Microplastic contamination in aquatic environments has become an urgent environmental issue, particularly in riverine and coastal areas. The Musi River in Palembang, Indonesia, is one of the water bodies at risk of microplastic pollution, which can affect ecosystems and human health through the food chain. This study aimed to evaluate the distribution of microplastics in fish, ecological risks, and public health risks in Palembang, Indonesia. Results showed that all ten fish species studied contained microplastics, with Barbonymus schwanenfeldii showing the highest level of contamination, with 25 particles per fish in the intestines. Fragment shaped and black colored microplastics were the most dominant, with an average abundance of 12.6 particles per fish and sizes ranging from 0.1 mm to 5 mm. Identified microplastic polymers included Polyethylene Terephthalate (PET), Polyethylene (PE), and Polyvinyl Chloride (PVC), categorized as medium risk based on the Polymer Hazard Index (PHI), while Polypropylene (PP) and Polystyrene (PS) were categorized as low risk. These findings reflect the complexity of microplastic pollution and its ecological risks. The study also indicated that the public consuming fish from the Musi River is still within the low-risk category regarding health impacts. These findings emphasize the importance of continuous monitoring and effective plastic waste management to reduce long-term environmental and public health impacts.