A lack of adequate building maintenance is a significant obstacle faced by governmental hospitals. This paper evaluates factors that negatively impact building-maintenance practices in Iraq. A literature review was conducted to identify factors affecting maintenance. A list of 42 factors affecting hospital-buildings was collected from previous studies and tested using a structured questionnaire distributed to hospital-maintenance experts. During the data analysis, 76 valid questionnaires were used. Based on the respondents’ ratings, the relative-importance index (RII) was used to determine the level of importance of each factor. From the results, it was concluded that twelve factors affect maintenance practices in hospital buildings: faulty design (0.889), lack of funding (0.874), inadequate training (0.871), misuse of building facilities (0.866), construction errors (0.863), lack of work experience (0.858), building age (0.826), individual modifications carried out by the hospital staff (0.826), shortage of maintenance staff (0.824), administrative corruption (0.821), selection of unqualified maintenance contractors (0.816) and unavailability of skilled appointed maintenance personnel (0.808). Understanding these factors’ effects is essential for maintenance-department managers to develop strategies for maintaining hospital buildings in Iraq by controlling them, as well as identifying problems and finding appropriate solutions to avoid them. KEYWORDS: Governmental hospitals, Maintenance, Iraq, Building maintenance, Maintenance practices, Factors affecting maintenance