Background <p>Vector-borne neglected tropical diseases are still an underrecognized public health problem in the Arabian Peninsula. Of these, leishmaniasis is endemic in multiple regions, while the epidemiology of rickettsial infections remains incompletely understood. This systematic review synthesizes existing evidence on the epidemiology, distribution, and surveillance of these two diseases in the region.</p> Methods <p>Following PRISMA 2020 guidelines, a systematic review was performed. The protocol was registered with PROSPERO. We searched PubMed/MEDLINE, Scopus, Web of Science, EMBASE, and relevant grey literature for studies published from January 2000 to December 2025 that describe human cases of leishmaniasis or rickettsioses in countries of the Arabian Peninsula. Two reviewers independently screened studies, extracted data, and assessed methodological quality (risk of bias) using validated tools.</p> Results <p>A total of 44 studies were included. The majority of studies investigated leishmaniasis (<i>n</i> = 31), with fewer on rickettsioses (<i>n</i> = 9) or mixed febrile illness (<i>n</i> = 4). Most publications originated from Saudi Arabia. In the Arabian Peninsula, particularly in Saudi Arabia, cutaneous leishmaniasis remains endemic, with localized transmission hotspots and the coexistence of multiple Leishmania species, including <i>L. major</i> and <i>L. tropica</i>. Evidence for rickettsial infections remains sparse, primarily derived from case reports and serologic surveys.</p> Conclusion <p>Leishmaniasis remains a public health challenge in the Arabian Peninsula, particularly in Saudi Arabia. In contrast, rickettsioses are likely underdiagnosed due to limited surveillance and diagnostic capacity. Improved, integrated surveillance systems, paired with febrile illness investigations that include diagnostic testing for rickettsial pathogens, will lead to fewer missed cases, contributing to disease detection and control.</p>