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The article considers several generations of Pakistani immigrants from Karachi to various cities in the United States such as Chicago and New York and explores how chronic diseases are shaped by the reverberations of conflict in kin relations in the US and Pakistan. Instead of examining the experience of chronic illness in isolation, the article considers how webs of evolving relations, tensions, competition, and conflicts among distant and close kin are experienced by the vulnerable and those who try to care for them. These conflicts are shaped by the experience of absence and also in the lives of intimate kin, and often appear in violent form. In navigating these relations, caregivers of those with illnesses develop strategies to maintain communications with wider kinship networks while also shielding the sick from the ramifications of ongoing disputes. [ABSTRACT FROM AUTHOR]