The Fundão dam failure, the worst environmental disaster in Brazilian history, launched 50 million m ³ of iron ore tailings mud through the Doce River, reaching the Atlantic Ocean. Generally, mine tailings increase the sediment inflow, leading to mud burial of epibenthic macrofauna, and the raise of metal(oid)s concentration causing macrofauna long-term changes. After almost four years, tailings mud was still spreading on the Doce River Shelf, while impacts on marine macrofauna were still unknown. Herein, the IMS index (a tracer of Fundão dam tailings mud), sediment variables, organic pollutants, and metal(oid)s were integrated to uncover the drives of macrofauna structure from Costas da Algas to Abrolhos bank MPAs. Tailings mud was present only in Doce River Mouth and Degredo, organic pollutants and metal(oid)s above safety levels were concentrated in those same areas. Tailings mud (IMS index) drastically reduced species richness and diversity, favoring the abundance of opportunistic species. Mud, IMS index and Al, Ba, and V, metal(oid)s linked to dam failure, structured macrofauna composition in this impacted area, dominated by resistant groups as Nuculidae, Spionidae, and Magelonidae. Conversely, an opposite pattern was found for further and deeper sites with high CaCO3 content and total nitrogen that also showed large grain size, in areas known to harbour biogenic structures, sustaining a macrofauna composition distinct from the impacted areas, dominated by Syllidae and Crassatellidae, sensitives to impacts. Macrofauna composition was most structured by sediment variables, followed by the intersection between metal(oid)s-IMS and Mud, both gradients acting almost entirely on a broad spatial scale. Benthic macrofauna at the Doce River Shelf is still impacted by Fundão dam tailings mud, even after almost four years of the disaster, and may continue to, since the influx of tailings does not stop, and sediment resuspension is a recurrent source for those impacts.