Background: Wars and political volatility in Iraq have decimated healthcare systems for decades. Iraq’s healthcare demands cannot be delivered without quality pharmaceutical systems that regulate, supply, and promote the appropriate use of medicinal products. Healthcare services and pharmaceutical systems are interdependent. Without accurate reporting about Iraq’s pharmaceutical processes, systems and challenges, meaningful healthcare reform consistent with national goals for social stability will not be achievable. Aims: This article evaluates the pharmaceutical system in place for delivery and use of medical products to ensure patient protection and the optimisation of health outcomes in Iraq. Current challenges are outlined. Potential solutions and recommendations are described. Methodology: A narrative review collected peer-reviewed articles, publications from PubMed, Scopus, Web of Science and Google within the last 25 years. The articles were analysed in the context of Iraq’s pharmaceutical context. Figures were synthesised and a diagram was used with the data to guide recommendations. Results:The administrative and technical units were elucidated. Streamlining of regulatory processes was highlighted as an area lacking funding. Deficiencies in oversight of the private sector and the need for empowerment of the domestic pharmaceutical industry were significant findings. Improvements in educational curricula and training of pharmaceutical professionals are required. Modernisation of health information and research systems were considered necessary. Success in the development of a functional pharmaceutical system was strongly associated with both reform of the healthcare system and development of national economic interests to support the State’s legitimacy.