War is Hell. As I scramble to coordinate my medic teams who are exhausted and on the verge of collapsing, another attack yields another twenty injured soldiers. My nurses are short-staffed, engineers burning the candles at both ends. I’ve already got five people in surgery, and I’m running out of supplies. War Hospital now fronts me with choices: who do I try to save and who do I let go?
Some titles try, and fail, to encapsulate the true horror of war. War Hospital makes it look easy. Death, agony and impossible choices are everywhere. Demands you can’t meet. Refugees you can’t afford to house. It’s an artillery barrage of every conceivable stressor, and it works fantastically… when it works. Despite its brutal and despairing atmosphere assaulting your senses successfully, War Hospital’s issues extend to glitches and bugs, instead of just shell shock and physical trauma.
Gather whatever scraps of resources you have and clear the decks, let’s lay this trooper out and triage the damage.
To The Wards
If Theme Hospital and Valiant Hearts had a trench baby, it would be War Hospital. Being a strategy management game, you’re placed in command of a treatment centre near the frontline during World War One. There’s a mixture of short cutscenes, text-based events and a smattering of voiced dialogue to ground you within the period and set the scene.
While there are a couple of characters that either bark out orders or helpfully inform you when the next disaster is about to strike, it’s fairly minimal. Instead, War Hospital lets the intensity of the experience itself tell the story. Being a medic and attempting to make life-defining choices with little but a suture and a split-second must have been harrowing. War Hospital’s biggest achievement is connecting to this devastating atmosphere.
The little details are what sell the story itself. The cries and bone-chilling screams from the injured being transported. Your starting hospital is a bombed-out, broken-down series of buildings, barely standing on their timber. Watching your medic teams exhaustively work to move bodies and broken people to surgery alike. It’s handled supremely well, making it an immersive management simulation of the era.
Voiced dialogue and the odd short cutscenes are more touch-and-go. Some of the voice acting can be dodgy, while various typos I came across showed a slight lack of polish to the storytelling. The projector-like cutscenes detailing German assaults were choppy, low-res and tanked the framerate too, which didn’t help. I’m all for keeping things similar to the time period, but this didn’t come across as an intentional choice.
First, Do No Harm
Being the commander of a field hospital comes with more than just a bleak atmosphere, however. It comes with an abundance of stress, too. You’re based just off the front line, you’re cut off without reinforcements, and your only supplies are those you make that you import via train. War Hospital can be boiled down to managing staff and juggling timers, for the most part.
Split between your surgeons, nurses, engineers and medic teams, you’ll have a few staff to allocate and keep track of. Across the three chapters, you’ll need a lot of everything – treatment resources, food, alcohol, draft papers (for upgrades and trading), personnel – if you want to reach the end. Your staff are precious, however, and you can’t work them into the ground to appease your altruistic tendencies.
Early on, you need to allocate squads to buildings and roles manually. Once you develop shift patterns (quite the discovery back in the day!), you can establish a system. Overwork your important people and they’ll be out of action for longer than you can stomach. On the whole, it’s a great system, incentivising you to constantly pay attention and micro-manage time effectively.
The interface is relatively intuitive on console, but some issues arise like a bone snapping through the skin. For one, the selection reticle is unnecessarily fiddly in menus, which can be annoying. In later chapters, I ran into a problem where buildings wouldn’t provide the visual notification that my medic teams were tired. Cue all five of them collapsing from exhaustion and requiring a restart.
Unfortunately, this isn’t the only time technical problems burn the experience like mustard gas on an open wound.
Full Medic Jacket
Deciding who to rest and who to work is only the tip of the choice-based iceberg, however. Like the Titanic, the initial choices you see disguise the massive catastrophe lurking beneath the surface. Treating and rehabilitating patients brings you your first dilemma – send them to the trenches, to HQ or discharge them.
You need all three – soldiers ward off attacks, preventing more casualties. HQ will provide supply points for research and trade for resources. Discharging improves morale, which has to be maintained above 0% (sounds easy, it isn’t). As the difficulty ramps up, more and more patients will be thrust upon your under-resourced field hospital, meaning difficult moral decisions need to be made.
A sudden influx of 30 injured soldiers is bad enough. Worse is when I only had one available surgeon and no trauma medication left. Some will be able to last a while, others are almost terminal on arrival. Knowing who to treat and who to deny is key, yet it always feels awful. Refugees may turn up requesting aid, but I had to torturously turn them away as I was already overwhelmed.
