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Objective To describe the epidemiology of injuries and illnesses at the Paris 2024 Paralympic Games.Methods Injuries and illnesses were recorded daily via a web-based injury and illness surveillance system and local organising committee medical facilities. Adjusted incidences (injuries/illnesses per 1000 athlete days; 95% CIs), injury prevalence (IP; %) and injury burden (days lost per 1000 athlete days; 95% CIs) are reported.Results In total, 4450 athletes (1978 female; 2472 male) from 163 National Paralympic Committees were monitored prospectively during the 14-day Games period (62300 athlete days). A total of 535 injuries (IP=10.9%) were reported in 485 athletes, with an incidence of 8.6 (7.9–9.4). Taekwondo (27.3 (20.7–35.8)), football 5-a-side (22.3 (14.4–37.7)) and sitting volleyball (19.9 (14.8–26.7)) showed higher incidences of injury compared to other sports (p<0.001). Injury burden was 8.5 (6.5–11.1) and 19.1% of injuries resulting in time loss from training/competition. The highest burden was observed in taekwondo (64.3 (35.9–115.2)) and football 5-a-side (23.4 (6.2–88.3)). A total of 520 illnesses were reported in 467 athletes (IP=10.5%), with an incidence of 8.3 (7.6–9.1). Illness incidence for female athletes (10.6 (9.4–11.9)) was higher than recorded for male athletes (6.6 (5.7–7.5)); p<0.001 and higher in triathlon (18.2 (12.6–26.7)) compared to other sports (p<0.05).Conclusion The incidence and burden of injury in taekwondo and football 5-a-side were significantly higher compared with other sports at the Paris 2024 Paralympic Games. The highest incidence of illness was observed in triathlon and female athletes had a higher illness incidence than male athletes.