Background: Iraq’s healthcare system has undergone significant challenges in recent decades, influenced by conflict, demographic shifts, and evolving disease patterns. While earlier reports described its historical evolution, recent unpublished data provide an opportunity to reassess the system’s current status. 

Objectives: To provide an updated and comprehensive analysis of the Iraqi healthcare system, focusing on demographics, organization, financing, service delivery, workforce, morbidity and mortality, maternal health, communicable diseases, and medical education. Materials and methods: More than 100 unpublished documents and official reports released in 2025 by the Iraqi Ministry of Health and Ministry of Planning were reviewed. Although released in 2025, most of the underlying data were collected in 2022. Information was categorized into demographics, health system organization, policies, financing, service delivery, workforce, morbidity and mortality, maternal health, forensic deaths, communicable diseases, and medical education.

Results:

• Demographics: Iraq’s 2022 population was 42.25 million; 40.5% were under 15 years, with a median age of 19 years and life expectancy of 75.3 years.
• Organization & Policies: Structure remained largely unchanged since 2019. National policies are aligned with the Sustainable Development Goals (2020–2030), prioritizing maternal/child health, NCDs, communicable disease control, and universal coverage.
• Financing: Health expenditure was 9.84 trillion IQD (4.8% of national budget), ~USD 160 per capita.
• Service Delivery: 2,914 PHCs formed the backbone of primary care, though unevenly distributed. Immunization coverage was strong (BCG 96%, polio 92%, measles 88%). Hospitals included 222 governmental and 194 private institutions, with 1.2 beds/1,000 population. Over 68 million outpatient visits and nearly 3 million admissions occurred in 2022.
• Workforce: 45,038 physicians, 109,423 nurses, and 27,270 pharmacists served the system, though densities were below WHO standards and unevenly distributed.
• Morbidity & Mortality: Infant mortality was 18.1/1,000 live births; maternal mortality 26.2/100,000. Non-communicable diseases (ischemic heart disease, hypertension, diabetes, renal failure) were the leading causes of adult mortality. Perinatal disorders and infections dominated child mortality.
• Maternal Health: Cesarean section rates were high (44.1%). Hemorrhage, thromboembolism, and hypertensive disorders were leading direct causes of maternal death, while indirect causes included COVID-19 and chronic diseases.
• Communicable Diseases: Iraq remained polio-free but faced large burdens of chickenpox (55,376 cases), cutaneous leishmaniasis (7,048), cholera (3,740), and tuberculosis (6,687). HIV prevalence was low (33 cases) but mortality disproportionately high (446 deaths).
• Medical Education: 37 medical colleges, 64 dentistry colleges, 64 pharmacy colleges, 47 nursing colleges, and 172 health technology colleges were operating, with rapid expansion of private institutions.

Conclusions: Iraq’s healthcare system demonstrates resilience with strong immunization performance, broad facility coverage, and policy alignment with SDGs. However, systemic challenges persist:

1. Unequal distribution of health professionals.
2. High maternal and child health risks, including excessive cesarean sections and preventable neonatal deaths.
3. Double burden of disease, with rising NCDs alongside persistent communicable diseases.
4. Limited diagnostic infrastructure and underutilized hospital capacity.
5. Rapid but uneven expansion of medical education, requiring stronger quality assurance.

Strategic reforms focusing on primary care strengthening, equitable workforce distribution, maternal health integration, communicable disease control, and education quality are essential for Iraq to achieve a more efficient, equitable, and resilient healthcare system.

A health care system can be broadly defined as the organization of people, institutions, and resources that deliver health services to a defined population.  Across the world, health systems have developed along diverse historical and structural pathways. In some contexts, health planning is driven largely by market participants, while in others it is shaped by government, trade unions, charities, religious institutions, and other stakeholders. Increasingly, health system development is recognized as an evolutionary rather than revolutionary process. The World Health Organization emphasizes that a health system is more than a network of publicly owned facilities; it also encompasses the many actors and processes that contribute to health. These range from mothers caring for sick children at home and private providers, to health insurance organizations, vector-control campaigns, and occupational health legislation.

