In this paper, we introduce the concept of “city‐island‐state” into a discussion of small highly urbanised islands. We place the “city” at the forefront of our analysis by bringing together the geographies of the “city” and “state,” together with a wider discussion of factors that may cause both the wounding of the city and an increase in the precariousness of the “island.” We apply this concept to the advanced city‐island‐state of Malta (Central Mediterranean), which is a densely populated, urbanised small island archipelago with about 500,000 inhabitants and operates as a single city with an urban core, suburbs, and a rural hinterland that is rapidly decreasing in size. This city‐island‐state is frequently considered as being “safe” from external geophysical, climatic, and anthropogenic wounding, but, in reality, Malta, as a city, an island, and an independent nation‐state, is faced with multiple internal and external pressures that increase its precariousness and vulnerability to such externalities. Some of these are socio‐economic, but others are environmental. We argue that the potential for wounding is particularly marked in Malta, that it is exacerbated by the contemporary globalised neoliberal world of flows and interconnectivities, and that this represents a multi‐level wounding cascade: wounding the city wounds the island and, by extension, the state.