There is surprisingly little consensus about what people die of during famines. In this paper, the causes of the increases in mortality during the Greek famine of 1941-43 are examined. The focus of the study is three island populations: Syros, Hios, and Mykonos. Death registration for these islands was not disrupted during the famine and the records give cause for death, certified by a doctor. Archival material and hospital records are utilized to assess public health during the famine. The findings point to the overwhelming importance of starvation for increased mortality during the famine and the virtual absence of either significant epidemics of infectious diseases or a breakdown in the public health system. The paper concludes by comparing the findings for the Greek famine with those for other famines. A model that attempts to explain the different courses that famine mortality can take is proposed.