To investigate the distribution, source, contamination, and ecological risk status of heavy metals in the Red Sea-Gulf of Aqaba coast, Saudi Arabia, 33 surface sediment samples were collected for Fe, Zn, Sb, Co, Cu, Hg, Pb, Mn, Cr, Ni, Cd, As, and TOC analysis using ICP-MS. Three single and three multi-element contamination indices were used to assess the sediment quality. Evaluation of the three single pollution indices suggested some contamination or anthropogenic inputs with Cu, Cd, Hg, and, to a great extent, As. The potential ecological risk indicated low ecological risk at all sites for Pb, Zn, Ni, Cu, Co, Cr, and Sb; and considerable risk for Cd, Hg, and As. Moreover, the average values of Hg and As were higher than those recorded in the sediment quality guidelines. The multivariate statistical tools revealed that Fe, Mn, Cd, Cu, Co, Zn, and Cr were mostly of terrestrial origin, derived from weathering of the nearby Pre-Cambrian basement rocks, Tertiary, and Quaternary sedimentary rocks; while As, Sb, Hg, Ni, and Pb were mostly attributed to anthropogenic activities from traffic emissions, industrial activities, and the dredging of marine sediments. The results of this work will guide the future projects of environmentally sustainable development in northwest Saudi Arabia.