The characteristics of groundwater systems and groundwater contamination in Finland, Norway and Iceland are presented, as they relate to outbreaks of disease. Disparities among the Nordic countries in the approach to providing safe drinking water from groundwater are discussed, and recommendations are given for the future. Groundwater recharge is typically high in autumn or winter months or after snowmelt in the coldest regions. Most inland aquifers are unconfined and therefore vulnerable to pollution, but they are often without much anthropogenic influence and the water quality is good. In coastal zones, previously emplaced marine sediments may confine and protect aquifers to some extent. However, the water quality in these aquifers is highly variable, as the coastal regions are also most influenced by agriculture, sea-water intrusion and urban settlements resulting in challenging conditions for water abstraction and supply. Groundwater is typically extracted from Quaternary deposits for small and medium municipalities, from bedrock for single households, and from surface water for the largest cities, except for Iceland, which relies almost entirely on groundwater for public supply. Managed aquifer recharge, with or without prior water treatment, is widely used in Finland to extend present groundwater resources. Especially at small utilities, groundwater is often supplied without treatment. Despite generally good water quality, microbial contamination has occurred, principally by norovirus and Campylobacter, with larger outbreaks resulting from sewage contamination, cross-connections into drinking water supplies, heavy rainfall events, and ingress of polluted surface water to groundwater.

Two case studies were carried out in central Norway in order to assess the performance of bank filtration systems in cold-climate fluvial aquifers relying on recharge from humic-rich surface waters with moderate microbial contamination. Three municipal wells and two surface-water sources at operative bank filtration systems were monitored for naturally occurring bacteriophages, fecal indicators, natural organic matter (NOM) and physico-chemical water quality parameters during a 4-month period. Aquifer passage effectively reduced the microorganism and NOM concentrations at both study sites. Bacteriophages were detected in 13 of 16 (81%) surface-water samples and in 4 of 24 (17%) well-water samples, and underwent 3 ± 0.3 log₁₀ reduction after 50–80-m filtration and 20–30 days of subsurface passage. NOM reductions (color: 74–97%; dissolved organic carbon: 54–80%; very hydrophobic acids: 70%) were similar to those achieved by conventional water-treatment processes and no further treatment was needed. Both groundwater dilution and sediment filtration contributed to the hygienic water quality improvements, but sediment filtration appeared to be the most important process with regard to microbial and NOM reductions. A strengths-weaknesses-opportunities-threats analysis showed that bank filtration technology has a high potential as a pretreatment method for the provision of hygienically safe drinking water in Norway.