The Indian Ocean tsunami of 2004 killed 31,000 people in Sri Lanka and produced morbidity primarily resulting from near-drownings and traumatic injuries. In the immediate aftermath, the survivors brought bodies to the hospitals, which hampered the hospitals' operations. The fear of epidemics led to mass burials. Infectious diseases were prevented through the provision of clean water and through vector control. Months after the tsunami, little rebuilding of permanent housing was evident, and many tsunami victims continued to reside in transit camps without means of generating their own income. The lack of an incident command system, limited funding, and political conflicts were identified as barriers to optimal relief efforts. Despite these barriers, Sri Lanka was fortunate in drawing upon a well-developed community health infrastructure as well as local and international resources. The need continues for education and training in clinical skills for mass rescue and emergency treatment, as well as participation in a multidisciplinary response.