We provide a synthesis of the history and the extent of human impact on the terrestrial ecosystems of the small islands and islets of the western Mediterranean. We focus on the exploitation of islands smaller than a few thousand hectares. The use of microinsular biotic resources (e.g., timber, soda ash, wild mammals) began as early as the Upper Palaeolithic, intensified during the Neolithic, and expanded during the Iron Age, peaking around the end of the nineteenth to the mid-twentieth century. As a consequence of long-lasting land exploitation, in many cases local terrestrial ecosystems were severely damaged and some of their living components disappeared. In other cases, even with uninterrupted human occupation over millennia, several insular resources have been sustainably managed. Although these small islands are currently under less pressure compared with neighbouring mainland coastlines, their protection or even the restoration is unquestionably necessary.