This is the first publication on arsenic contamination of the Red River alluvial tract in the city of Hanoi and in the surrounding rural districts. Due to naturally occurring organic matter in the sediments, the groundwaters are anoxic and rich in iron. With an average arsenic concentration of 159 micrograms/L, the contamination levels varied from 1 to 3050 micrograms/L in rural groundwater samples from private small-scale tubewells. In a highly affected rural area, the groundwater used directly as drinking water had an average concentration of 430 micrograms/L. Analysis of raw groundwater pumped from the lower aquifer for the Hanoi water supply yielded arsenic levels of 240-320 micrograms/L in three of eight treatment plants and 37-82 micrograms/L in another five plants. Aeration and sand filtration that are applied in the treatment plants for iron removal lowered the arsenic concentrations to levels of 25-91 micrograms/L, but 50% remained above the Vietnamese Standard of 50 micrograms/L. Extracts of sediment samples from five bore cores showed a correlation of arsenic and iron contents (r2 = 0.700, n = 64). The arsenic in the sediments may be associated with iron oxyhydroxides and released to the groundwater by reductive dissolution of iron. Oxidation of sulfide phases could also release arsenic to the groundwater, but sulfur concentrations in sediments were below 1 mg/g. The high arsenic concentrations found in the tubewells (48% above 50 micrograms/L and 20% above 150 micrograms/L) indicate that several million people consuming untreated groundwater might be at a considerable risk of chronic arsenic poisoning.