A detailed study was carried out in a cluster of villages known as Sagarpara Gram Panchayet (GP), covering an area of 20km2 and population of 24,419 to determine the status of groundwater arsenic contamination and related health effects. The arsenic analysis of all hand tubewells (n = 565) in working condition showed, 86.2% and 58.8% of them had arsenic above 10, and 50 μgl-1, respectively. The groundwater samples from all 21 villages in Sagarpara GP contained arsenic above 50 μgl-1. In our preliminary clinical survey across the 21 villages, 3,302 villagers were examined and 679 among them (20.6%) were registered with arsenical skin lesions. A total of 850 biological samples (hair, nail and urine) were analysed from the affected villages and, on average, 85% of them contained arsenic above the normal level. Thus, many people of Sagarpara might be sub-clinically affected. Our data was compared with the international one to estimate population in Sagarpara GP at risk from arsenical skin lesions and cancer. Proper watershed management and economical utilization of available surface water resources along with the villagers' participation is urgently required to combat the present arsenic crisis. © IWA Publishing 2005.