Pedestrian health and safety are critical components of sustainable urban mobility, yet they face significant threats in rapidly urbanizing cities of the Global South, such as Port Harcourt, Nigeria. This study provides a detailed investigation of these challenges within the densely populated Borikiri area of Port Harcourt. The research aimed to assess the availability and condition of pedestrian facilities, evaluate physical health risks and safety awareness among pedestrians, and proffer evidence-based solutions. A descriptive cross-sectional survey design was employed, utilizing a structured questionnaire administered to 287 residents, selected through a stratified random sampling technique to ensure demographic representation. Data was analyzed using both descriptive statistics (frequencies, means, standard deviations) and inferential statistics (Chi-Square tests, Pearson Correlation) with MATLAB 2024b and Excel 2013. The findings reveal a precarious pedestrian environment. The infrastructure was rated as mediocre, with an overall mean score of 3.03 on a 5-point scale, indicating only "fair" conditions. Key deficiencies were identified in sidewalk maintenance, crosswalk visibility, and accessibility for persons with disabilities. Notably, Chi-Square tests confirmed that occupational category significantly influenced perceptions of infrastructure quality (p<0.05), with traders and students reporting more acute challenges. Regarding physical health and behaviour, pedestrians reported moderate risks from mobile device distraction (mean=2.83) and frequent encounters with reckless cyclists on sidewalks (mean=2.80). A correlation analysis (r=0.440) further showed that these hazards were interlinked and negatively influenced the preference for walking as a transport mode. Public safety awareness was critically low; respondents felt particularly unsafe walking at night (mean=2.68), citing inadequate street lighting and infrequent driver yielding at crosswalks (mean=2.79). The study concludes that the pedestrian environment in Borikiri is systemically inadequate, characterized by inconsistent infrastructure, measurable behavioural risks, and eroded public confidence. To address this, the study recommends a multi-faceted intervention strategy including urgent infrastructure rehabilitation, targeted public education campaigns, stringent enforcement of traffic laws, and the formal adoption of a WHO-aligned checklist for designing safe pedestrian crossings to foster a safer, healthier, and more inclusive urban space.