Mud, Blood, Healing, Hope and Death Merge in Historically Inspired War Hospital Sim

Historical games are getting a lot of time in the sun these days and for good reason. It’s fun to play in a world where the plot and underlying story is based on the strangest of settings: real life. And if that realistic title just happens to be very well done and set during an interesting period, like the years surrounding World War I, or The Great War as it was known at the time, so much the better.

We recently got treated to another World War I game, Last Train Home from Ashborne Games and THQ Nordic, which followed the adventures of a train full of Czechoslovak Legion soldiers stranded far behind enemy lines after The Great War and their quest to try and make it home again. Last Train Home was a combination real-time strategy title and management simulation that was really fun to play while also having a strong educational component that taught players about a lesser-known aspect of the aftermath of The Great War. Last Train Home was praised by many publications including GiN, where it earned 4.5 out of 5 GiN Gems in our full review.

And now there is another World War I title for history buffs to enjoy. Made by newer developer Brave Lamb Studio with the full support of Imperial War Museums, War Hospital puts players in the role of the sometimes thankless, impossible job of the administer of a World War I field hospital situated on the front lines of the Western Front. A pure management title, players will be tasked with trying to save an endless stream of wounded soldiers from a variety of different injuries ranging from bullet and shrapnel wounds to battlefield traumas and even chemical burns. And you will need to accomplish that critical mission in the face of limited supplies, exhausted personnel and the constant threat of being overrun by the enemy. At times it can be a really challenging environment, especially once you realize that you can’t save everyone. It’s actually a victory if you can save more than half of the poor souls who come to you in their most desperate hours.

Although War Hospital is set during World War I, there is no actual combat for a player to deal with. There is a kind of secondary goal where you need to send some of your cured patients to the trenches surrounding the hospital because the Germans are always threatening to overrun your position, but other than supplying enough manpower to keep the enemy at bay, you don’t have any direct control over that situation. Instead, gameplay consists largely of moving nurses, surgeons, doctors and medics around the camp to jobs or stations so they can help with whatever needs doing, and then making sure that you also force them to rest before they collapse from exhaustion. If you enjoy management simulations in extremely challenging, some might even say almost impossible environments, then War Hospital has got plenty of that. But note that there is no actual wargaming beyond the top-level management aspects, so if you shy away from combat-oriented games, you won’t have to face any firing squads here – at least not directly.

There is a story involved with War Hospital, although it too takes a backseat to the management aspects of the game. You play retired British Major Henry Wells, an aging former combat medic drafted to the frontlines to manage a medical hospital. You learn in the prelude that your son has recently died on the frontlines, and you consider it your mission to try and save as many young men from that same fate as you can. Unfortunately, Wells finds himself at a critically understaffed and sparsely supplied field hospital that is in want of everything other than mud from the near-constant rainfall. As such, the morale starts fairly low in most chapters of the game, making it one more thing that you will need to try and somehow improve.

The assets that you have at your disposal include a few people with core jobs to attack various problems. First you have your engineers. They are tasked with building new facilities and improving what you already have. So for example, they can expand your housing so that you can hire more workers, improve your operating rooms with things like directed lighting, better equipment and tools. They also can work on peripheral buildings like your canteen so that people can get a hot meal between shifts. You can also assign engineers to help directly produce critical supplies like medicines and food if you have built the appropriate workspaces. Engineers work off of a construction resource which dribbles into your camp via supply trains, and it takes a long time to accumulate large amounts of it, so your upgrades will be slow going for a while.

Nurses are the ultimate support staff. They can be assigned to various buildings to improve their efficiency. For example, if you put a nurse in the operating room, it increases the chance of a successful outcome for surgeries. Some buildings like the rehabilitation center where all patients go to recover from surgery require at least one nurse to be on duty to function, while adding other nurses can speed up the healing process. Medics by contrast don’t work inside buildings for the most part, but those two-person teams are vital because they move patients from one place to another. If you want to move a patient from the triage center into surgery, then you will need a team of two medics to make that happen. Medics also perform the sad duty of burying the dead after failed treatments, so you will need a team assigned to cemetery duty if you don’t want bodies lying around bringing down everyone’s morale more than it already is whenever someone dies, which is sadly a frequent occurrence.

Surgeons arguably have the most important job in the hospital because they are the ones who treat most battlefield injuries, and there never seems to be enough of them at the hospital. Their operations can go on for hours for complicated injuries, and then you need to rest them before they collapse from exhaustion. It’s a sad fact that at some point you will likely have patients waiting for treatment who you can’t save because all of your surgeons are either exhausted or working on other patients. As such, maximizing the number of surgeons at your facility through building upgrades and hiring as many as you can is probably going to be a priority for most missions. There are also two special doctor/surgeons that you can hire who only treat either the mental aspects of battlefield trauma or the specific wounds caused by chemical warfare. They generally have fewer patients than the main surgeons, but you need them in your facility if you want to successfully treat anybody with those specific injuries.

The hospital also has a scout corps of rugged individuals who can be tasked with scouting the countryside for resources or going on possibly dangerous missions like looking for German spies in a series of missions that unfold kind of like storybook or narrative events. Those teams can also be upgraded to improve their effectiveness and survivability with things like trained war dogs or extra men to increase their efficiency, but the scouts are more of a mini game than an actual core gameplay element in War Hospital. Still, it was nice to see them included as they break up the sometimes-monotonous chore of treating an endless line of critically injured patients.

In addition to trying to heal everyone against impossible odds, the Germans are also located very close in proximity to your hospital. As such, trenches have been dug and you need to send some of your cured patients into them to defend against German attacks, and then probably retreat them when they get injured doing so. Whenever you are set to discharge a patient, you can choose to send them to the trenches for defense, send them back to headquarters to earn requisition forms for camp upgrades or release them from service which grants a small boost in morale. Cured patients are a limited resource like everything else, so you need to carefully decide where to send each one you discharge.

War Hospital is not an easy game to play. The odds are stacked against you and seem to only get worse as the war drags on. It is broken up into chapters with each one offering increasingly complex challenges. As such, this is certainly not a title for those who want a light experience. I consider myself a bit of an expert in management types of games, and I had to start over several times when my first few hospitals become hopelessly backlogged with dying patients or morale dropped so low that nobody wanted to work anymore. But after I learned all of the mechanics and some of the tricks of War Hospital, like buying a morgue early to hide some of the bodies from the living patients, or hiring as many surgeons as I could early and upgrading their rooms so they could get rested more quickly, I slowly turned things around to the point where even the sim people said they were surprised that I was doing so well while walking around the muddy compound.

If you put a lot into it, War Hospital is quite the rewarding experience. And it certainly shows the difficulty that medical personnel faced during The Great War. For a challenging but interesting and entertaining experience, management simulation players or those who enjoy historical titles should definitely check into War Hospital.

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