Winner of four world championship titles in the 1,500 m from 1997 to 2003, as well as three other indoor world titles, he won the gold medals in the 1,500 m and 5,000 metres during the 2004 Olympic Games in Athens, becoming the second athlete in history after the Finn Paavo Nurmi to achieve the double in these two disciplines.

He is the current holder of the outdoor world records for the 1,500 m (3 min 26 s 00), the mile (3 min 43 s 13), and the 2,000 m (4 min 44 s 79), and also holds the best world performances of all time for the 1,500 m and the mile indoors.

His domination of world middle-distance running extended from 1996 to 2004, a period in which he established the best world performance of the year in the 1,500 m eight years consecutively, from 1996 to 2003, and suffered only three defeats, including two in the finals of the 1996 and 2000 Olympic Games. He was named best athlete of the year by the IAAF in 2001, 2002, and 2003.

Hicham El Guerrouj has been a member of the International Olympic Committee since 2004.