Sjúklingurinn segir að vinurinn sakni sín.

Questions & Answers about Sjúklingurinn segir að vinurinn sakni sín.

Why use the reflexive pronoun sín here instead of hans (him)?
This is a long-distance reflexive. Normally, reflexives only refer to the subject of their own clause. However, in indirect speech (like after segir að), a reflexive pronoun in the subordinate clause points back to the subject of the main clause (Sjúklingurinn). If we used hans, it would mean the friend misses a third, entirely different person.
Why is the reflexive pronoun in the genitive case (sín) rather than accusative (sig) or dative (sér)?
The case of the reflexive pronoun is determined by the verb in its own clause. The verb sakna (to miss) always requires its object to be in the genitive case. Since the friend is missing the patient, the reflexive pronoun takes the genitive form sín.
Why is the verb spelled sakni instead of the regular present tense saknar?
sakni is the subjunctive mood form of sakna. Subordinate clauses that report someone's speech or thoughts (indirect speech) frequently use the subjunctive in Icelandic. Furthermore, using a long-distance reflexive across a clause boundary generally requires the verb in that subordinate clause to be in the subjunctive mood.
What tells us for sure that the friend is the one doing the missing, and not the other way around?
We can tell by the grammatical cases. In the subordinate clause, vinurinn (the friend) is in the nominative case, which means it is the subject performing the action. The pronoun sín is the genitive object receiving the action.

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