The film takes place mostly against a backdrop since the World War I years, the Russian Revolution of 1917, and the Russian Civil War. A narrative framing device, set in the late 1940s or early 1950s, involves KGB Lieutenant General Yevgraf Andreyevich Zhivago searching for the daughter of his half brother, Doctor Yuri Andreyevich Zhivago, and Larissa (“Lara”). Yevgraf believes a young woman, Tanya Komarova, may be his niece and tells her the story of her father’s life.
After the burial of his mother in rural Russia, the orphaned child Yuri Zhivago is taken to be cared for by his mother’s friends in Moscow: Alexander and Anna Gromeko. In 1913, Zhivago, as a medical student in training, but a poet at heart, meets their daughter’s friend Tonya, as she returns to Moscow after a long visit to Paris. Lara, only 17 years, is involved in an affair with her mother’s friend, the older well-connected Victor Ippolitovich Komarovsky. One night, the idealistic reformer Pavel Pavlovich “Pasha” Antipov is wounded by sabre-wielding militia violent attack of peaceful civil demonstration. Pasha runs to Lara, whom he wishes to marry, to treat his wound and asks her to hide a gun he picked up at that bloody event.
After Lara’s mother learns of her daughter’s affair with Komarovsky, she attempts suicide, for which medical treatment is given by Zhivago, alerted by the man to Lara’s home. When Komarovsky learns of Lara’s intentions to marry Pasha, he tries first to dissuade her, and when refused he rapes her In revenge. Humiliated Lara then takes Pasha’s pistol hidden for him, follows Komarovsky to his Christmas party, and shoots at him, barely wounding his hand. The man insists that no action be taken against Lara, who is soon escorted out by Pasha who happened to be around, whereas Komarovsky’s wound, is taken care of by Zhivago. Although devastated by Lara’s ill relations with Komarovsky, Pasha marries her, and they have a daughter named Katya.
During World War I, Yevgraf Zhivago is sent by the Bolsheviks to subvert the Imperial Russian Army. Yuri Zhivago is drafted and becomes a battlefield doctor. Pasha is reported missing in action following a daring attack on German forces, and Lara enlists as a nurse to search for him. During the February 1917 Revolution, Zhivago enlists Lara’s help to tend to the wounded. Together they run a field hospital for six months, during which time radical changes ensue throughout Russia as Vladimir Lenin return from exile to Moscow. Before their departure there, Yuri and Lara eventually fall in love, yet Yuri remains true to Tonya, by then his wife.
After the war, Yuri returns to Tonya and their children, and settle at their house in Moscow, which was split and divided into tenements by the new Soviet government. Yevgraf, now a member of the Cheka, informs him that his poems were condemned as antagonistic to Communism. Further he provides Yuri the travel passes and documents to escape the austere life of Moscow, to the far-away Varykino estate in the Ural Mountains. The family board a heavily guarded freight train, bound to be travelling through contested territory, being secured by the infamous Bolshevik commander named Strelnikov, who is in fact Pasha Antipov.
While the train is stopped early one morning, Zhivago wanders near the armoured train of Strelnikov and summoned by his guards to his office. He recognizes him as Pasha Antipov, who informs Yuri within a tense interview, that his estranged wife Lara is now living in the town of Yuriatin, still occupied by the anti-Communist White forces, and nevertheless lets Zhivago return safely to the train and his family. They settle and live peacefully in a cottage at the Varykino estate until Zhivago contacts Lara in nearby Yuriatin. They surrender to their long repressed feelings, although Tonya has become pregnant. Yuri travels to Yuriatin to break off with Lara, only to be abducted by the Communist partisans on the trip back, to join their field medical service.
After two years, Zhivago deserts the partisants and trudges days and nights through deep snow, to Yuriatin where he again finds Lara. She informs him that Tonya had reached her while searching for him, and is now back in Moscow. However, as Lara hands Yuri a sealed letter mailed six months earlier to her own address, it was revealed that Tonya, her father, and their children were deported by then and are living in Paris. Eventually Yuri and Lara renew their relationship, but one night Komarovsky arrives and warns them they are being watched by the Cheka because of Lara’s marriage to Strelnikov. Komarovsky offers her and Yuri, his help in leaving Russia, which they promptly refuse. Instead they return to the abandoned Varykino estate, taking up residence in the banned main house, where Yuri begins writing his “Lara” poems which will later make him famous, but also entail apparent government displeasure. Komarovsky however reappears in their house and informs Yuri that Strelnikov was captured five miles away, while apparently looking for Lara, and then committed suicide en route to his own execution. Hence Lara is now in real risk, as the only one left to the Cheka’s anticommunist retaliation. Zhivago sends Lara and Katya away with Komarovsky, recently appointed as regional official in the independent Far Eastern Republic. Refusing to accompany the despised person, Yuri remains behind to face his fate.
Years later, during the Stalinist era, Yevgraf meets Yuri in Moscow, sick and destitute, and gets him a new suit and a job. Looking out the window of a crowded tram, Yuri sees Lara walk by. Unable to attract her attention, he struggles to get off at the next stop, and runs after her, but suffers a fatal heart attack before she sees him. Yuri’s funeral is well-attended, despite the ban on his poetry at the time. Lara approaches Yevgraf at the funeral, and tells him she gave birth to Yuri’s daughter in the Far East, but the girl was lost when the Russian Civil War broke out there. After vainly looking for her, with Yevgraf’s help, in various orphanages, Lara disappears; Yevgraf thinks she must have died in one of the labour camps.
While Yevgraf still believes that Tanya Komarova is Yuri and Lara’s daughter, she is not convinced, and still insists that her father was Komarovsky, who later let go of her hand and lost her in the street. When about to leave with her fiancé, Yevgraf notices Tanya’s balalaika, the instrument which Yuri’s mother was so gifted at playing. Questioned further, Tania confirms that she is indeed self-taught at it, whereupon her boyfriend proclaims what a ‘great artist’ she is. To which Yevgraf smiles, “Ah well, then it’s a gift!”, leaving no doubt as to whose daughter she is.