Indigenous communities in Canada are disproportionately affected by issues related to water security, especially access to clean water to meet human needs. The issues these communities face are diverse and widespread across Canada, with many causes and consequences. This review summarizes the types and magnitudes of risks associated with the water security of these communities, the consequences considering health and social perspectives, and the means of responding to these issues. Risks are broadly divided into quantitative risks (e.g., water quality and availability) and qualitative risks (e.g., lack of funding and jurisdictional conflicts). These risks lead to unique consequences, resulting in challenges in developing generalized risk response frameworks. Management of these risks includes a mix of techniques relying on legislative and technical approaches. Nevertheless, the affected communities should be included in the decision-making process that should be holistic, incorporating indigenous knowledge. Good governance, cooperation between communities, policy improvement and the development of an institutional mechanism for clean water supply will provide a pathway and guidelines to address the water security challenges among indigenous communities.