We seem to be experiencing a new era of bleak realism in management sims. The likes of This War of Mine and Frostpunk eschew optimistic growth in favour of grim survival at all costs. The latest in this cycle is War Hospital, a WWI-era triage-'em-up that has you overseeing a medical compound under relentless assault from enemy forces.

You play Henry Wells, a retired medic pulled back into the blood and mud to manage a field hospital. Surrounded by tired medical staff and gruff military personnel barking orders at him, Wells must keep the hospital afloat and save as many as he can. As befits the setting, the tone is dark and never brightens. The tutorial starts with a failed operation and your first introduction to an eventually overflowing cemetery.

The core loop has you screen incoming patients and send them from casualty clearing to the operating centre. Each wounded soldier has a file and set of stats that'll help you judge whether to clear them for surgery or not. Those denied treatment plead with you to try and save them, while those on the operating table might not make it anyway.

Once patients are rehabilitated, you have the morally challenging choice of letting them go home or sending them back to the trenches. Keeping a healthy roster of healed soldiers is key to campaign success. Sending them back to the front lines stops the enemy from overwhelming the hospital, but you may also need to boost camp morale by letting them go home.

Orders occasionally come in to challenge the delicate balance of the hospital. Triaging VIPs, surviving sporadic attacks from enemy forces, and taking on scout missions break up the main goal of clearing patients.

As resources dwindle and morale declines, you'll shuffle personnel and scrape through upgrade trees in a sometimes tedious grind. Thankfully, the UI makes cycling menus and navigating the camp effortless; all actions are mapped to radial wheels that start awkwardly but eventually become second nature.

As much as this engages as a sobering alternative to the likes of Two Point Hospital, a large chunk of it just sees you cycling through familiar motions. The rich atmosphere and worthy setting are compromised by a narrow vision.