I.R.Iran is exposed to a wide variety of natural and man-made hazards. Human-related consequences of disasters and its impact on health service delivery bring the health to the top agenda of disaster management. This article presents the DHM’s progress in Iran and the related challenges. Iran has achieved considerable academic and administrative success in terms of emergency management and risk reduction in health sector, but many rooms for improvement are left. Earthquakes of Bam (2003), Zarand (2005) and Lorestan (2006), Golestan floods (2001 and 2005), Cyclone Gonu (2007) and re-current droughts were the largest disasters during last 10 years, which health system could learn from and apply the lessons learned. The challenges have been changed during last decade, as disaster health management upgraded from a unit under Center for Environmental Health to Emergency Management Center under deputy of minister directing national Emergency Operations Center (EOC). Heath system needs strengthening intra and inter-sectoral collaboration and coordination, information management system, community-based initiatives and integration of disaster health management in Primary Health Care (PHC) network. It also needs to focus on disaster risk reduction, while enhancing response capacity. Investing on research would lead to quality decision-making in disaster health management.