Historically Pattani was the centre of the semi-independent Malay Patani kingdom, but paying tribute to the Thai kingdoms of Sukhothai and Ayutthaya. After Ayutthaya fell in 1767 Pattani gained full independence, but under King Rama I it again came under Siam's control. In 1909, it was annexed by Siam as part of Anglo-Siamese Treaty of 1909 negotiated with the British Empire. Along with Narathiwat, Yala was originally part of Pattani, but they were split off and became provinces of their own. There is a separatist movement in Yala, which after being dormant for many years erupted again in 2004.

A long series of conflicts has resulted in over 2500 deaths in the past decade, with more than 2300 occurring since an escalation of violence in January of 2004.