The quality of surface water has a significant impact on human health and the entire ecological system. Sewer spillages from the surrounding informal settlements discharging into the river, carrying high concentrations of fecal coliforms, are one of the major causes of extreme pollution in the rivers of South Africa. These informal settlements are common in many developing countries, and they are usually located near waterways to compensate for basic demands for water, sanitation, and recreational space, where municipal infrastructure lags behind urban growth. One major problem has been poor sanitation and poor waste disposal practices in the informal settlements, which has led to the contamination of water resources. This study aims to assess the extent to which poor sanitation in informal settlements impacts the water quality of South African rivers, given the rapid rise in population and unemployment rate. The study also highlights health and environmental issues in the local regions caused by poor sanitation. Contamination of water bodies is associated with serious health problems and fatalities. Therefore, there is a need for frequent monitoring and management of waste products discharged into the neighboring aquatic environments.