The abundance of cockroaches in hospital environments, particularly in sewage systems, makes them potential human health risk factors through the transmission of various pathogens. This study evaluates the parasitic contamination carried by American cockroaches collected from the sewage systems in hospitals in Dhuluiya, Salah Al-Din Province, Iraq. A total of 37 American cockroaches were collected from sewage systems, and both internal and external parasites were isolated between October 2024 and March 2025. The parasites were identified microscopically using Lugol's iodine dye. The results revealed the presence of 14 different parasite species, with Nyctothyrous ovalis being the most prevalent gut flora. Other dangerous types, such as Strongyloides stercoralis and Enterobius vermicularis, were also identified. Additional pathogenic parasites included Ancylostoma duodenale, Trichomonas hominis, Entamoeba histolytica, Dipylidium spp., and Fasciola hepatica. This study suggests that the sewage systems in local hospitals in Salah Al-Din Province, Iraq, act as a source of medically important parasites.