This realist review of 67 studies identified 27 strategies to enhance migrant health in Iran, focusing on trust-building through intersectoral governance, inclusive insurance to reduce financial barriers, cultural competency to improve accessibility, and community or digital outreach to extend service reach. The findings highlight how context-specific adaptation of global best practices—such as piloting migrant-inclusive insurance for vulnerable groups and expanding culturally tailored services—can address systemic barriers, strengthen healthcare delivery, and promote health equity for migrants within Iran’s health system. These evidence-based insights provide actionable guidance for policymakers aiming to localize interventions effectively.