The novel's historical backdrop is the North African/Italian Campaigns of World War II. The story is told out of sequence, moving back and forth between the severely burned "English" patient's memories from before his accident and current events at the bomb-damaged Villa San Girolamo, an Italian monastery, where he is being cared for by Hana, a troubled young Canadian Army nurse. The English patient's only possession is a well-worn, and heavily annotated copy of Herodotus's The Histories that has survived the fiery parachute drop. Hearing the book constantly being read aloud to him brings about detailed recollections of his desert explorations, yet he is unable to recall his own name. Instead, he chooses to believe the assumption by others that he is an Englishman based on the sound of his voice. The patient is in fact László de Almásy, a Hungarian Count and desert explorer, one of many members of a British cartography group.
Caravaggio, an Italian-Canadian in the British foreign intelligence service since the late 1930s, befriended Hana's father before the latter died in the war. He learns that Hana is at the villa caring for a patient. He had remained in North Africa to spy when the German forces gain control and then transfers to Italy. He is eventually caught, interrogated, and tortured; they even cut off his thumbs. Caravaggio bears physical and psychological scars from his painful war experience for which he seeks vengeance.
Two British soldiers yell at Hana to stop her from playing a piano since the Germans often booby-trapped them. One of the soldiers, Kip, an Indian Sikh, a trained sapper, specializes in bomb and ordnance disposal. Kip decides to stay at the villa to attempt to clear it of unexploded ordnance. Kip and the English patient immediately become friends.
The English patient, sedated by morphine, begins to reveal everything: he fell in love with the Englishwoman Katharine Clifton who, with her husband Geoffrey, accompanied Almásy's desert exploration team. Almásy was mesmerized by Katharine's voice as she read Herodotus' Histories out loud by the campfire. They soon began a very intense affair, but she cut it short, claiming that Geoffrey would go mad if he were to discover them.
Geoffrey offers to return Almásy to Cairo on his plane since the expedition will break camp with the coming of war. Almásy is unaware that Katharine is aboard the plane as it flies low over him and then crashes. Geoffrey is killed outright. Katharine is injured internally and Almásy leaves her in the Cave of Swimmers. Caravaggio tells Almásy that British Intelligence knew about the affair. Almásy makes a three-day trek to British-controlled El Taj for help. When he arrives, he is detained as a spy because of his name, despite telling them about Katharine's predicament. He later guides German spies across the desert to Cairo. Almásy retrieves Katharine's body from the Cave and, while flying back, the decrepit plane leaks oil onto him and both of them catch fire. He parachutes from the plane and is found by the Bedouin.
The novel ends with Kip learning that America has bombed Hiroshima and Nagasaki. He departs from Villa San Girolamo, estranged from his white companions.
Count Ladislaus de Almásy is the titlular character who comes under Hana's care in Italy after being burned unrecognizably in Africa. Although Hungarian by birth, because he has lived without government identification or many verifiable long-term interactions, his accent prompts the authorities around him to perceive an English affiliation and to refer to him as the English Patient. Almásy serves as a blank canvas onto which the other characters project their experience during this time in Italy. For example, Hana treats him tenderly to redeem herself for not being by the side of her father when he was engulfed in flames and died. She provides comfort to the English Patient that she could not provide to her own father.
The rejection of a nationalistic identity enables Almásy to rationalize his duplicitous actions with his associates. He socializes with, and is a mapmaker for, the British before the war, then uses that information to smuggle German spies across northern Africa. Almásy is portrayed in a sympathetic light, partly because he tells his own story, but also because he always adheres to his own moral code.
Almásy is also at the centre of one of the novel's love stories. He is involved in an adulterous relationship with Katharine Clifton, which eventually leads to her death and the death of her husband, Geoffrey Clifton. Katharine is the figure who leads Almásy to sensuality. He falls in love with her voice as she reads Herodotus. Sensuality, both sexual and observational, is a major theme in the novel.
The character is loosely based on László Almásy, a well-known desert explorer in 1930s Egypt, who helped the German side in World War II. Almásy did not suffer burns or die in Italy, but survived the war and lived until 1951.
Hana is a twenty-year-old Canadian Army nurse torn between her youth and her maturity. Being a good nurse, she quickly learns that she cannot become emotionally attached to her patients. She calls them all "buddy," and forgets them immediately once they die. Her lover, a Canadian officer, is killed and because of this, Hana comes to believe that she is cursed and that all those around her are doomed to die.
