Surgical care is an important service to provide to victims of a disaster. A specialized response team has been created by the National Disaster Medical Treatment division of the Federal Emergency Management Agency to respond when local hospital facilities are either unavailable or unusable. When a major earthquake destroyed Bam, Iran, in December 2003, the US Government mobilized the International Medical Surgical Response Team-East and deployed a team of 57 health care providers to aid in rescue and response efforts. The challenges of designing, maintaining, and keeping a Deployable Rapid Assembly Shelter/Surgical Hospital are described.