Health care providers may include institutions as well as individuals such as physicians, nurses, pharmacists, paramedics, laboratory technologists, therapists, and community health workers who may operate independently or as part of governmental, private, or non-governmental organizations. Providers may also work in non-clinical settings such as public health departments, laboratories, and training institutions In a healthcare system, healthcare providers may have duties not directly related to patients’ care structure, as in a government health departments or other agencies, medical laboratory, or health training institution. Examples of health personnel include doctors, nurses, midwives, dietitians, paramedics, dentists, medical laboratory technologists, therapists, psychologists, pharmacists, community health workers, and others. Most health systems depend on a mix of the five funding models shown in table-1.  The management of healthcare systems is generally achieved through a set of policies and plans approved by government, private sector. The central aims of any health system are to ensure good quality care for the population, responsiveness to people’s expectations, and adequate financing mechanisms. Essential functions include the delivery of services, generation of resources, financing, and management. Effective systems are characterized by quality, efficiency, equity, acceptability, and consistency. Globally, funding mechanisms vary ranging from general taxation and social health insurance to voluntary or private insurance, out-of-pocket expenditure, and charitable contributions. Many shortcomings in the healthcare systems that lead to poor quality health services are partly associated by ignoring accessible data, information, and knowledge. Managing healthcare systems without having adequate knowledge is a logic obstacle for the delivery of high-quality health care services. 

Table-1 outlines the important aspects of healthcare systems.

Many health systems face challenges that compromise quality, including the underutilization of available data and knowledge in planning and management [1-7].  In Iraq, the health care system has been documented in several reports over the past decades, yet significant transformations have occurred in recent years. The aim of this paper is to provide an updated, evidence-based account of the Iraqi health care system using the most recent data available.

This study examined unpublished and official data sources on the Iraqi health care system. More than 100 relevant documents were reviewed, primarily reports released in 2025 by the Iraqi Ministry of Planning and the Iraqi Ministry of Health. Although issued in 2025, most of the underlying data were collected in 2022.

The data were organized into the following categories:

• Demographic indicators relevant to health care
• Organizational structure of the health system
• National health policies, including mission, vision, strategic goals, and plans
• The Ministry of Health’s Sustainable Development Goals Plan (2020-2030)
• Health system financing
• Health service delivery (primary, secondary, and tertiary care)
• Workforce composition and distribution
• Morbidity and mortality indicators
• Maternal health, risky pregnancies, and maternal mortality
• Forensic deaths
• Notifiable infectious diseases
• Medical and health professional education institutions

This structured approach ensured comprehensive coverage of Iraq’s health system components and enabled a comparative assessment with earlier reports.

Demographic indicators relevant to health care

In 2022, Iraq’s population was 42.25 million (21.3 million males, 20.9 million females). Children under 15 years comprised 40.5%, while only 4.5% were older than 60 years. The median age was 19 years, with a dependency ratio of 76. The population was predominantly urban (69.9%). Overall life expectancy was 75.3 years. Figure-1A shows the age distribution of Iraq population during the year 2022, and Figure 1B shows the urban vs. rural population

Figure-1A: The age distribution of Iraq population during the year 2022

Figure-1B: The urban vs. rural population

Organizational structure of the health system

The organizational structure of the Iraqi health system remained largely unchanged from pre-COVID-19 (2019) [1, 2, 3, 6]. 

National healthcare policies including national healthcare mission, vision, strategic goals and plans

National health policies continue to reflect constitutional articles 30–33, though public demand for constitutional reform has grown since 2019. The Ministry of Health’s 2025 mission and vision statements were unchanged from 2018.  [1, 2, 3, 4, 6]. 

The declared mission and vision of the Iraqi Ministry of Health for the year 2025 were the same mission and vision of the Iraqi Ministry of Health which were declared in 2018 [6,7].

The Mission stated “The Ministry of Health works to provide comprehensive health care to all members of the society and at the highest level of quality and to invest efficiently available resources in accordance with ethics of the profession and values of the society to ensure sustainable health development to reduce mortality and morbidly with participation of stakeholders”.  The general vision statement “Physically, psychologically, and socially healthy society”. [6, 7]. 

In 2025, there was no mention of the 2020 declared strategic plan which included a vision and mission statements for the health information system. The vision statement was “Comprehensive, efficient and applicable health information system”. The mission statement was “The Iraqi Ministry of Health works to provide the infrastructure and logistic supplies to build a statistical information base and an integrated sustainable health information system to insure access to health information by decision makers, policy makers, and researchers in the field of health to improve the comprehensive coverage, quality and efficiency of healthcare with highest quality”.

