OBJECTIVE: To describe the health beliefs and practice in a rural Iraqi community. METHODS: Personal observations and practice; narratives of colleagues. RESULTS: Rural Iraqi society has remained unchanged in beliefs and practices in many ways since the Babylonian and Sumerian eras over four millennia ago. Like other rural societies, it has a culture that includes values, beliefs, customs, communication style, and behaviors. Those beliefs often invoke supernatural agents such as evil, jinni, witchcraft and the results of sin, bad luck and envy. Primitive and current religious beliefs join with the effects of poverty and illiteracy. These rural people view health and disease quite differently from the views of their physicians and these cultural beliefs and practices confound current patient-clinician communication. Although physicians view the medical encounter as the main tool of diagnosis and therapy, especially when biomedical technology is lacking, ignorance of the characteristics of the rural society and people may make physicians' work all the more difficult. CONCLUSIONS: As with all cross-cultural interactions, better understanding of the patient or family's beliefs allow the clinician to find compromises and reach agreements that ignorance of their beliefs would deny. PRACTICE IMPLICATIONS: Simply asking the patient and the family how they view the illness, what they consider to be the cause, what treatments they have already tried and what treatments they hope you will use, may go a long way toward building a therapeutic relationship