KILINOCHCHI, Sri Lanka -- The line of sick and injured tsunami victims snakes through the refugee camp's makeshift clinic and up to Dr. Joseph Angelo, who has traveled from Bel Air, Md., to treat his native countrymen.

"This area is totally neglected," says Dr. Angelo, 44, who fled Sri Lanka in 1983 after war erupted between the island nation's Sinhalese and Tamil ethnic groups.

"It is so pathetic. The health care is so primitive. No medications," says Dr. Angelo, a Tamil, as he examines patients at a long wooden picnic table. "I have to do something for this community."

The table is half-covered with bottles and boxes of medicine that have not been used in the United States for years.

Dr. Angelo sees the seemingly endless parade of patients in quick succession: A 47-year-old man with a fever from a possible case of meningitis; a 2-year-old boy with multiple hernias who could die without surgery, but has gone untreated for a year; a 24-year-old woman with fever and chills from a viral infection.

Their maladies are as much a product of scarce health care in Sri Lanka's war-torn northern provinces as they are the result of the Dec. 26 tsunami, though the natural disaster has exacerbated the region's refugee crisis and further taxed its overburdened hospital system.

The tsunami forced many Sri Lankans to abandon entire towns within a land mass that is slightly larger than West Virginia and located off the southern tip of India. Sri Lanka's tsunami death toll is estimated at more than 30,900. About 225,000 in all may have perished in the tidal waves, most in Indonesia.

Many of Dr. Angelo's clinic patients at Vidyananda College, a rural school housing 1,451 refugees, came from the nearby town of Kalapadu. The giant waves crashed through homes, leveled the church and reduced the once-prosperous fishing village to mounds of rubble scattered along the seashore.

As the doctor examines a rash on a 12-year-old boy's foot -- probably the result of walking in dirty water in the tsunami's aftermath -- the boy's mother tells through an interpreter how they escaped, but lost their home and possessions.

"My son was swept away and clung to a tree," says Jegatheeswary, 36, who, like many other Sri Lankans, uses only one name. "I grabbed my daughter and ran away. When I came back for my son, he was naked -- everything was washed away."

-A divided nation-

In Sri Lanka, the tidal waves left more than 200,000 homeless. Nearly two-thirds of the dead and 75 percent of the displaced families were Tamils living in territory controlled or influenced by the separatist Liberation Tigers of the Tamil Eelam (LTT).

The Sinhalese control the Sri Lankan government, but the Tigers control much of the northern provinces. The United States lists the Tamil Tigers as a terrorist group.

Though few condone the Tigers' trademark suicide-bomb attacks, many Tamil expatriates in America and throughout the world support the struggle against what they see as discriminatory policies of the Sri Lankan government.

"It bothers me. It is part of our community name," Dr. Angelo says of the suicide bombers. "[But] they are the people who fight for our freedom."

The tsunami complicated an already complex political scene.

The conflict between Sinhalese, who make up 74 percent of the population and are mostly Buddhist, and the Tamil, who make up 18 percent of the population and are mostly Hindu, has claimed tens of thousands of lives in the past two decades.

A February 2002 cease-fire brought an uneasy peace to the island. But just before the tsunami, international observers predicted the cease-fire would collapse. The disaster may have postponed another outbreak of violence by delivering setbacks to both armies, but the crisis also enflamed tensions over aid distribution.

Still, the northern and eastern districts under the Tigers' control remain backward outposts in contrast to the more prosperous and developed south.

In Kilinochchi, the Tigers' administrative capital, the two-lane main road is bordered by dirt walkways and open drainage ditches. The streetscape boasts shops with three-sided concrete stalls and corrugated tin roofs, along with a bombed-out school, church and water tower.

Communications are limited by the town's 50 phone lines and absence of mobile-phone service. Power outages are common. The district hospital here has 125 beds for about 250 patients, and medicine is in short supply.

-'It's sad'-

Dr. Angelo arrived with 20 other U.S. doctors and nurses on a relief mission sponsored by the International Medical Health Organization (IMHO), an aid group set up 18 months ago by his medical partner and fellow Tamil expatriate, Dr. Sinnarajah Raguraj.

The organization originally aimed to open 15 medical centers behind Tiger lines in the impoverished northern districts. However, the tsunami prompted the doctors to mount a hasty relief effort.

Fears among Tamil expatriates that their suffering brethren would be forsaken by the Sinhalese-dominated government made their mission seem all the more urgent.