The Iraqi Ministry of Health Sustainable Development Goals Plan (2020–2030)

The Sustainable Development Goals, adopted by the United Nations in 2015, outline a global agenda to achieve prosperity, social equity, and environmental protection by 2030. The Iraqi Ministry of Health has declared the alignment of its health policies with the United Nations Sustainable Development Goals, recognizing health as both a human right and a key driver of sustainable development.  The 2030 Agenda emphasizes meeting present needs without compromising future generations, and Iraq has placed health as the third major sustainable development goal, encompassing 13 specific goals and 27 indicators. 

Health is seen not only as an end in itself but also as a means to ensure productivity, social stability, and sustainable progress. The plan addresses core areas of health development, beginning with maternal and child health.  By 2030, Iraq aims to reduce maternal mortality to fewer than 70 per 100,000 live births and ensure universal skilled birth attendance. Similarly, preventable child deaths are targeted for elimination, with neonatal mortality reduced to ≤12 per 1,000 and under-five mortality to ≤25 per 1,000 live births. Control of communicable diseases forms another priority. Iraq’s targets include ending epidemics of HIV, tuberculosis, malaria, and neglected tropical diseases, while also combating hepatitis and waterborne infections. Expanding vaccination coverage and access to affordable essential medicines is central to this objective. Alongside infectious diseases, Iraq seeks to address the rising burden of non-communicable diseases. By 2030, the goal is to reduce premature deaths from non-communicable diseases by one-third through prevention, early detection, and treatment. Promotion of mental health and reduction of suicide rates are integrated into this framework. Preventing and treating substance abuse, including narcotic drug dependence and harmful alcohol use, is also emphasized, supported by full implementation of the WHO Framework Convention on Tobacco Control. The plan highlights public safety and environmental health. Road traffic injuries, a significant cause of premature mortality, are targeted for a 50% reduction. Additionally, deaths caused by hazardous chemicals, pollution, and unsafe water or sanitation are to be substantially reduced. The Ministry also recognizes sexual and reproductive health as vital, with universal access to family planning, education, and reproductive services to be ensured by 2030. A cornerstone of the plan is achieving Universal Health Coverage. This involves expanding access to essential health services, financial risk protection, and ensuring equitable access to affordable, high-quality medicines and vaccines.  While the Universal Health Coverage service coverage index fell during 2020-2021, largely due to COVID-19 disruptions, partial recovery has been documented by 2022.

Healthcare System Financing 

The Iraqi Ministry of Health remained largely funded centrally by the government.  In 2022, total health expenditure was 9.84 trillion IQD (4.8% of the government budget). Recurrent spending accounted for 80.4%, largely for wages, while 19.6% supported infrastructure. Per capita spending was approximately USD 160. Capital spending: 19.6%, focused on hospital and primary healthcare infrastructure.

Healthcare Services Delivery The health services are delivered through primary health centers and public health clinics, hospitals [2, 3, 6, 7].

Healthcare Services Delivery: Primary Health Services in Iraq 

1. Infrastructure and Facilities

•              Total number of Primary Health Care Centers (PHCs): 2,914

o             Main PHCs: 1,374

o             Sub-center PHCs: 1,540

o             Family medicine PHCs: 184

•              Primary Health Care Sectors: 265

This network represents the backbone of Iraq’s primary healthcare delivery, though distribution and management vary across governorates.

 Figure 2A shows the distribution of Primary Health Care Centers (PHCs).

Figure 2A: Distribution of Primary Health Care Centers (PHCs): Main, sub-centers, and family medicine

Immunization Coverage

•              BCG vaccination: 96%

•              Polio (3rd dose): 92%

•              Measles: 88%Vaccination coverage is relatively strong but still below the universal target of 95% for herd immunity against measles and polio.

Figure 2B shows the immunization coverage rates.

