In the 19th century, the world witnessed multiple epidemics of cholera that took countless lives across the globe. In the context of the Ottoman empire, cholera gave literal meaning to the trope of the "Sick Man of Europe." In 1866, the third in a series of International Sanitary Conferences intended to address the issue of cholera was convened at Istanbul in response to an outbreak that killed thousands during the annual Hajj. There, the nations of Europe put pressure on the Ottoman state to adopt new public health practices. In the provinces of modern-day Iraq, distant from Istanbul and late in adopting the institutional reforms of the Tanzimat, the creation of new public health institutions was complicated by the extensive economic and political penetration of the British empire. Focusing on the second half of the 19th century, this paper draws upon the substantial unpublished diaries of Joseph Svoboda, an Austro-Hungarian resident of Baghdad. As a clerk aboard a river steamer, Svoboda had considerable connections amongst the British political and economic community in Baghdad and Basra. He was a witness to three of the six worldwide cholera pandemics in the 19th century, as well as to the occasionally fraught relationship between the Ottoman authorities and the representatives of the British Empire in the region. Utilizing the wealth of observations in Svoboda’s diaries allows us to draw two conclusions. First, cholera was a disease that was spread from place to place by human movement. This paper argues that in considering the full disease environment of the Ottoman empire, historical patterns of the spread of cholera indicate that it entered the Iraqi provinces through the port of Basra, environmentally linking it much more closely with Persia and British India than with the rest of the Ottoman empire, from which it was cut off by the vast barrier of the Syrian desert. Second, the contested process of instituting new public health measures between the Ottoman state and representatives of the British empire in the Iraqi provinces reveals that, even after the re-assertion of direct Ottoman rule in the region in 1831, local sovereignty remained fluid. Understanding the process of medical change and the disease landscape of the Iraqi provinces of the Ottoman empire necessitates a reevaluation of established political and environmental realities in the region.