Urban water security is of critical global and local importance. Across many parts of low- and middle-income countries, urban water security either remains elusive or is becoming stressed. Rapid urbanisation and climate change are two key drivers of resource insecurity and at the forefront of urban water discourse. However, there are manifold and complex socio-political processes functioning alongside these megatrends that are often underemphasised. Drawing on three urban case studies in Ethiopia, we highlight these structural issues and the need for their continued consideration to fully understand and address urban water insecurity. Household water-use surveys, semi-structured interviews and participatory exercises with community residents, stakeholders and informal water vendors were used as part of a mixed-method approach in three urban areas. We found that government-managed urban water supplies were intermittent and unsafe, resulting in economic, health and time-use burdens for households, and that the socio-political dimensions reproducing urban water insecurity have historical roots. We argue that the uncertainty of climate change and unprecedented urbanisation do not offer sufficient explanation for why urban water insecurity persists. Moreover, we call for caution in only employing these narratives, to avoid obscuring deeply rooted challenges within socio-political systems. We call for socio-political processes to continue to be a central component of future interventions that seek to improve urban water insecurity.