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Khaled Hosseini first two novels have sold over 38 million copies.Evan Agostini/The Associated Press

By calendar measurement, it has been six long years since the literary voice of Khaled Hosseini has been heard from.

But the author of two of the most popular novels of the past decade, The Kite Runner and A Thousand Splendid Suns – their combined global sales now exceed 38 million copies – has been more productive than the passage of time alone suggests.

In fact, his new book, And the Mountains Echoed – its own bestseller status already assured – took him only two and a half years to write.

As he explained it in a recent interview, Hosseini spent a year or more mulling new ideas, after Suns was published in 2007. Then, he took an extended hiatus – to attend, as both physician and son, to his dying father.

His thinking about a new novel only began to crystallize during his third trip to his native Afghanistan in September, 2009.

"I saw again the bleak living conditions of returning refugees," he recalled, on the phone from his northern California home. "I was struck by how worried they were about the onset of winter, this looming spectre. So many children there die just of exposure to the cold, and lack of shelter. I'd read stories about families being forced to sell their kids, because they could not take care of them. And I began to wonder about the sacrifices you might make to protect your children."

More dramatically, the book was catalyzed by a visual epiphany – a clear image that suddenly presented itself to him: of a man walking in a desert, pulling a child's red wagon. Inside the wagon was a little girl and, walking 10 paces behind it, a young boy.

"I had no idea who these people were, where they were going, or what the relationships were. The image just came. I became so curious about this picture that I had to sit down and explore it. The novel snowballed from there."

Some authors, among them John Irving, are notorious for not beginning a new work until its entire story has been carefully plotted. "I envy the ability to do that," laughs Hosseini, 48. "But I can't do that. I never know where the book is going." As new characters emerge, they become, he says, "like pebbles in a shoe, and I have to see what they are all about."

The downside of this approach, he confesses, is that "I end up in a lot of blind alleys and have to fumble around until I can find my way back."

Echo is a sprawling, multigenerational tale that weaves together thematic motifs about identity, loss and the responsibility of parents for their children, and children for their parents. It begins slowly, with the retelling of an Afghan fairy tale, but soon gains lift-off. It had me weeping at the end.

Hosseini's wife, Roya, the first reader of his manuscripts, is his in-house guide. "She's a very tough critic, which is what you need," he said "You don't need a cheerleader. That's the worst thing that can happen to you. But Roya is very good at picking out what works and what doesn't."

Hosseini tries to write every day, including weekends, from about 9:30 until 2 o'clock, in a home office. Then he picks up his children (Haris and Farah) at school. "But a lot of writing takes place away from the computer," he says, "when you're driving or mixing spaghetti sauce. It does take you out of the moment at times, but that can't be helped."

The son of an Afghan diplomat, Hosseini spent his early life in Kabul, Tehran and Paris. The family was still in France when Communists seized power in Afghanistan in 1978, precipitating the Soviet invasion. Unable to return, they sought political asylum, and eventually settled in southern California, where Hosseini became a doctor, specializing in internal medicine. His three books have drawn heavily on both his medical knowledge and his Afghan cultural legacy.

Hosseini says he had the impulse to write from a very young age, and continued to write all through his years in medicine. "But I never thought what I wrote was good enough to be published. I thought of myself as completely detached from that constellation of real writers. It was completely for myself."

It was The Kite Runner, based on his own unpublished short story, that allowed him to write full-time.

Among his major influences is Canadian short story writer Alice Munro. "There is never a single note of artifice," he says. "Everything feels so true. Her stories never go where you think they will go.They always surprise you.She never explains the mystery of how humans behave, but she expands it, raising more questions than answers. And her stories are epic in scale, even if they are very local."

Named a goodwill envoy for the United Nations High Commissioner for Refugees, Hosseini says he's concerned about Afghanistan's future after the planned withdrawal of Western forces in 2014. "There are scenarios under which things could turn out relatively well," he says, hopefully. "But there are also fears that we will see a return to the militia days of the 1990s, which were perhaps the darkest days the country has known."

It does not help, he add, that corruption has been institutionalized, and that pay scales are completely out of whack. Civil servants struggle to survive on salaries of $100 a month, while drivers retained by an NGO may be paid $1,000 a month.

But consider the historical context, he suggests. "There's no excuse for the macro corruption, but Afghanistan was always an informal society, with a weak central government. But put that through 30 years of war, take down every state institution, destroy traditional modes of justice, decimate the economy, and uproot millions, and it's unrealistic to expect a transparent, democratic and stable society can emerge within 10 years. This is a marathon, not a hundred-yard dash."

He also believes that the West's hundreds of millions of aid dollars have yielded significant benefits in Afghanistan, particularly in health care: vaccination campaigns, dramatic drops in rates of infant and childhood mortality, increases of a decade in life expectancy. "The question is, can these gains, painstakingly made and at huge cost, be maintained?"