<p>Groundwater serves as a crucial source of drinking and irrigation water in the Cixian area of the Fuyang River Basin (FRB) in northern China. Assessing its quality is essential for sustainable resource management. In the present study, hydrochemical diagrams, multivariate statistical methods, and human health risk models were used to reveal the processes controlling groundwater quality and associated health risks. The results showed that the quality of pore groundwater (PGW) was poor, and dominated by HCO₃·SO₄-Ca and HCO₃·SO₄-Ca·Mg hydrochemical facies with high total dissolved solids (TDS) value. The main indicators influencing groundwater quality included SO₄^2–, NO₃^–, Cl^–, Na⁺, TDS, and total hardness (TH). The quality of fissure groundwater (FGW) was relatively good, mainly composed of HCO₃-Ca and HCO₃-Ca·Mg facies, with only a few samples exceeding the permissible limits. The quality of PGW was influenced by both water–rock interactions and anthropogenic activities, whereas that of FGW was predominantly controlled by natural conditions. The human activities mainly included agricultural activities, industrial production, and domestic sewage discharge. The health risk assessment (HRA) model showed that half of PGWs posed a potential health risk to children and infants, whereas over two-thirds of FGWs were safe for all age groups. The results will provide a scientific basis for the development and utilization of groundwater in arid and semi-arid regions in northern China.</p>