In this chapter we emphasise the critical role of leadership within the Kurdistan Region in Iraq (KRI) health system governance. In particular, we critically assess the role extent to which the Ministry of Health, Department of Health, Medical Professional Syndicate, and hospital management teams are able to successfully fulfil the roles of setting directions, encouraging participation, promoting transparency, and ensuring accountability. We expose a number of problems that have emerged with leadership—not least dysfunctional allocation of responsibilities, over-reliance on doctors, and an inadequate degree of team-oriented healthcare.