"You would expect the whole country to come together and help the people. Unfortunately, that is not what is happening," says Dr. Gnanam Thambipillai, 36, an expatriate who practices in Chester, Pa., and is a member of the IMHO mission.

"The Sri Lankan government is ignoring the north and concentrating on the south," he says. "It's sad. You would think the government would use this opportunity to win the hearts of the north."

The government, however, insists aid is being distributed wherever it is needed.

Last week, President Chandrika Bandaranaike Kumaratunga announced that a convoy of 12 pickup trucks and 30 tractors, as well as 90 generators and 50 water pumps, had been dispatched to the northern and eastern provinces to help clear debris and begin reconstruction.

"There is definitely no truth to the statement that the government has not been delivering aid to the north and the east," says Niranjan De Soysa, spokesman for the Sri Lanka Center for National Operations (CNO), which oversees the relief effort.

"We have been very careful," he says. "It would be foolish for us not to distribute food and medical aid equitably."

-Distrust and delays-

CNO documents provided by Mr. De Soysa show that as of Jan. 13, northern and eastern provinces received 7,013 metric tons of rice, sugar, dal and wheat flour, while southern provinces received 992 metric tons.

The figures did not impress Dr. Angelo.

"The government does not help our people," he says after reviewing the documents. "I don't think they are helping the people, healthwise."

Both sides accuse each other of hampering aid to tsunami victims in Tamil territory. And there is evidence their mutual distrust caused delays in delivering some supplies.

When the IMHO convoy of a bus, two minivans and a pickup truck reached the Sri Lankan army's boundary to enter the northern districts, soldiers opened every piece of luggage three times and closely scrutinized the contents.

The inspection stalled the convoy for three hours, nearly until the close of the border for the day at 5:30 p.m. The soldiers did not let the doctors pass until an International Committee of the Red Cross monitor intervened.

"If they have the right paperwork, [the army] shouldn't be searching the truck at this hour," Red Cross agent Robin Creelman says. "They could just open the truck up and look inside."

Tamils in the group says the delay tactics evince discrimination by the Sinhalese.

"It's just harassment," Dr. Thambipillai says.

-Starting over-

The Vidyananda campus consists of a series of long concrete buildings separated by dirt paths with semi-enclosed classrooms on each side. The classrooms are filled with the clutter of displaced lives, including laundry hanging from lines.

The refugees nevertheless appear clean and well-fed. The U.N. refugee agency and various nongovernmental organizations, including the Tamil Rehabilitation Organization (TRO), have provided the camp with bathroom facilities, clean water and food.

But villagers have little to occupy their time. They wander about the schoolyard or sit in small groups. Children pitch marbles against overturned desks on the dirt walkways. On the school's athletic field, boys play volleyball and cricket.

Groups of men -- some in saris, some in short pants -- sit under shade trees on the field's perimeter.

The refugees will move this week to a tent city being erected nearby so the school can reopen. But the villagers are unable -- owing to fear or lack of resources -- to begin rebuilding their homes.

"Most of the people can't stand to stay in their native village because they have lost all their property," says K. Kumaresan, 32, the TRO camp coordinator. "They were mostly fishermen, and the tsunami destroyed their nets, their [outboard] motors, their boats."

Lives were disrupted in so many ways.

Abigail Thomas, a graduate student from the Johns Hopkins School of Public Health in Baltimore, escorts a 14-year-old girl named Sindu to the clinic for counseling. Sindu had begun menstruating for the first time and had no female relatives left to guide her.

According to local custom, a young girl's first menstruation is cause for a monthlong celebration, with cleaning rituals and special foods prepared by the girl's mother.

"None of that is happening," says Mrs. Thomas, 28. "These are the kind of things you never think of."

-'Washed away'-

Sindu, a Christian, was attending a Sunday church service last month with her family when the waves knocked down the walls and swept away the congregation, including her mother, father and two other relatives.

Of her family, only Sindu and her 12-year-old brother survived.

"They were washed away in front of our eyes," Sindu says through an interpreter.

On the school's athletic field, Mrs. Thomas and another volunteer, Nira Ravindran, hand out crayons and notepads to children.

Malhivathana, 11, who lost nine relatives in the tsunami, draws a crude picture of his family's home with a blue wall of water towering above it.

The boy proudly presents his drawing to Mrs. Ravindran, a Tamil expatriate who works as a counselor in Wolverhampton, England.

"We just told them to draw what is in their hearts, and that is what they come up with," she says.