Healthcare facilities are vital establishments to improve the public health, but with poor waste and wastewater management, may turn into a potential health risk. The fecal-oral transmission potential of SARS-CoV-2 and the role of the wastewater as a potential source of infection, more than ever highlights the importance of proper wastewater management during the COVID-19 pandemic. This systematic review represents a picture of the current state of hospital wastewater (HWW) management in Iran; an upper-middle income country with a paucity of proper data concerning HWW management and further provides suggestions for hospital wastewater management during COVID-19 pandemic in the country. We reviewed 31 papers that published from 2005-2020 evaluated 163 hospitals from 82 cities and 17 provinces. Per capita HWW generation in Iran varies from 354 to 1892 liter per bed per day (839±363 liter.bed/day). BOD, COD and TSS in the raw HWW were in the range of 119-1270, 205-1611 and 58-464 mg/L, respectively. Total coliforms and/or total fecal coliforms were in the range of 105-108 (MPN/100 mL). 44.2% of hospitals had an active WWTP at the time of the study from which, only 15.3% complied with discharge standards. More than 55% of the hospitals in Iran use no disinfection, and less than 7% comply with the discharge requirements. HWW management in Iran is very poor and there has been no improvement in HWW management within the last decade. To best respond to this pandemic, responsible authorities should address wastewater management in hospitals.