Maltese civilians endured an immense amount of hardship between 1940 - 43. They have been a tough race through previous sieges dating through the Napoleonic era to the siege of the Ottomans against the Knights of Saint John in 1565. Voltaire said 'Nothing is better known than the siege of Malta'. The dockyard areas especially were heavily bombed & civilians from these areas were advised to relocate to country areas. This was not a popluar thing but deemed to be necessary for survival.
Three thousand civilians evacuated to the Island of Gozo in the early part of the war. Those remaining in the 3 cities around Grand Harbour had to suffer regular trips to shelters to avoid the axis raids. Malnutrition was always to be found as little food was available during the siege. Vitamin deficiency was common & diseases such as pellagra & ulcerative stomatitis abounded. Rickets & scurvy were also seen along with Trachoma & other eye diseases which became widespread.
During 1942 Tuberculosis spread & this hit particularly the underground tunnels of Lascaris Bastion which were damp & dank areas to work in. Typoid reached epidemic proportions in the summer of 1942. Bacillary & amoebic dysentry accompanied this disease. This epidemic started by sewer pipes being bombed with the resulting waste seeping onto cultivated land as well as in some areas crude sewage being used to irrigate land.
Main sewers were mainly destroyed by bombing & sanitary conditions were not good. The disposal of human excreta & household rubbish remained a problem well after the siege was lifted. Refugee centres were under the supervision of hygiene officers & toilet rooms were organised with walls, floors & bedding regularly disinfected. Home shelters relied on buckets to dispose of human wastes. Lice, fleas & scabies were commonplace with the latter being almost the worst plague. The best treatment at the time was Benzyl benzoate but this was in short supply on the Island. Many developed septic sores from scratching & this combined with acute hunger was to be remembered by the civilians on Malta for many years to come.
Paul Cassar in 'Medical History of Malta (Wellcome Historical Medical Library) 1963. quoted:-

Before the opening of hostilities it was anticipated that the people would react to the horror & havoc of modern warfare in an exaggerated & abnormal manner. It was consequently forecast that the number of psychiatric casualties would be high & beds for 'cases of war neuroses & psychoses' were prepared in special wards at the Mental Hospital at Attard. Subsequent experience, however, showed that this precaution was unnecessary because the factors that were regarded as being precipitants of mental illness did not produce the expected baleful effects on the population. Indeed anxiety for one's personal safety, sudden bereavements, the disruption of family life & the precense of material discomforts & food privation did not react unfavourable on the mental health of the population. Panic & hysteria were absent. A most remarkable feature was the fact that administration to the mental hospital fell to 138 in 1942 from the pre-war figure of 169 in 1939.

Maltese family living in rock cave

Maltese Lady.
Photo courtesy of Louise Dardart.

Christ the King Monument outside Valletta. 1941.

Parish church of Tarxien with blast walls in front of doors.
Photo courtesy of Louise Dardart.

Main Guard at St.Georges Square, Valletta.
Photo courtesy of Dave Powell

Maltese carts.
Photo courtesy of Louise Dardart.

View of Valletta. Photo courtesy of Tony Cox.

George Allen's old gun position, Malta 1942.
Fort Ricasoli.
Photo courtesy of Marie (nee Allen) Curley. maris.stella@bigpond.com.au

Zejtun Square with the Zejtun parish church in the background.
Photo courtesy of Chris Rukin.