War Hospital Review

More than fifteen hours into my playthrough of War Hospital, I’m staring at yet another long list of patient cards. Some are soldiers wounded in battle, others are civilians beset by a mysterious disease. But instead of actual people, I only see a bundle of abstract stats and uncertain operation success chances to weigh against dwindling supplies and the limited energy of a few doctors.

Unfortunately, I never reached a point where strategic thinking completely overshadowed any sense of empathy, not due to the sway of expertly designed game mechanics or a compelling narrative that evoked sympathy for the plight of my subordinates.

In its initial hours, before settling into a repetitive pattern, War Hospital manages to capture your interest as you familiarise yourself with its various mechanics. Assuming the role of the newly appointed leader of the game’s namesake medical facility, you face the challenge of making numerous critical decisions. A constant influx of patients arrives at your Casualty Clearing Station, and you must efficiently allocate them to a finite group of available doctors to prevent them from languishing without care.

Accessing patient cards in the game provides insights into each individual’s background, current health status, potential contribution post-recovery, and the likelihood of their treatment leading to complications or improvements. However, complete control remains elusive. Even the most experienced doctors may lose patients, mirroring the harsh realities of conducting medical operations near the frontlines during World War I.

For successful operations, doctors require adequate supplies, but pushing them too hard can lead to exhaustion and eventual collapse unless they are afforded sufficient rest. Inevitably, you’ll find yourself in situations where you must refuse treatment to some patients, relegating them to palliative care as they approach the end of their lives.

Initially, making life-or-death decisions is a somber responsibility, but over time, it becomes a tedious routine. There are moments when the medical staff is overwhelmed by the surge of incoming patients. In some instances, denying treatment becomes a necessary strategy to prevent the hospital’s complete breakdown, particularly when patients arrive in a critical or terminal state.

This decision-making process helps conserve vital energy and resources and also minimises the morale impact that occurs when patients die during surgery. However, if morale ever drops to zero, the game abruptly ends with a rather unceremonious game over screen. This sudden conclusion reflects the game’s user interface, which tends to have a somewhat basic appearance and feel.

Beyond managing patient care, your responsibilities include recruiting and allocating staff to suitable facilities. Medic Teams are tasked with transporting the wounded and ensuring the deceased receive a dignified burial in the local cemetery. Nurses provide comprehensive care, assisting patients from admission through surgery and into rehabilitation. Meanwhile, engineers are responsible for constructing and upgrading facilities, as well as producing medicine, albeit at a slower rate.

Similar to doctors, other staff members also require rest periods, meaning a significant portion of time with the game involves navigating through menus to manually rotate them between active duty and rest. This adds an extra layer of repetitive management, involving various perks that, while often simplistic and not always clearly explained, can enhance staff performance to a certain degree.

Even after gaining the capability to schedule shifts, the task of shuffling these portrait cards around remains cumbersome and does little to help you get to know your staff. Unlike patients, who receive brief background descriptions, staff members lack any such introductory details, making them less familiar and more abstract figures within the gameplay.

There’s certainly a case to be made for having to approach things with a rational, cold attitude, given the desperate situation, but War Hospital feels overwhelmingly impersonal, never getting anywhere close to its declared goal of painting you as “the last bastion of humanity.”

In addition to producing three types of medicines, each tailored for a specific Ward (surgical, chemical, and trauma), maintaining your staff’s efficiency requires a steady supply of food and alcohol, which also aids in the in-house production of medicine. Military Drafts serve as a crucial resource for ordering supplies in urgent situations and for upgrading your facilities. However, acquiring Military Drafts is more challenging, as they are granted either for making specific choices during random events that occur during gameplay or more consistently, for dispatching rehabilitated soldiers back to headquarters.

Freight is a different resource over which you have no control, being delivered at regular intervals by the same trains that allow newly hired staff to join your hospital once you secure enough Staff Permits by completing objectives. War Hospital’s resource juggling is a fickle thing that keeps you on your toes, to an extent, but can be too unpredictable at times, resulting in stretches during which you’re bottlenecked by a lack of resources that’s largely solved by waiting.

The game’s fragile narrative is supported by a handful of named characters, though they are largely unmemorable. Periodically, these characters present requests and missions, which again boil down to making choices between limited options. Decisions such as whether to allocate food or alcohol to aid civilians in return for other resources or a morale boost, or choosing to treat a soldier in better health over a VIP in critical condition, risking a morale decrease if the VIP dies and incurring temporary disfavor from HQ, are part of the strategic dilemma you face.