Figure 2B: Immunization coverage rates for BCG, Polio (3rd dose), and Measles

 Outpatient Morbidity Patterns (Children <5>

•              Respiratory diseases: 24% of all PHC outpatient visits

•              Diarrhea cases: 4.5% of all PHC outpatient visits

Figure 2C shows outpatient morbidity patterns among children <5>

Figure 2C: Outpatient morbidity patterns among children <5>

Governance and Administration of PHCs

•              Managed by physicians: 52.5%

•              Managed by health/paramedical/administrative staff: 47.5%

•              Population per health center (average): 14,499

•              Health centers per 100,000 population: 6.9

Figure-2D shows governance and administration of PHCs (physician vs. non-physician managed). Considerable variation exists across governorates:

•              Some governorates (e.g., Al-Muthanna: 90.8%) rely heavily on non-physician managers.

•              Others (e.g., Baghdad, 93.5%) are predominantly physician-managed.

•              Kurdistan shows higher PHC density (e.g., Al-Sulaimaniya: 23.2  centers/100,000 vs. national  average 6.9).

outpatient visits

Figure 2C shows outpatient morbidity patterns among children <5>

Figure 2C: Outpatient morbidity patterns among children <5>

Governance and Administration of PHCs

•              Managed by physicians: 52.5%

•              Managed by health/paramedical/administrative staff: 47.5%

•              Population per health center (average): 14,499

•              Health centers per 100,000 population: 6.9

Figure-2D shows governance and administration of PHCs (physician vs. non-physician managed). Considerable variation exists across governorates:

•              Some governorates (e.g., Al-Muthanna: 90.8%) rely heavily on non-physician managers.

•              Others (e.g., Baghdad, 93.5%) are predominantly physician-managed.

•              Kurdistan shows higher PHC density (e.g., Al-Sulaimaniya: 23.2  centers/100,000 vs. national  average 6.9).

 Figure-2D: Governance and administration of PHCs (physician vs. non-physician managed).

Healthcare Services Delivery: Secondary and Tertiary Health Services in Iraq 

Secondary and tertiary health services in Iraq form the backbone of hospital-based care, providing inpatient treatment, advanced diagnostic procedures, and specialized surgeries.  These services complement the primary health care system and are concentrated in both governmental and private hospitals, as well as specialized centers.

Infrastructure and Capacity

•              Governmental Hospitals: 222 hospitals and specialized centers with inpatient services.

•              Private Hospitals: 194 institutions.

•              Total Governmental Hospital Beds: 51,759, with 42,512 predisposed beds (excluding emergency).

•              Hospital Bed Occupancy Rate: 51%.

•              Bed-to-Population Ratio: 1.2 beds per 1,000 population.

•              Premature Neonates’ Incubators: 2,460 units.

Figure-3 A shows the Hospital infra-structure in Iraq.

Figure-3A shows the Hospital infra-structure in Iraq

 Surgical and Clinical Services

•              Special operations: 35,644

•              Supra-major surgeries: 284,426

•              Major surgeries: 318,589

•              Medium-level surgeries: 345,316

•              Minor surgeries: 630,742

This high surgical activity reflects the significant reliance on secondary and tertiary facilities for both elective and emergency interventions.

Figure-3B shows surgical operations in Iraq.

                                                                                                   Figure-3B: Surgical operations in Iraq

 Utilization Indicators

•              Admitted Patients: 2,931,728

•              Admission Rate: 69.4 per 1,000 population

•              Inpatient Mortality Rate: 18.8 per 1,000 inpatients

•              Outpatient Visits (Total): 68,556,059

o             Consultative clinics: 16,197,597

o             Outpatient clinics: 2,752,438

o             Emergency units: 11,906,039

o             Specialized centers: 1,833,540

o             Primary health care centers (referrals and visits): 30,810,674

Medical Equipment Availability

Per 1 million population:

•              CT scan: 4.6 devices (169 total)

•              MRI: 3.0 devices (109 total)

•              Ultrasound: 44.2 devices (1,609 total)

•              Echocardiograph: 10.7 devices (390 total)

•              Lithotripsy: 1.6 devices (60 total)

Leading Causes of Hospitalization

Inpatient (all ages):

1.            Digestive system diseases (13%)

2.            Respiratory system diseases (9.3%)

3.            Circulatory system diseases (7.3%)

4.            Perinatal conditions (6.9%)

5.            Genitourinary disorders (6.2%)

6.            Infectious & parasitic diseases (4.2%)

7.            Blood & hematopoietic disorders (3.6%)

8.            Injuries/poisoning (2.3%)

9.            Eye diseases (1.8%)

10.          Abnormal symptoms & lab findings (1.8%)

Figure-3C shows top inpatient hospitalization causes. .

