Imperial Army committed atrocities against civilians. Local residents also suffered widespread food shortages, limited rationing and hyper-inflation arising from the forced exchange of currency from Hong Kong Dollars to Japanese military banknotes. The initial ratio of 2:1 was gradually devalued to 4:1 and ownership of Hong Kong Dollars was declared illegal and punishable by harsh torture. Due to starvation and forced deportation for slave labour to mainland China, the population of Hong Kong had dwindled from 1.6 million to 600,000. The Japanese demolished the Sung Wong Toi Monument (宋王台). Hospitals available to the masses were limited. Most hosipital such as the Kowloon Hospital and Queen Mary Hospital were occupied by the Japanese army and turned into millitary hospitals. Schools were also turned into millitary hospitals. The Diocesan Boys' School (拔萃男书院) was even used by the Japanese as a place of execution. Very few public hospitals were available. With the lack of medicine and funds, the Tung Wah and Kwong Wah Hospital continued their social services but to a limited scale. These included provision of food, medicine, clothing, and burial services. Although funds were provided, they still had great financial difficulties. Failure to collect rents and the high reparation costs forced them to promote fundraising activities like musical performances and dramas. Tung Wah hospital and the charitable organisation Po Leung Kuk continued to provide charity relief. Substantial donations were given by members of Chinese elite. Po Leung Kuk also took in orphans. However faced with financial problems during the occupation, their bank deposits could not be withdrawn under Japanese control. Their services could only be continued through donations by Aw Boon Haw, a long-term financier of Po Leung Kuk. Food supply were inadequate. Necessities such as rice, oil, flour, salt and sugar were rationed. Each family was given a rationing licence, and every person could only buy 240g of rice per day. Most people did not have enough food to eat, and many died of starvation. In June 1943 the management of water, gas and electricity was transferred into private Japanese hands. According to eyewitnesses. The Japanese committed atrocities on many local Chinese and thousands of Chinese females may have been raped. During the three and half years of occupation by the Japanese. An estimated 10,000 Hong Kong civilians were executed, while many others were tortured, raped, or mutilated.

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With the unsatifaction of Japanese Imperialism, Guangdong People's Anti-Japanese East River Guerrillas place great efforts to resist Japanese Rule. When the war reached Hong Kong in 1941, the guerrilla force grew from 200 to more than 6,000 soldiers. In the wake of the British retreat, the guerillas picked up abandoned weapons and established bases in the New Territories and Kowloon. In January 1942, the guerrillas established the  Guangdong People's Anti-Japanese East River Guerrillas (广东人民抗日游击队东江纵队) to reinforce anti-Japanese forces in Dongjiang and Zhujiang Pearl River deltas. Applying the tactics of guerrilla warfare, they killed Chinese traitors and collaborators. They protected traders in Kowloon and Guangzhou, attacked the police station at Tai Po, and bombed Kai Tak Airport. During the Japanese occupation the only fortified resistance was mounted by the East river guerillas. At the same month and year the Guangdong People's Anti-Japanese East River Guerrillas established the Hong Kong-Kowloon Brigade (港九大队).