During the extraction of palm oil by smallholders in Cameroon, the use of enormous quantities of water results in palm oil mill effluent (POME), which contains substances that are deleterious to the environment at concentrations above the threshold values. A detailed description of the various processes involved is imperative so as to develop methods of reducing loss and minimising the environmental effect caused by the wastes produced. In this study, we characterise the small-holders’ palm oil production sector in Cameroon, along its entire production chain. The main demographics of smallholder farmers are adult males (64.4%) and married (46.7%) with low levels of formal education (51.1% attained only primary education). Plantation establishment involves deforestation of pristine vegetation (46.7%) as well as replacing other farming systems. Processing is carried out by the farmers with their own mills (48.9%) bought at exorbitant prices. Access to finances (51.1%) remains a key limitation to plantation expansion and the adoption of innovations in this sector. Workers’ health issues abound (75.6%) and are treated mainly using ethnomedicine (31.1%), and there is little or no social security; thus, sick workers generally pay their own bills (64.4%). Issues of environmental pollution from production to waste processing abound with solid waste mainly burnt (57.8%) and POME directed into open pits and streams (37.8%) where they become a nuisance and serve as breeding grounds for mosquitoes (51.1%); these issues will require greater state involvement for mitigation. Our findings suggest that farmers in the palm oil sector have deep knowledge base and competence, but government intervention are needed to stimulate further growth in this important sector.