Visceral leishmaniasis (VL) is an endemic parasitic disease transmitted by the bite of sand flies. To describe trends and demographics of reported VL cases, we reviewed surveillance data from 1990–2009. Reported VL incidence per 100 000 population was 2·6 in 2007, 3·1 in 2008, and 4·8 in 2009, mostly in children aged <5 years. The number of cases varied greatly in step with prevailing economic and security conditions, raising concerns about the completeness and quality of surveillance data. Nevertheless, we conclude that VL remains an important endemic disease in Iraq and that surveillance system is recovering the capacity to detect cases as the country experiences greater stability. We recommend conducting formal entomological investigations, and evaluating existing control measures.