Arbaeen is one of the world’s largest religious gatherings. It is held in Karbala, Iraq, and can pose many significant challenges to the health of pilgrims and the host population as well as the health system of Iraq.

The present study was conducted to reflect an overview of the health-related challenges associated with the Arbaeen ceremonies.

This qualitative study was conducted from October 6 (ten days before Arbaeen ceremonies) to October 16, 2019, in Najaf, Karbala, and the route pilgrims walk in Iraq. Semi-structured and in-depth interviews were conducted with disaster and emergency specialists, health experts, nurses, general physicians, and specialist doctors. Twelve experts and six pilgrims were interviewed. Thematic analysis was used to analyze the data.

The findings were categorized into three main groups: treatment issues, public health, and infrastructure. The main complaints pilgrims had were bone and joint pain, muscle spasms, headache, toothache, pharyngitis, rhinorrhea, and common cold, purulent throat, and gastrointestinal symptoms. The main problems of those with chronic conditions included having forgotten to take medications or running out of medications. Food and water safety and sanitary conditions were inappropriate. Iraq’s health system was not prepared to fulfill the health needs of the people at such a gathering.

Arbaeen ceremonies impose a heavy burden on Iraq’s healthcare system and cause numerous health challenges. Moreover, Iraq’s healthcare system does not have the capacity or readiness to meet the challenges of this event; international aid from the countries whose citizens attend the event are needed. Although the Iranian Red Crescent cooperated extensively, the collaboration must be more coordinated and broadened.