Hilsenrath was born in Leipzig. In 1938 his mother escaped with her two children to Siret (Sereth), in Romanian Bukovina, where they enjoyed a respite from persecution. At the time that he should have received an entrance card to higher education, he and his mother were interned in the ghetto of Cernăuţi (Czernowitz).

He began to write about the Holocaust after his liberation when he moved to Paris. Hilsenrath also lived in Palestine, Israel, and New York.

According to Dagmar C. G. Lorenz, Simon Wiesenthal Center, “Hilsenrath calls things by their proper names and portrays life first and foremost as physical existence, of whose details the reader is constantly made aware: birth, nursing, feeding, sex, and excretion accompanied by feelings of pleasure and pain. The rhetoric of politicians and political theory are shown to be the schemes of beings ultimately dependent on these bodily processes and subject to physical desires. Hilsenrath’s very approach is a protest against disrespect toward the mortal body, against the tyranny of the mind over matter.”