This won’t be a full review of War Hospital, instead, it will be more like basic impressions of the game after around 8 hours of playing it. This is because I was one of the unfortunate ones who ran into serious issues with the game, which is one of the reasons it holds a mixed rating on Steam. Because of these problems, I wound up unable to progress the story without having to restart the whole game, and by that point, I didn’t have the time. I’ll get into the details of what happened toward the end of this piece, but I still wanted to discuss the game as it does have a very interesting premise.

It’s been very cool to see games branching out and exploring avenues less walked when it comes to world wars. Last Train Home was a great example of this, and it introduced me to a perspective I never even knew about which was that of the Czech soldiers trying to make their way across Russia after World War 1. It’s not easy to juggle such heavy subject matter with it becomes an enjoyable game to play.

The first stage is getting the incoming wounded into the casualty centre where you can check their files and see what the damage is. Triage, in other words. Randomly generated bios are available to peruse, but it doesn’t take long to start skipping over those and focusing on the raw data – how difficult surgery will be, the likelihood of success, the length of time and the chances of complications. Using these stats you can assign soldiers to surgeons or opt to deny them surgery at all. That might sound harsh but the reality is that if your surgeons are exhausted already, a patient in critical condition may be sacrificed to help several others down the line.

Various upgrades can be applied to the surgery wards, including expanding them to include a trauma war and support amputation. That last one gives a prime example of the choices you can make: amputation costs less medical resources to perform and makes operations simpler, but also means soldiers can only be sent home instead of to the frontline or HQ. Thematically, however, the option to amputate is strange because you can choose to amputate anybody you want, regardless of whether it makes sense or they actually need it. It’s one of those game elements that doesn’t mesh with the subject matter

Soldiers who successfully survive their operations are transported to the rehabilitation building where nurses can oversee their recovery. Where they’ll go from there is up to you. They could be redeployed to the front lines to help repel enemy attacks, which you must successfully do multiple times; they could be sent to HQ which will grant special requisition documents that you can use to construct new buildings; or they could be returned home which boosts morale. That’s important because if the morale of your staff hits zero it’s game over.

That’s the basic gameplay loop of War Hospital, and making it all work is having to manage your staff and resources while slowly expanding the hospital’s capabilities, all while ensuring you send enough soldiers back to the front line to hold off incoming attacks. Failing to have enough bodies on the front to survive an assault means game over, so that’s the major priority.

Staff in particular are the biggest source of management as they tire out quickly and you often don’t have enough to keep everything running smoothly. Medic crews, for example, are needed at both the casualty clearing station and the cemetery, otherwise, bodies, alive or otherwise, can end up piling up and blocking surgeries being performed. Meanwhile, engineers are vital because not only can they construct upgrades and new facilities, but they can also be set to producing important supplies like medicine needed to perform operations and rations to keep everyone fed. Nurses can be sent to just about every building type to do things like slow down a patient’s declining health, aid in surgeries, etc.

There’s an intriguing metastory to War Hospital where wounded, terrified human beings who have faced unimaginable horrors become little more than stats and numbers, another resource to spend. The bios don’t matter much compared to boosting hospital morale or deciding that a lengthy, potentially complex operation isn’t worth it compared to helping out one of the special VIPs that come through the door. Resources and numbers are the ultimate deciding factor, not a man’s desire to get home to his family. Playing through the game, balancing lives vs the supplies I have access to and my own needs, made me wonder if this is what people in charge of hospitals on the frontline had running through their minds – how much empathy had to be sacrificed at the alter of cold, hard logic?

Of course, the argument could be made that War Hospital is a horrible representation of those people. I have to imagine that the people in those horrid hospitals were doing the very best they could to help every single soldier, though hard decisions surely had to be made. But the more realistic part of me realises that yes, sometimes it probably did come down to numbers, facts, supplies and calculated decisions. War Hospital can easily turn you into a brutal person, willingly throwing away lives to focus on the ones that will bring in the most resources due to their rank or VIP status. I like it, I really do, because it puts you into a different mindset.

It’s an extremely slow game, mind you. And I don’t mean that in the good slow-burn way, I mean it in the “why is this taking so long?” kind of way. This doesn’t mean War Hospital should be fast-paced and the gameplay doesn’t need to be “fun” in the traditional sense. I mean, Frostpunk sure isn’t fun in the normal sense of the word, but it’s still one of the most engaging strategy games I’ve ever played. But War Hospital’s pacing is glacially slow. Even the first chapter takes about 6-8 hours to finish up, and that’s while abusing the hell out of the fast-forward button. And in that timeframe, there isn’t much going on. I spent all of it moving staff around from one building to the next or sending them for a rest, with the occasional event popping up or upgrade being built. The core gameplay loop simply isn’t very engaging, at least not to me, because it felt like a lot of number-balancing and little else.

While there’s a very cool idea at the centre of War Hospital, its foundations are crumbling under a host of technical problems, including one that ended my time with it prematurely.

After 8 hours of playing, I faced a problem: the story didn’t seem to be advancing, and a train derailment in chapter 1 hadn’t been properly resolved by giving me a chance to assign engineers to the problem. On top of that, my strength meter was no longer working. I was stuck in a holding pattern where new casualties came in, but I couldn’t hire more staff or request resources since the train line was out of action and no new objectives were appearing. The hospital was slowly collapsing because I couldn’t keep producing everything I needed with the limited staff I had.

I took to the Steam forums to see if anyone else had run into the problem and if there was a workaround, only to be told by the developer that I had indeed run into a known problem and it couldn’t be fixed. My save was useless, and I didn’t have a backup one. My only option is to restart the game and slog through the slow first chapter again, and as harsh as it sounds I’m not willing to go through it again and risk hitting even more bugs when I could move on to the next game instead.

I would have been willing to replay it if I hadn’t always encountered a host of other problems. Ambulances would end up in traffic jams due to doctors not performing surgery, or medics not doing their jobs. This would often turn out to be because of dead bodies that the game didn’t tell me about. The shift system would frequently break, meaning multiple people would end up working the same shift and then go off duty at the same time, causing more pile-ups. In the end, micromanaging staff members is far more effective. I had staff members never returning after being sent to complete an event, engineers not constructing anything after being told to, menus not working correctly and a heap more small issues that didn’t break the game but added up to a less-than-polished experience.

Sadly, it seems like bugs both small and large are very common in the game. The Steam forums are packed with people having issues, and many of them are encountering major problems like mine that have stopped them in their tracks or caused them to restart the whole game.

I think you can hopefully understand why I can’t recommend War Hospital, then, at least not based on my experiences with the game. There’s something very compelling about the game despite its slow nature and somewhat simple gameplay, but until it gets some updates under its belt, War Hospital isn’t worth taking a risk on unless you’ve got plenty of money to burn and fancy something to tide you over until Frostpunk 2.