Mitrovica, northern Kosovo, is the site of some of the highest Pb concentrations reported in human populations; exemplified by Pb concentrations in scalp hair of up to 130 μg g−1 and widely-publicized of Pb-related ill-health and mortality amongst internally displaced populations. High human Pb burdens are accompanied by elevated concentrations of potentially harmful elements (PHEs) in soils and house dust within the city, which has a long history of mining and metallurgy. In this study enrichment-levels for PHEs in soils are quantified and compared to environmental quality guidelines and a statistically-derived estimation of background concentration. In addition, Pb isotopes (207Pb/206Pb, 208Pb/206Pb) are used to characterise the isotopic signatures of potential point sources of Pb and a mixing model employed to quantify the contribution of sources to Pb present in soils, house dust, and the scalp hair of children and young people. Pb isotopic evidence suggests that Pb in surface soils and house-dust is predominantly sourced from historical deposition of Pb-containing aerosols from metal smelting, with lower contributions from wind-blown dispersal of metalliferous waste. Pb present in scalp hair is interpreted as the result of non-occupational exposure and the ingestion and/or inhalation of Pb-enriched surface soil and house dust. This study represents one of the very few instances where this type of geochemical tracing technique has been successfully applied to definitively identify the source of Pb present within biological samples. The results of this study are of particular relevance to environmental management and highlight the human health risk posed by the legacy of now inactive mining and metallurgy in addition to the challenge posed in mitigating the risk posed by diffuse soil pollution.