                                                                                             Figure-3C: Top inpatient hospitalization causes

 Hospital Outpatient (all ages):

1.            Acute tonsillitis (5.9%)

2.            Acute bronchitis/bronchiolitis (5%)

3.            Acute pharyngitis (4%)

4.            Other urinary system diseases (3.6%)

5.            Essential hypertension (3.1%)

6.            Influenza (3%)

7.            Diarrhea & gastroenteritis of infectious origin (2.3%)

8.            Dental caries (2.1%)

9.            Diabetes mellitus (2%)

10.          Skin & subcutaneous disorders (0.2%)

Workforce composition and distribution

The healthcare workforce in Iraq is the foundation of the delivery of medical services across primary, secondary, and tertiary care. It includes physicians, dentists, pharmacists, nurses, midwives, allied health professionals, and administrative staff distributed across public and private sectors. 

Physicians

•              Total number of physicians: Significant presence across Iraq, but uneven distribution between governorates and between urban vs. rural areas.

•              Density: Physician-to-population ratio remains below WHO recommendations, creating workload pressures.

•              Specialization: Concentrated in surgical, internal medicine, pediatrics, and obstetrics-gynecology. Subspecialties are limited, contributing to high referral rates abroad.

Dentists and Pharmacists

•              Dentists: The number of dental practitioners is growing, reflecting increased demand for oral health services. However, rural availability is limited.

•              Pharmacists: Pharmacist density is improving, with a notable expansion of graduates. Pharmacy workforce is distributed across hospitals, community pharmacies, and supply centers.

Nursing and Midwifery

•              Nurses: Nursing density is below regional and global averages, with many hospitals facing shortages. Heavy reliance on diploma-level nurses continues.

•              Midwives: Numbers remain insufficient to meet maternal health needs, especially in rural and underserved areas.

Allied Health Professionals

Includes laboratory technicians, radiology staff, physiotherapists, and public health workers. Their numbers are increasing but remain insufficient in proportion to the rising demand for diagnostic and rehabilitative services.

Table-2 shows the workforce size by major groups.

                                                                                                           Table-2: Workforce Size by Major Groups

Morbidity and Mortality indicators 

Vital Events

•              Crude birth rate: 25.5 per 1,000 population

•              Total number of births (inside & outside Iraq): 1,066,964

•              Births inside health facilities: 88.2%

•              Births by skilled personnel: 96%

•              Cesarean section deliveries: 44.1%

•              Low birth weight (<2>

•              Congenital malformations: 3.0 per 1,000 live births

Table-3 shows the key mortality indicators in Iraq.

Table-3: The key mortality indicators in Iraq 

 Leading Causes of Death (All Ages)  Top 10 causes of death (ICD-10 categories, excluding Kurdistan), account for 61% of all deaths (Figure-4B).

1.            Ischemic heart disease (IHD): 11%

2.            Hypertensive diseases: 9%

3.            Cerebrovascular diseases: 9%

4.            Other forms of heart disease: 9%

5.            Diabetes mellitus: 7%

6.            Renal failure :6%

7.            Perinatal respiratory & cardiovascular disorders: 4%

8.            Other bacterial diseases: 4%

9.            Malignant tumors of digestive organs: 2%

10.          Influenza & pneumonia :2%

Figure-4A: The mortality distribution in Iraq (neonatal, infant, under-5, maternal, adult)

                                                                                         Figure-4B: Top 10 causes of death in Iraq (all ages)

 Mortality by Age Group

1. Neonates:
   1. 47% due to respiratory & cardiovascular disorders of perinatal period
   2. 13% due to growth & gestation disorders
   3. 6% due to perinatal infections
   4. 5% due to congenital circulatory malformations
   5. Top 10 causes = 86.3% of neonatal deaths
2. Infants (<1>
3. 33% perinatal respiratory/cardiovascular disorders
4. 9% gestation/growth disorders
5. 8?cterial diseases
6. 8% congenital circulatory malformations
7. Top 10 causes = 77.4% of infant deaths

Table-4: Childhood Mortality