Background: The basic step in planning and policy-making for hospital surge capacity in disasters is the awareness of the current situation and problems. This issue is of greater importance in hospitals of developing countries that usually face many problems in ordinary situations; this paper aimed at identifying the status of hospitals in a developing country for surge capacity and the associated challenges at the time of disasters, and strategies to solve them. Methods: In this qualitative study, semi-structured interviews were conducted with 27 participants, who were mostly officials of hospitals and the authorities of the ministry of health in Iran. Thematic analysis was used for analyzing the data. Results: In this study, 40 subthemes and 12 themes under 4 main categories, including space, medication/supplies, manpower, and functional structures/plans, were identified. Some of these themes included shortage of space inside the structures, weakness in providing medication/emergency medical supplies, general shortage of manpower, weakness in maintaining and recalling staff at the time of hospital surge capacity in disasters, content defect in hospitals disaster preparedness plan, and weakness in training for disasters Conclusions: Generally, there are various challenges hospital surge capacity at the time of disasters, and hospitals are disadvantaged in this regard. However, implementing strategies recognized in this study may help resolve these challenges.