Trincomalee, the coastal peninsula town where Koneswaram is located is an anglicized form of the old Tamil word "Thiru-kona-malai" (Tamil: திருகோணமலை), meaning "Lord of the Sacred Hill", its earliest reference in this form found in the Tevaram of the 7th century by Sambandhar.

Thiru is a generally used epithet denoting a "sacred" temple site while Malai means mountain or hill; Middle Tamil manuscripts and inscriptions mention the monumental compound shrine as the Thirukonamalai Konesar Kovil.

[1] The population of the district, like the rest of the east and north, has been heavily affected by the civil war.

[16] Several hundred thousand Sri Lankan Tamils, possibly as much as one million, emigrated to the West during the war.

[17] In 2016, the district was one of the poorest in Sri Lanka and had the third-highest incidence of extreme poverty according to the World Bank.