The Sumatra-Andanaman tsunami was one of the greatest natural disasters in recorded human history. Here, we show that on the northwest coast of Aceh, Indonesia, where the tsunami was most ferocious, the damage to corals, although occasionally spectacular, was surprisingly limited. We detected no change in shallow coral assemblages between March 2003 and March 2005, with the exception of one site smothered by sediment. Direct tsunami damage was dependent on habitat and largely restricted to corals growing in unconsolidated substrata, a feature unique to tsunami disturbance. Reef condition, however, varied widely within the region and was clearly correlated with human impacts prior to the tsunami. Where fishing has been controlled, coral cover was high. In contrast, reefs exposed to destructive fishing had low coral cover and high algal cover, a phase shift the tsunami may exacerbate with an influx of sediments and nutrients. Healthy reefs did not mitigate the damage on land. Inundation distance was largely determined by wave height and coastal topography. We conclude that although chronic human misuse has been much more destructive to reefs in Aceh than this rare natural disturbance, human modification of the reef did not contribute to the magnitude of damage on land.