War Hospital (Xbox) review: Major surgery is needed to save this terminally buggy Frostpunk-like

I've been quite looking forward to War Hospital for some time, and I'm sad to report that I'm quite disappointed with the final result — but that's not to say this patient is unsalvageable. 

Set in WW1, you're tasked with the careful management of a frontline British medical outpost, based in the ruins of a small French village. German soldiers and artillery batter your position with increasing frequency over the course of the game, forcing you to make dire decisions about who lives, and who dies, while managing a precariously diminished supply of resources and manpower. 

War Hospital is without a doubt analogous to games like Frostpunk. It's not shy about its similarities either, borrowing Frostpunk's atmospheric treatment down to the UI delivery. The execution is actually fairly good overall, and War Hospital brings some of its own unique twists to the formula to keep things fresh. Sadly, there's too much about War Hospital that needs to be amputated before I can give it a full-blown recommendation.

This review was conducted on Xbox Series X with a copy provided by the publisher. 

The Good Stuff: Graphics, gameplay, and design

As someone who is too jaded to enjoy the dearth of cuddly and cozy city builders out there, games like War Hospital are far more my cup of tea. The dire situation that War Hospital puts its players into is well presented, with rather impressive environmental design. The game takes place in a blown-out village somewhere along the front lines. Setting up in a church, players will hollow out the ruins to set up a makeshift war surgery, and it's as gristly and grim as you might expect — and all without being exploitative. 

One of my favorite innovations within War Hospital is the fact you can zoom into the different buildings and explore their interiors. It adds an extra dimension to the simulation and doubtlessly builds immersion. Sombre orchestral scores accentuate the desperate situations, as patients queue up in ambulances, brought in from the frontlines. And that represents the primary "danger" mechanic of War Hospital. 

To the north of your makeshift base lies the trenches, where German forces attack with increasing intensity — similar to the temperature mechanic in Frostpunk. This was quite an elegant way to anchor the game with familiarity for fans of the genre, while also presenting something unique. I was a bit disappointed, however, to discover that the combat scenarios play out in heavily-compressed pre-rendered videos from in-engine sequences. It feels as if there were some cut features here, given the fact the trenched area is quite thoughtfully laid out. I thought perhaps there might be some sort of tower defence gameplay, or at the very least, we'd be able to see combatants exchanging fire. Alas, you're simply told that your defences are "strong" at the top of the UI, which undermines the potential of the mechanic here. Still, War Hospital does do some interesting and unique things with its setting. 

As your War Hospital grows, you'll get access to new facilities and features. You will eventually be able to launch scouting parties to find resources to help with your survival effort, given the fact that supply lines are stretched incredibly thin all across the country. At regular intervals, a train arrives with random types of supplies. It might be stuff you actively need, but it also might not. You can review the train schedule to get an idea of what supplies you have coming in, and plan accordingly around that fact — and it's the on going "life or death" decisions that really gives War Hospital its greatest hooks. 

As war wounded come flooding in, you'll have to carefully manage the workload, while managing resources to pay, feed, and house staff. If you don't have enough graveyard workers then bodies will pile up in your triage center, which prevents patients from being seen. Wounded patients can deteriorate quite rapidly if left untreated, giving you a persistent sense of urgency as the game grows in complexity. 

Managing the flow of research, manufacturing supplies, triaging patients, deciding who gets operations and who gets rejected gradually increases in cognitive load over time. Thankfully, the developers had the forethought to let you eventually research ways to automate and schedule staff, which arrives just before things get too hectic. 

The game also offers dynamic events and quests, not dissimilar from Frostpunk, to keep the day to day work cycle fresh. Perhaps fresh is the wrong word, since some of the crisis events can be incredibly stressful — in a good way. 

At one point, German artillery shelled my train station, completely cutting me off from supplies for a time. Managing a dwindling supply of food, medical supplies, and juggling which patients had the best chances of surviving during these sequences were difficult, but also incredibly rewarding. It's in these moments of crisis and calm that War Hospital really finds itself, and shines through. Sadly, there's a litany of ailments holding the game back. 

The Bad Stuff: Bugs, performance, and lost progression

War Hospital is developed by a comparatively small team, and it's easy to see which aspects of the game have been held up by budgetary realities and the like. It's worth mentioning though that while War Hospital's environmental treatment is quite good, the character animations and models are stiff, and the user interface lacks the elegance of Frostpunk — the game it clearly wants to emulate. These things can be forgiven, though, since the gameplay loop is quite solid. What can't be forgiven right now, though, is just how clunky the game handles with a controller on Xbox. 

The worst part of War Hospital, and the part far more stressful than triaging bullet riddled patients, is battling with the game's UI on a gamepad. I'm sure it's fine on PC, but since we're reviewing the Xbox version here today, you should really know that the developers have some work to do to improve things. 

Managing the sleep cycles of doctors and surgeons is particularly irritating here. You can move patient records into a queue to be shipped out to the surgery room for procedures, while also moving in rest periods for your doctors in between. A tired doctor is also a doctor more likely to make mistakes, and lead to dead patients. Dead patients means decreased village morale, which will eventually see the locals revolt against your stewardship, resulting in a game over. 

When it's the game's UI rather than its gameplay mechanics that offer the bulk of the difficulty, there's a problem. There are various other issues with the ui, whether it's highlighting tooltips, managing other types of employees, reading text, or selecting elements — it's all choring, and makes the game more laborious to play than it should.

Perhaps the worst aspect of the game right now is crash events, though. Certain situations can cause the client to just straight up close, and since there's no periodic autosave feature (at least that I could find as of writing), you stand liable to lose hours upon hours of progress if you forget to save. And yes, I fell afoul of this. To say it soured my opinion of War Hospital would probably be an understatement, but really it's not something that can't be fixed. There are aspects of the UI that are thoughtful and well-designed, so I can't help but feel like Brave Lamb just ran out of time here. 

I'm hoping that War Hospital finds its audience so we can get some of the bug fixes in the game desperately needs to be something I can truly recommend. But as of right now, developers Brave Lamb haven't made it easy. 

Conclusion: Botched surgery

War Hospital clearly has a ton of potential. The elements of the game that work do so extremely well. It wears its inspiration on its bloodied, lab coat sleeve, and it's easy to imagine how the game could expand with DLC and other types of updates down the line. I just wonder if it'll ever make it there. 

War Hospital is incredibly rough right now, particularly so on Xbox. Judging by the reviews on Steam, however, it suffers similarly over on PC as well. I didn't manage to complete War Hospital — the overlapping issues became far too much to make the slog worth doing so. I knew quicker than usual whether or not this is a game I'd recommend to most people, and right now, that answer is no. 

But like I said, it's not unsalvageable. We also live in times where publishers are counting each and every penny. I wouldn't be surprised if the publisher imposed a hard deadline on shipping War Hospital. I also wouldn't be surprised if the publisher cuts their losses and bails. 

The further into the game you get, the more bugs appear, painting the picture of a terminally ill patient that might be beyond rescue. As a huge fan of the setting, the concept, and aspects of the game's execution — I hope I'm wrong. 

War Hospital | $39.99

War Hospital puts you in control of a battered surgery on the frontlines of WW1. Make harrowing decisions as you carefully manage resources, staff, morale, and your facilities in this war-torn city builder. 

See at: Xbox | Steam 

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