Scouting in the game provides somewhat more extended, multi-stage narratives that strive to illuminate the lives of people beyond the confines of your hospital. These scenarios unfold on a sterile, wargame-style map, where your teams might encounter scenarios like German spies, a runaway daughter, or a sinister witch doctor. As each complex situation arises, you are presented with choices on how to navigate and solve these tricky encounters.

Unfortunately, while these scenarios are deeply rooted in the realities of war, their rigid and uninspired writing fails to lift them beyond basic, transactional decisions focused solely on the most needed resources at any given moment. In my initial playthrough of the second chapter, I chose to let numerous civilians impacted by the conflict take refuge in the hospital and even endeavored to provide them with treatment.

This choice, coupled with other less-than-ideal decisions, resulted in a scenario where maintaining morale became an unattainable goal as I approached the end of the chapter. Consequently, I restarted and opted not to allow any civilians in. This decision not only exposed the simplistic and binary nature of many choices in War Hospital, but it also reiterated my lack of emotional connection to the people within the game.

I didn’t care for the supposed lives I was sacrificing or that my efforts helped the British hold off the German advance. I was simply weighing star ratings against numbers and moving portraits from one screen to the next, with a whole other chapter still left to complete.

Partly due to its writing, partly due to its dour, static presentation, War Hospital failed to draw me into its fantasy, only translating the repetition involved in managing a hospital under duress. Perhaps this says something about the ruthless approach hospital managers have to take during wars, but it also means that I was less and less invested in the game the more I played.

You can tackle War Hospital’s three chapters separately once unlocked. However, keep in mind that the staff you hire and the upgrades you purchase will carry over between chapters. Despite this segmented approach, the chapters are woven into a cohesive story where you aid the British in their defense against the Germans. This entails the critical responsibility of ensuring there are sufficient capable soldiers to repel periodic enemy assaults.

This core mechanic keeps up the pressure; if you find yourself overpowered, you’ll be met with the game over screen once more. However, a reliable and simple strategy to prevent being overwhelmed is to prioritise deploying soldiers marked with red chevrons to the front lines until your forces achieve a ‘Strong’ rating.

You do have to actively choose between the trenches and sending troops to HQ for Military Drafts or releasing them from duty for a morale boost, but there’s little variety to the system. If you fail because you didn’t assign enough troops, you simply have to reload the save and move a few portraits into the left slot; if morale is giving you trouble, move them to the right – not exactly the most compelling example of trial and error.

While the overarching story of the game attempts to incorporate additional elements like constructing tunnels or handling the Spanish flu outbreak, these aspects often boil down to basic, unremarkable decisions or the temporary unavailability of certain staff members. As a result, these tasks tend to blur into one another, lacking distinctiveness.

War Hospital struggles to deliver a compelling narrative or to introduce varied challenges across its three chapters. Compounding these issues, other flaws sour the experience even further.

The game’s user interface struggles with effectively conveying certain information. Players often find themselves toggling between multiple windows to monitor character perks or the flow of resources, or they may encounter elements that are inadequately explained. A case in point is the unlockable trucks sent to depots on the scouting map. It remains unclear whether these trucks require manual retrieval or if they offer any tangible benefits, an ambiguity that adds to the game’s challenges.

Morale can experience abrupt shifts that are often difficult to foresee, potentially leading to an abrupt end to your run. While it’s reasonable for a series of deaths to significantly impact your staff’s morale, given the setting, the lack of warning, detailed explanation, or clear reasons for these sudden changes can make managing morale a source of frustration.

It took me a while to figure out that removing nurses from the Rehabilitation Center while enforcing a shift schedule caused pauses in my soldiers’ rehabilitation, which meant it took longer to send them to the front. These poorly explained elements can lead to situations where reloading older saves or restarting entire chapters feels entirely undeserved (as opposed to making several choices that chain together, straining your hospital’s capabilities). At least you can freely save whenever you need to.

Worse yet, ordering resources by train can sometimes bug out, resulting in a stuck timer that makes it impossible to resupply using that method, which can be vital depending on how things progress and how unlucky you get with complications during operations.

UI elements also bugged out two or three times, requiring me to Alt+F4 out of the game. The worst bug saw patients who were fully rehabilitated evaporating into thin air, leaving me with few resources and empty trenches as the Germans prepared their next attack.

These issues may be addressed in time, but they made my time with War Hospital much more frustrating than it needed to be.