Background: Measles is a highly infectious viral disease as a significant global public health concern, particularly in low-income countries with inadequate healthcare facilities. This study determined the prevalence and risk factors of measles infection, vaccination rates, and surveillance effectiveness in Babylon and Karbala provinces of Iraq from 2020 to 2022. Method: Surveillance data on suspected and confirmed measles cases were collected and analyzed using descriptive statistics and multivariate logistic regression models. Results: Results showed that males, children aged 1-10 years, and residents of rural areas, particularly Ain Al-Tammr/Karbala, were more susceptible to measles. 93 confirmed measles cases were reported, with 13 in Babylon and 80 in Karbala. Non-vaccinated individuals had a significantly higher risk of infection. The study found 11 confirmed cases among vaccinated and unknown individuals, while 71 cases were among non-vaccinated individuals. Vaccine efficacy varied, indicating challenges in achieving effective community immunity. Poor vaccination coverage was attributed to administrative issues, inadequate resources, and vaccine hesitancy. Males were disproportionately affected compared to females. Conclusion: The study demonstrated the importance of strengthening vaccination programs, improving surveillance systems, and enhancing public awareness to combat measles outbreaks and reduce morbidity and mortality, especially among vulnerable populations. Improvements in vaccine coverage, proper vaccine handling, and prompt reporting of suspected cases are all necessary to eliminate measles from Iraq, with a special focus on the provinces of Babylon and Karbala.