A significant number of Sri Lankan Tamils fled the violence unleashed during the civil war (1983–2009) between Tamils and the Sri Lankan government. The largest concentrations of Sri Lankan Tamils outside of Sri Lanka exist in Canada and India. The objective of this study is to examine the impact of pre-migration and post-migration experiences on Sri Lankan Tamil refugees in Canada and India. A total of 35 refugees participated in the qualitative study. Data were gathered through semi-structured interviews. About 28 participants were from Gummidipoondi refugee camps near Chennai, India, and seven were from Toronto, Canada. There were 22 males and 13 females. The content analysis revealed war-related complex distress among participants. Major themes identified were civil war, genocide and escape, settlement/Kudiyettam, the role of the United Nations and Refugee Board policies. The results of the study emphasize the distress caused by the civil war and the subsequent journey many refugees took to reach thei...