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Abstract Floods in Ghana have become a perennial challenge in the major cities and communities located in low-lying areas. Therefore, cities and communities located in these areas have been classified as potential or natural flood-prone zones. In this study, the Digital Elevation Model (DEM) of the Accra Metropolis was used to assess the drainage density and elevation patterns of the area. The annual population estimation data and flood damages were assessed to understand the damages and population trend. This research focused primarily on the elevation patterns, slope patterns, and drainage density of the Accra Metropolis. Very high drainage density values, which range between 149 and 1117 m/m2, showed very high runoff converging areas. High drainage density was also found to be in the range of 1117–1702 m/m2, which defined the area as a high runoff converging point. The medium and low converging points of runoff were also found to be ranging between 1702–2563 m/m2 and 2563–4070 m/m2, respectively. About 32% of the study area is covered by natural flood-prone zones, whereas flood-prone zones also covered 33% and frequent flood zones represent 25%. Areas in the Accra Metropolis that fall in the Accraian and Togo series rock types experience high floods. However, the lineament networks (geological structures) that dominate the Dahomeyan series imply that the geological structures in the Dahomeyan series also channel the runoffs into the low-lying areas, thereby contributing to the perennial flooding in the Accra Metropolis.