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The Fifth Symphony was composed from March to May 1946. Although Martinů initially spoke of dedicating it to the Red Cross, in the end the score was dedicated to the Czech Philharmonic, perhaps in anticipation of a return to his native land. Although this repatriation did not come about, the Fifth nevertheless is the only one of Martinů’s symphonies to have been premiered by a Czech orchestra: Rafael Kubelik conducted the Czech Philharmonic in the first performance, at the Prague Spring Festival on 28 May 1947.

The symphony is in three movements:

    1. Adagio—Allegro
    2. Larghetto
    3. Lento—Allegro

The general plan of the symphony does not adhere to the traditional form. Instead, Martinů said, it has a "more modern, better structure". This involves the alternation of slow and fast sections in all of the movements, and the symphony's most distinctive feature is its enlivenment by rhythmic devices.

Like the Sixth Symphony but unlike all the earlier ones, the first movement of the Fifth Symphony begins with a slow introduction that returns as a postlude at the end, creating a frame around the main structure. In this case, however, the adagio also is found in the middle of the movement as an interlude, where it is followed by a combination of recapitulation and new development.

The finale closes with a long passage in the minor mode, unlike any of the other five Martinů symphonies.