Groundwater is an essential resource in arid and semi-arid areas such as Upper Egypt, especially where surface water is limited or difficult to obtain. This study explores the hydrogeochemical properties, pollution levels, and related health risks of groundwater in the northern region of Assiut Governorate, Egypt. A total of thirty groundwater samples were systematically collected and analyzed through geochemical modeling, the Nemerow Pollution Index (NPI), and health risk assessment models. The findings showed that the groundwater samples had a pH ranging from slightly acidic to neutral, which aids the dissolution of carbonate minerals and increases the mobility of trace metals. Most of the water samples were categorized as hard to very hard, exhibiting high concentrations of calcium and magnesium in comparison to sodium and potassium. Bicarbonate levels were higher than those of chloride and sulfate, further supporting the notion that carbonate dissolution is the primary geochemical process, followed by ion exchange and evaporite dissolution. Four principal hydrochemical facies were identified—Ca-Mg-HCO₃, Ca-Mg-Cl, Na-HCO₃, and Na-Cl—reflecting diverse sources and interactions within the aquifer system. Human activities, including industrial and agricultural runoff, have significantly raised the levels of cadmium (Cd) and lead (Pb), with 67% of the samples classed as severely polluted according to NPI standards. Health risk analyses indicated that Cd and Pb present significant non-carcinogenic and carcinogenic threats, particularly to infants and children, whose exposure levels surpassed US EPA guidelines. Furthermore, land use/land cover (LULC) assessments using Sentinel-2 imagery from 2000 to 2024 revealed considerable urban expansion over productive agricultural land, coupled with groundwater over-extraction and deteriorating water quality. The combination of hydrochemical analysis, multivariate statistics, remote sensing, and GIS emphasizes the urgent need for groundwater protection, pollution reduction, and regulation of land use to ensure public health and the sustainability of water resources in Upper Egypt. The quality of groundwater is at risk due to swift urban growth and the expansion of agriculture. The main geochemical process observed in groundwater samples is the dissolution of carbonates. Most groundwater samples contain cadmium and lead levels that surpass the limits set by the WHO. 67% of the water samples indicate significant contamination according to Nemerow’s Pollution Index. The study area presents the greatest health risks from cadmium and lead for infants and children. The diagrams created by Piper and Gibbs illustrate the prevailing geochemical processes. From 2000 to 2024, changes in land use indicate urban expansion over productive floodplain soils. Sustainable groundwater and land use planning is supported by remote sensing and GIS. Most water samples continue to be appropriate for irrigation, even in the presence of salinity risks. Proper measures are essential to guarantee that groundwater is safe for human consumption.