ExplAIn: Explanatory artificial intelligence for diabetic retinopathy diagnosis

•An explanatory artificial intelligence framework is presented for image classification.•It classifies each pixel and the image as a whole with image-level supervision only.•A novel self-supervised approach is presented for foreground/background separation.•The image classification process can be explained visually and possibly in text form.•For diabetic retinopathy grading, explainability does not reduce classification performance.