images or other third-party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit: http://creativecommons. org/licenses/by/4.0/