World War II is slowly winding down. A man is piloting a prop plane slowly flying over the swirling sands of the Egyptian desert. A woman appears to be asleep in the other inside the other seat. Suddenly, gunfire erupts and the planes falls from the sky in flames. A desert tribe on the ground drag the man’s body from the wreckage, charred beyond all recognition. The sleeping woman is nowhere to be found.
A nurse named Hana has just learned that her boyfriend has been killed. He was a soldier fighting to keep democracy safe from the fascists. Later, she loses a close a friend name Jan to a land mine and is so distraught she runs out into the middle of a field surrounded by mines that must be detected and disarmed. Everyone that Hana has cared about throughout this long, miserable war to topple a maniac dozens or hundreds or thousands of miles away has died. As a result, she has become convinced that she is a curse upon those who get close to her.
In 1944, Hana finds herself in the Italian countryside assigned to a caravan of soldiers recovering their various wounds. One member of the caravan is burned almost totally across his body and the cause of his condition is every bit as mysterious as his identity. Because Hana is a dedicated nurse who puts her patients well ahead of her own concerns, she is deeply troubled by the pain that the movement of the caravan is causing the burned man. A bombed-out monastery seems a much better place to allow the burned man—known only as the English patient—to live out the misery of his final days before he inevitably succumbs to his wounds and dies.
For a while, Hana and her patient have the monastery all to themselves. She reads to him. She repairs stairs and grows a garden. Then they are joined by Kip, a Sikh who is an expert at defusing landmines and David Caravaggio, a self-confessed thief with a notable scarcity of thumbs.
Through flashbacks, much of the real story of the English patient comes into starker relief. For one thing, he is not English at all but a Hungarian Count named Laszlo de Almasy. His great use during the war—a time when a man’s talent counted for more than usual—was his mapmaking talents. Those mapmaking talents lead to his becoming involved with a group of men informally known as the International Sand Club. One of those men is pilot like Almasy, Geoffrey Clifton. Almasy is not terribly impressed by Geoffrey, but takes quite a liking to his beautiful blonde wife Katherine. One fateful day, Katherine joins Almasy on a trip to the desert to examine the latest geological discovery: the Cave of Swimmers. When making their way back to Cairo, a violent sandstorm stops them dead in their track and they are forced to spend the night together inside the jeep. Back at the hotel later, their affair begins in earnest. Overwhelmed by guilt at this betrayal of her husband, she attempts to break it off and Almasy responds with cruelty.
Meanwhile, in the present day circumstances at the monastery, Hana and Kip commence their own romantic relationship. The curse of Hana appears well on its way to claiming another victim when Kip is called upon to put his talents at defusing mines to the test. At the last moment, just before detonation, he successfully emasculates the weapon. Everything seems to be coming Hana a celebration of the Nazis surrendering reveals that a statue in the monastery was booby-trapped and claims Kip’s much-admired sergeant. Kip is overcome with emotions to the point where he leaves Hana behind in the monastery.
The thumbless thief Caravaggio, in the meantime, has been spying on Almasy and one day enters his room to ask if he knows about a man named Count Laszlo Almasy and a woman named Katherine Clifton. Caravaggio is the only person who knows that the English patient is not whom he seems to be. In fact, his story even seems to contradict the portrait of Almasy gained from the narrative of his own flashbacks. Caravaggio makes the accusation that Almasy is not only far from being English, he is a traitor in league with the Nazis. According to Caravaggio, he was a Canadian spy working for the Allies while Almasy betraying good guys left and right while in league with the Nazis. Caravaggio has been busy going about seeking vengeance on those responsible for his imprisonment, torture and loss of thumbs. The only one left to wreak vengeance upon is Almasy.
Another meanwhile: as the affair of Almasy and Katherine Clifton dragged on through its on-again, off-again rhythm, Geoffrey Clifton has been anything but ignorant.
Almasy tells Caravaggio the truth: the Royal Geographic Society was forced to abandon Egypt when war broke out. That exit mean that where would be no more mapmaking. And so, before the Nazis took over completely, Almasy embarked upon one last mission to put his skills to use. Part of the plan was him to meet up with Geoffrey Clifton and the two of them would leave in Clifton’s plane.
That was the plan, at any rate.
In reality, rather than meeting him in the desert to pick him up, Geoffrey Clifton attempt to fly his plane right into Almasy where he stood on the ground. That plan also went awry: Clifton crashes and dies, leaving Katherine—who was also aboard—seriously injured and incapable of walking. Almasy manages to get her into the Cave of Swimmers and leaves her with food and water while he sets off on foot for the closest village. When he gets there, the British are in control and he has no identification. They confuse his Hungarian name with that of being German and promptly arrested him. Almasy manages t escape from the train carrying British prisoners of war and his dealings with the Germans was to trade the maps he had in his possession for safe passage back to Cairo so he could rescue Katherine. However, by the time he gets there she is already dead so he puts her onto a plane and takes to the sky where the viewer now learns that the woman in the plane was not sleeping but dead.
Almasy lets Hana know he wants to die so she provides him with a fatal dose of morphine. She also reads from the last words that Katherine that she wrote to Almasy while in the cave. As Hana reads them to the English patient who is not really English, he dies. Caravaggio and Hana then head into the city where she will rejoin the medical caravan.