Water insecurity in Northern Indigenous communities in Canada remains a pressing problem, with multiple dimensions and health impacts. We carried out a case study of long-term water insecurity in the Southern Inuit island community of Black Tickle, Labrador, where there is no piped water and people rely on an under-funded potable water dispensing unit (PWDU) and unmonitored water sources. Our community-based multi-disciplinary project involved qualitative and quantitative methods including key informant interviews, focus groups, a census, a literature review, water testing, and an engineering site visit. In Black Tickle, water security was chronically and severely compromised and was linked to poverty, food insecurity, men's health, and mental health. We have taken a materialist approach; accordingly, later project phases involve research aimed at identifying appropriate solutions, and conducting pre-engineering and engineering work. This article reports on the first two phases of the project, through which we described the problem and identified its impacts.