Background <p>Crimean–Congo Hemorrhagic Fever (CCHF) is a high-fatality, tick-borne viral zoonosis endemic to several regions of the Eastern Mediterranean, including Iraq. This study aimed to characterize the spatiotemporal patterns, clinical spectrum, and exposure-specific risk factors of CCHF in Wasit Governorate, Iraq.</p> Methods <p>A retrospective analytical study was conducted using surveillance data from 369 suspected cases reported in Wasit Governorate between 1 January 2022 to 30 June 2025. Laboratory confirmation was based on RT-PCR and serological criteria. Demographic, clinical, hematological, and exposure variables were analyzed using SPSS version 25. Descriptive statistics, Chi-square tests, and binary logistic regression were applied to identify significant predictors. Spatial distribution was visualized using QGIS.</p> Results <p>Among 369 suspected cases, 98 (26.6%) were laboratory-confirmed. Confirmed cases peaked in 2023 and exhibited a seasonal distribution between April and September. The case fatality rate was 11.5%, with no deaths in 2024. Clinical predictors of confirmation included injection site bleeding (OR = 4.33), ocular hemorrhage (OR = 3.10), and severe thrombocytopenia (OR = 2.90). Adults aged ≥ 30 years had significantly higher odds of infection. Key risk factors included recent animal slaughter (OR = 3.74), tick bites (OR = 4.85), and handling raw meat (OR = 2.39). Human-to-human transmission was negligible.</p> Conclusion <p>CCHF remains a recurrent and seasonally driven public health threat in Wasit, primarily mediated through zoonotic exposures. Hemorrhagic manifestations and thrombocytopenia are critical clinical indicators. These findings underscore the urgent need for integrated One Health surveillance, targeted vector control, and risk communication strategies to mitigate transmission in endemic settings.</p> Clinical trial <p>Not applicable.</p>