The Kurdistan Region of Iraq (KRG), a globally significant part of the Irano-Anatolian biodiversity hotspot, harbors a rich concentration of medicinal plants integral to both its unique ecosystems and millennia-old ethnobotanical heritage, yet these plants are critical for local healthcare, economic resilience, and cultural identity, their existence is under severe and compounding threat. This study examines the multifaceted challenges to medicinal plant conservation in the KRG, focusing on ecological pressures, socioeconomic barriers, and governance gaps. Key threats include accelerating climate change, unsustainable harvesting driven by economic hardship, habitat loss from urbanization, and weak institutional enforcement. These pressures, combined with a significant lack of comprehensive floristic data, threaten to cause irreversible loss of species, genetic erosion, and the disappearance of invaluable traditional knowledge. Addressing this dual ecological and ethnobotanical crisis requires a multi-pronged and interdisciplinary approach. We propose evidence-based conservation strategies, including the establishment of new protected areas, strengthening community-based conservation, and integrating ethnobotanical documentation with modern scientific research. Such an approach, which leverages both in situ and ex situ methods, is not only a biological necessity but also a cultural and national heritage priority.