Khouri's first major involvement on the Arab literary scene was as a member of the editorial board of the journal Mawaqif, which he joined in 1972. Other members included Adonis, Hisham Sharabi and, somewhat later, Palestinian national poet Mahmoud Darwish. Of this group, Khoury later remarked that it was important, but marginal: "We were neither on the liberal right nor on the classical left. Intellectually speaking, we were very much linked to the Palestinian experience."
From 1975 to 1979 he was editor of Shu'un Filastin (Palestinian affairs), collaborating with Mahmoud Darwish, and from 1981 to 1982 editorial director of Al-Karmel. From 1983 to 1990 he was editorial director of the cultural section of Al-Safir. He has been editor of Al-Mulhaq, the cultural supplement of Al-Nahar, since its reappearance after the end of the civil war.
He has taught in Columbia University, New York, in the American University of Beirut, the Lebanese University, the Lebanese American University and New York University.
Interviewed for the Israeli newspaper Yediot Aharonot after the appearance of the Hebrew translation of the novel, Khouri remarked:
...when I was working on this book, I discovered that the “other” is the mirror of the "I." And given that I am writing about half a century of Palestinian experience, it is impossible to read this experience otherwise than in the mirror of the Israeli “other.” Therefore, when I was writing this novel, I have put a lot of effort into trying to take apart not only the Palestinian stereotype but also the Israeli stereotype as it appears in Arab literature and especially in the Palestinian literature of Ghassan Kanafani, for example, or even of Emil Habibi. The Israeli is not only the policeman or the occupier, he is the "other," who also has a human experience, and we need to read this experience. Our reading of their experience is a mirror to our reading of the Palestinian experience.Khoury's most recent novel, Yalo, was controversial as it depicted a former militiaman accused of crimes during the civil war and portrayed the use of torture in the Lebanese judicial system.
Khoury's novels are notable for their complex approach to both political themes and more fundamental questions of human behaviour. His narrative technique often involves an interior monologue, at times approaching a stream of consciousness. In recent works he has tended to use a considerable element of colloquial Arabic, although the language of his novels remains primarily classical Arabic, which is also called standard Arabic. This use of dialect forms adds to the credibility and immediacy of the narratorial voice. While use of dialect in dialogue is relatively common in modern Arabic literature (for example, in the work of Yusuf Idris), Khoury introduces it into the main narrative, an unusual step although one clearly associated with the narrative technique of his works.
Elias Khoury's works have been translated into English, French, German, Hebrew, Portuguese,Italian, and Swedish.
In March 2001 Khoury signed a statement along with 13 other Arab intellectuals (including Mahmoud Darwish, Samir Kassir and Adonis), opposing the holding of a Holocaust denial conference in Beirut, a statement which was praised in Le Monde by the Israeli ambassador to France. Khoury responded angrily to the ambassador's remarks, pointing to the Israeli repression of the Palestinian intifada.
Khoury, along with Samir Kassir and other intellectuals and political activists, was involved in the establishment of the Democratic Left Movement.