In contrast, upon hearing of her father's death Hana has an emotional breakdown. She then puts all of her energy into caring for the English Patient. She washes his wounds and provides him with morphine. When the hospital is abandoned, Hana refuses to leave, staying with her patient. She sees Almásy as saint-like and falls in love with his pure nature.
In addition to her relationship with Almásy, Hana also forms a strong relationship with Kip during his stay at the villa.
Kirpal (Kip) Singh is an Indian Sikh who has volunteered with the British military for sapper bomb disposal training under Lord Suffolk. This act of patriotism is not shared by his Indian nationalist brother; the skepticism of his unit's white peers discourages a sense of community for Kip.
Lord Suffolk, an eccentric English nobleman, has developed techniques to dismantle complicated, unexploded bombs in what is a very dangerous occupation. Kip feels a sense of belonging in a community when he is welcomed into the Suffolk household. Lord Suffolk and his sapper team are killed while attempting to dismantle a new type of bomb. Their deaths cause Kip's emotional withdrawal to become more pronounced. It should be noted that Charles Howard, 20th Earl of Suffolk, was a real person who did dismantle bombs and was killed while attempting to dismantle one.
Kip is transferred to another unit in Italy where he and his partner hear a piano playing. As they enter the villa, they come across Hana and urge her to stop playing as the Germans were known to sabotage musical instruments. Kip stays on at the villa to clear any remaining unexploded bombs, mines, or other booby-traps. Kip feels a sense of community and confidence when he becomes Hana's lover. Kip sees the interactions of the Westerners at the villa as those of a group that disregards nationality. They get together and celebrate Hana's twenty-first birthday, a symbol of their friendship and Kip's acceptance. However, when he learns of the nuclear bombing of Hiroshima Kip is thoroughly shocked. He leaves immediately, unable to believe that Westerners would do such a thing. Kip goes back to India and never returns, though he never stops recalling the effect of Hana in his life.
David Caravaggio is a Canadian thief whose profession is legitimized by the war, as the Allies needed crafty people to steal Axis documents. He is a long-time friend of Hana's father and becomes known as "the man with bandaged hands" when he arrives at the villa; the bandages cover his severed thumbs, the result of an interrogation by the Italians in Florence. He recalls that Ranuccio Tommasoni ordered the interrogation tactic. This is a reference to a man by the same name who was murdered by the historical Caravaggio in 1606. The mental and physical outcome of the torture is that Caravaggio has "lost his nerve" and ability to steal. Hana remembers him as a very human thief. He would always be distracted by the human element while doing a job. For instance, if an advent calendar was on the wrong day, he would fix it. She also has deep feelings of love for Caravaggio. At times, Caravaggio seems to display a romantic love towards Hana. Caravaggio and Almásy share a morphine addiction. Caravaggio works this to his advantage to confirm his suspicion that Almásy is not English.
Katharine is the childhood friend and recently wedded wife of Geoffrey Clifton, whom she married after their days at Oxford University. The day after their wedding, she and Geoffrey flew to join Almásy's expedition. She entertained the camp in the evening by reading aloud from Almásy's copy of Heroditus' Histories, after which she and Almásy began an affair. Geoffrey discovered the affair after she had ended it, and she is wracked with guilt. Geoffrey attempts to kill all three of them by crashing his plane while they are flying. After Geoffrey is killed in the crash, Katharine admits that she always loved Almásy.
Geoffrey is Katharine's cuckolded husband, on a secret mission for the British government to make detailed aerial maps of North Africa; his joining the Almásy expedition is only a ruse. The plane he claims to be his own was appropriated by the Crown, and he leaves his wife with the other expedition members while on his mission, leading to her infidelity.
Christopher McVey has discussed the nature of Ondaatje's use of metaphysical aspects of body, history and nation in the novel. Amy Novak and Mirja Lobnik have separately analysed aspects of the treatment of memory in the novel. Thomas Harrison and Rachel Friedman have each examined the references and use of Herodotus in the novel. Madhumalati Adhikari has critiqued the treatment of World War II and its effects on the characters of the novel.
The novel won the 1992 Booker Prize and the 1992 Governor General's Award.
The book was adapted into a 1996 film by Anthony Minghella, starring Ralph Fiennes, Kristin Scott Thomas, Willem Dafoe, Colin Firth, and Juliette Binoche. The film received nine Academy Awards—including Best Picture and Director—at the 69th Academy Awards.