Extreme weather events disproportionately affect residents of low-income urban settlements in the global South. This paper explores the impacts of extreme heat and flooding on water and electricity services in Accra and Tamale, Ghana. Interviews with water/electricity providers and water quality analysis are combined with household interviews, focus group discussions and observations conducted in eight low-income urban settlements. The findings highlight the interconnected nature of service provision during extreme weather events, with challenges in one sector reinforcing problems in another, exacerbating difficulties with access. Although households can utilize rainwater during flooding, it is highly susceptible to faecal contamination, and electricity supplies are often disconnected. During extreme heat, demand for water and electricity outstrips supply, leading to severe shortages, especially in Tamale. Water and electricity service providers should consider their interconnected nature and adopt a joined-up approach to cope with extreme weather events, which are predicted to increase with climate change.