Urban flood risk is significantly shaped by ground conditions and the built environment, which are constantly modified and transformed by human actions. This paper examines the intertwinement of flood risk and unregulated urban expansion processes in three selected sites in Accra’s expanding periphery. All three sites have been included in Accra’s urban extent since the 1990s, but differ with regard to the timing of development and socio-economic characteristics of residents. The research illuminates how flood risk is produced and “built-in” to the urban fabric through widespread practices associated with unregulated urban expansion processes, especially the persistent encroachment on water retention areas, wetlands and riparian zones and the highly fragmented provision of transport infrastructure in emerging residential areas in the periphery. Such harmful development practices are neither confined to homebuilders from poorer segments of the urban population nor spatially concentrated in low-income areas. The research highlights how the actions and inactions of a wide range of social groups and actors engaged in urban land administration and development contribute to flood risk in various ways, making flooding an increasingly alarming issue of citywide concern. Different stakeholders highlight fragmented urban governance as an underlying root cause for the obstruction of sustainable land and water management. Overall, the study calls for a more robust recognition of spatial planning and transport infrastructure provision in flood risk mitigation and highlights the urgent need for planning and governance practices that challenge the existing fragmentation of urban governance systems.