War Hospital (Xbox Series) Review

War Hospital is a fascinating attempt to pair a tragic real-world setting with resource management and decision-making mechanics. Despite being an indie title that gets a lot of mileage out of limited assets, it mostly works by keeping the stakes high. You never feel in complete control for long, and it often feels like one bad decision could lead to disaster down the line. You could argue that’s common enough in strategy and management games, but while many of us interested in those genres can settle into the rhythm of treating digital lives as simple numerical considerations, War Hospital tries to humanise both staff and patients, making simple decisions that much harder.

You play from the perspective of a retired combat medic assigned to a field hospital not far from the Western Front during the final months of World War I. His son has died fighting and he hopes to put his skills to use, saving others from the same fate. It’s a simple and effective premise but, perhaps keeping with the themes of the game, names and faces quickly fade into the background as you desperately juggle figures. It was only the scouting missions – which play out like choice-driven visual novels – that left an impact, drawing on stories of human resilience or simple humanity in the face of atrocities.

Shortly after a tutorial-heavy opening, the front lines collapse, orders from HQ are to hold out, and the Major finds himself trying to strike a balance between expanding facilities; sourcing medicines and food; managing limited staff rotations; treating and rehabilitating patients suffering from surgical, chemical, and trauma injuries; and sending rehabilitated soldiers to reinforce a new defensive line in the north – all the while keeping morale from plunging. It is a lot to take in, there are no difficulty settings or modifiers, and the tutorials can only guide you so far when it comes to decision-making. As bad decisions often have a knock-on effect, you can expect to sink hours into the first chapter of the campaign and still fail a few times over.

Despite the mix of medical and military responsibilities, War Hospital is more of a management game than a strategy game – and surprisingly “hands-off” if you take a breather and think back on what you’ve been doing. You’ll never directly order staff, soldiers, or patients anywhere, with 80% of your time spent in menu screens, before adjusting the game speed and watching the AI scurry about the hospital map. That may sound a little dry – and it can be during brief lulls while waiting on upgrades or train deliveries to arrive – but trouble in War Hospital tends to come thick and fast.

Playing War Hospital feels a lot like getting caught in a wave and just trying to keep your head above water. At first, you’ve got limited staff and a steady but manageable supply of casualties, allowing you to triage and micromanage doctors, nurses, medics, and engineers effectively. You’ll release enough rehabilitated soldiers to secure the trenches or send them to HQ for requisition points; you’ll have time to assign engineers to produce surgical supplies or build upgrades; and not have to worry about food supplies, scouting missions, and random events. It’s a short-lived sensation though.

Before long, German assaults will trigger mass casualties with critical patients; surgical supplies and food run low; reagents for chemical burns and drugs for trauma mean shifting production from the basics; while exhausted staff spread across casualty stations, the operating ward, rehabilitation, the cemetery, and production facilities require longer rest periods. At this point, every merciful decision you made earlier starts to feel like a poor one, and ruthless efficiency is needed to survive. Major operations, no matter how stable the patient may be, are denied; rotating shifts are abandoned; staff and patients are placed on half rations, impacting morale; and requisition points vital for upgrades are consumed for emergency train deliveries – assuming your rail network hasn’t been knocked out by artillery.

I’m not quite sure how I felt during these moments. I couldn’t tell if reducing my decision-making to balancing numbers was brilliant, intentional design, or just my video game brain kicking in and dissociating my actions from the context. Either way, it was incredibly uncomfortable and left me questioning who or what I was serving by holding on. It was a sensation was reinforced by VIP patients I could treat preferentially in the hope of receiving personal points to acquire more staff; seeing wounded soldiers return again and again from the front, many of whom would die as a consequence of my decisions; all the while scouting missions reminded me the entire country is suffering beyond the walls of your field hospital.

That said, War Hospital is far from a hopeless or unrewarding game and I’d recommend it to fans of management games looking for higher stakes – you might just want to wait on a patch or two. Each new chapter is a reset of sorts, accompanied by a restock of supplies and medicine while retaining your facility and staff upgrades. It’s a design not everyone will approve of, but it means the longer you hold out, the easier it gets to keep your field hospital intact, become self-sufficient, and save more lives. Unfortunately – two weeks from launch – what you can’t survive are bugs. These include scripts not triggering (like the time I lost a rail line and could never assign engineers to clear it) and a common issue where ambulances block the AI pathing between the casualty station and operating ward, effectively soft-locking the game. If a couple of patches can resolve these issues, it’ll be much easier to praise the developers for creating such a smart fusion between premise and gameplay.

War Hospital was reviewed on Xbox Series S|X using a code provided to gameblur by the publisher. It is also available on PC and PS5.