During the nineteenth and early twentieth centuries, recurring epidemics of cholera, plague, and malaria in the Ottoman port city of Basra invited increased state intervention in matters of environmental management. Such intervention focused on improving flood control and reducing water pollution in Basra so as to improve the city’s sanitary conditions. At the same time, Ottoman sanitary authorities continued to promote the use quarantines at Basra as a way of inspecting individuals arriving from Qajar Iran and British India – locations which the Ottoman government believed to be the primary exporters of cholera and plague in particular. As the Ottoman government’s use of quarantines represented a threat to British commercial interests in the Gulf, British authorities increasingly urged Ottoman authorities to focus on improving Basra’s sanitary conditions, rather than rely on quarantines, which a growing scientific consensus began to view as ineffective in preventing cholera epidemics in particular. As such, the relationship between Basra’s ecology and the city’s susceptibility to epidemics became matters of heated debate among Ottoman and British officials. Despite the extent to which Ottoman sanitary authorities were aware of the ways in which Basra’s ecology itself was a contributing factor in the region’s susceptibility to epidemics, the Ottoman government’s own environmental awareness has been obscured by scholarship that has focused on documenting the evolution of the Ottoman quarantine program during the nineteenth and early twentieth centuries. This paper seeks to highlight that environmental awareness by arguing that quarantines were just one tool in a broader Ottoman strategy to combat epidemics in Basra. While quarantines did represent a threat to British commercial interests, they were primarily used by Ottoman authorities to combat regional sanitary threats during specific outbreaks. Moreover, the Ottoman government’s use of quarantines in no way precluded the implementation of sanitary policies focused on improved environmental management. By highlighting the Ottoman government’s complex and flexible approach to the problem of recurring epidemics Basra, this paper contributes to our knowledge of late Ottoman health policy by demonstrating the importance of local and environmental conditions in shaping Ottoman understandings of disease. By emphasizing the local, this paper also helps us move beyond analyses that focus on the broader evolution of the late Ottoman sanitarian state without regard to the ways in which local conditions influenced policy making in the Ottoman imperial capital.