Hard-hitting moral choices feel perfectly at home in War Hospital. Most interestingly, you’ll become more desensitised to it the longer it goes on. This puts you in the mindset of the medics having to make one traumatic decision after another, albeit without the reality. You’ll know you’ve lost your empathy when you lament a truck of broken souls arriving only to curse the burden they place on your dwindling stocks.
Trenches Aren’t The Only Bug-Ridden Places
I’ve alluded to it already, but the main roadblock to my appreciation of War Hospital is its technical problems. There are more bugs here than the muddy bog of No Man’s Land. From my medic teams getting stuck and refusing to move, to visual icons not triggering correctly, or even at all. For the most part, many of these are relatively harmless, aside from breaking the immersion.
That is, until I reached near the end of chapter 2. War Hospital’s later portions of chapters are veritable gauntlets, throwing wave after wave against the trenches you’ve erected to stay above water. They’re intense, and reaching the end is a test of your preparation and adaptability. Which would be wonderful, if all the systems worked consistently. Like a rusted and muddy rifle, however, it jams just at the moment you need it most.
With two in-game days to survive, my rehabilitation tent glitched. Upon discharging soldiers, they would be removed from the menu, but there would be no reward granted. The game screamed at me that it was overcrowded with 13/10 inhabitants… there were two. Cue my morale dropping to 0% and my game abruptly ending. Reload saves from 10-20 minutes before, the same problem, again and again. Each time it ended my run.
Then I had events fail to trigger properly. After completing a scouting mission, the menu just closed and didn’t inform me of the consequences. Turns out my scouts had died… would have been useful information. Chapters can take multiple hours to survive, so the prospect of restarting all over again is infuriating. I love challenging systems and tough games, but they need to work and be reliable, War Hospital simply isn’t yet, which mars the experience significantly.
Heroes In The Darkest Hour
I will preface this by stating that your experience may differ significantly from mine. You may not run into many or any of these issues that curtail your progress like I did. I suspect you’ll enjoy the game a heck of a lot more as a result. Sadly, I have to review the game I’ve played, and the issues have proven a massive stumbling block for me. Fingers crossed these problems can be ironed out via patches post-launch.
War Hospital’s presentation and atmosphere thankfully perform much better. Like a highly skilled surgeon weaving through organs, War Hospital has an eye for detail that’s fantastic to behold. The little animations of engineers working, to watching in horror as the bloodshed unfolds before you face an avalanche of patients.
War Hospital does a lot with the limited number of pixels it has to work with. The gameplay runs relatively smoothly and the menus fit the time period well. The sound design is brilliant, with minimal use of music to keep the focus on the sombre aura. Sound cues alert you to important events and hearing the dreaded “!” notification will spring your hairs to a stand.
The bleak outlook is expertly realised and when War Hospital is functioning well, it’s so easy to be absorbed into the dire drama of it all. That’s when the game is at its best, when you’re firefighting dozens of crises and desperately keeping the hospital functioning whichever way you can.
Anatomy of Hope
So how do you sum up a game like War Hospital? Much like how you might analyse which patients to treat and which to deny, in truth. They look stable and often even good, but they almost always end up deteriorating or running into some unforeseen complication. The connection to the time period and the immersive nature of its stress-inducing management gameplay genuinely impresses.
Which made it all the more agonising and incredulous when it broke. Having to repeat hours worth of gameplay just to be able to progress, through no fault of your own, is galling. Much like the broken soldiers you’re treating, once War Hospital has had the chance to be fixed up and patched, it’ll be an excellent strategy management title.
In its current state, it’s more damaged and unstable than a battalion left in No Man’s Land. There’s so much in here I appreciate and respect, but it’s got some work to do to reach its full potential. Across its three chapters, there’s about 15-20 hours worth of game here, which is impressive, let’s hope it can be bandaged up to be discharged back to the front.
Positively drowning the player in guilt-ridden moral choices and gameplay-orientated dilemmas, War Hospital is an immersive and intense management title. Its limbs are battered and bruised, owing to significant technical issues and more minor glitches, making it more unstable than the soldiers you desperately try to save. War is hell, and you’ll be lamenting both your choices when losing each soldier and your mind when you lose hours of your time.
War Hospital is available January 11th on PlayStation 5 (review platform), Xbox Series S|X and PC.
Developer: Brave Lamb Studio
Disclaimer: In order to complete this review, we were provided with a promotional copy from the publisher.