Mining activities are responsible for the elevated input levels of suspended sediment and hazardous metals into the riverine ecosystem. These have been shown to threaten the riverine fish populations and can even lead to localized population extinction. To date, research on the effects of mining activities on fish has been focused within metal contamination and bioaccumulation and its threat to human consumption, neglecting the effects of suspended sediment. This paper reviews the effects of suspended sediment and metal pollution on riverine ecosystem and fish population by examining the possibilities of genetic changes and population extinction. In addition, possible assessments and studies of the riverine fish population are discussed to cope with the risks from mining activities and fish population declines.