Casualties: Unknown Review

A brutal survival roguelike where every injury, decision, and breath could be your last.

Casualties: Unknown is a weird survival roguelike that takes the familiar loop of exploring perilous places, gathering resources, and building equipment and turns nearly every facet of survival into a sophisticated medical simulation. The game is an ambitious project that first grabbed attention under the name Scav Prototype, created by sole developer Orson. 

What began as a curious survival experiment has become a far more complex experience centered around procedural exploration, resource management, crafting, and a very realistic health system. It also has a unique personality thanks to its unique foundation. Instead of commanding a normal human survivor, you play as a genetically modified creature created from a strange bio-experiment.

Your character is part of the SAW project, a company venture trying to produce new technology and medical treatments with a strange living substance found after a failed teleportation operation.

The story begins with mankind attempting to build teleportation technology, but the attempts keep failing. In one especially failed attempt, scientists find a strange yellow material with amazing healing and reproductive qualities. After analyzing it, the business began experimenting with different creatures and eventually created the SAW subjects.

They are intelligent, have working hands, and have the biology that allows them to be used to test new technology. The corporation then uses them to create medical treatments, brain implants, and other technical advances. But the company's relationship with its creations is far from pleasant. The SAW subjects are throwaway lab experiments, and researchers test deadly drugs on them and even implant gadgets that can kill their hosts with radiation or explosives.

The company’s decision to send them on dangerous missions to reduce operating expenses shows their lack of independence. You have been assigned to Gray Planet, a strange and unfriendly world where a very vital power source has been mistakenly lost. The corporation figures it’s cheaper to send another test subject than to pay for an expensive recovery operation.

The subject is, of course, you. The aim is to descend into the planet’s subsurface ecosystems, retrieve the lost technology, and somehow survive the expedition. The story does a nice job of contrasting the organization's scientific advances with its total disregard for the lives of its creatures. You aren't introduced as a particularly important person either.

You were trained on data up to October 2023. Thousands of people have been thrown into comparable settings before, and your prospects of surviving aren't particularly encouraging. This makes the adventure feel more personal because your character is effectively battling an organization that sees them as replaceable.

Environmental storytelling also contributes to the plot.

On your quest, you will find abandoned landing pods, notes, and personal digital assistants that provide more facts about the globe and prior missions. You can also meet other surviving subjects, who will offer opportunities for trade and brief conversation. These moments bring a human touch to an otherwise unpleasant setting.

The normal finale is a fascinating end to the first trip but not necessarily the end of your journey. You get the power source, then have to trek back up toward the surface, and the firm ultimately sends another pod to pick you up. But after a successful expedition, the way back to the scientists is full of difficult questions about your future and whether you can really trust their assurances. Multiple endings and more New Game Plus content further incentivize exploring alternatives.

The core gameplay loop is descending through more perilous underground landscapes while keeping your character’s physical and mental state intact. Casualties: Unknown blends survival principles with roguelike exploration, forcing you to gather resources, find helpful gear, build supplies, and make smart choices about how to tackle each situation.

The underground environment is procedurally generated, so the landscape and accessible items can change between runs. This encourages experimenting, as you can’t rely on remembering where important resources are. Instead, you have to learn how different materials work and adjust your technique based on what you find.

Exploration itself is surprisingly perilous. While your primary goal is to just fall,  being careless can be fatal. Falls from heights can cause fractures, internal injuries, and life-threatening damage. The settings also feature traps, aggressive creatures, and hazards that can harm your health in various ways. Depending on the area, you may have to worry about hypothermia, hyperthermia, dehydration, malnutrition, and drowning.

That’s why movement and physics are so crucial. You can’t just charge through every area without thinking about where you'll land or what is under you. Unfortunately, the mobility method can be cumbersome at times, and certain falls or fatalities can feel more irritating than satisfying. You notice this particularly when the physics doesn’t behave as smoothly as you’d anticipate.

Gathering and crafting resources is equally vital. The game boasts a deep crafting system with roughly 300 unique pieces that allow you to turn common environmental elements into valuable survival gear. Eventually, you can craft equipment like helmets, spotlights, syringes, and dynamite. Medical supplies are vital, since even a small injury can become serious if not treated.

The crafting system promotes experimentation, but it takes a fair amount of effort to learn all the options. Inventory management makes this harder. Your carrying space is limited, so you have to decide which items and equipment take priority. Extra storage comes in different containers, but if you pack too much gear, you slow down. That means you have to always balance preparation with movement.

You might want to bring medical supplies, food, water, crafting tools, and defense gear, but there isn't enough room for it all.

This creates a unique survival problem: an item that may not seem important in one moment can be critical a few minutes later. So learning which resources to prioritize is one of the most crucial abilities you build during the journey. Combat in Casualties: Unknown is less about traditional action and more about survival and resource management.

Hostile creatures populate the underground areas, and it can get dangerous quickly if you run into them unprepared. Some monsters deal direct physical damage; others can add poison and other damaging effects. And it’s not just the beasts that are the threat. Environmental risks and traps are just as deadly, particularly if you are already nursing injuries. A seemingly easy encounter can turn disastrous if you can’t move properly or you’ve lost too much blood.

Your survival in these situations depends a lot on how well you prepare. Essential items include defensive equipment, proper medical supplies, and knowledge of your body’s state. The most impressive mechanic in the game is by far the medical simulation. Casualties: Unknown doesn’t use a normal health bar; instead, it tracks many parts of your character’s body independently.

You have to check blood pressure and blood volume, heart rate, oxygen levels, muscle condition, skin condition, fractures and dislocations, internal bleeding, infections, and a whole slew of other medical issues. For example, a fall from a high place may cause several fractures and internal trauma. Not every problem can be fixed with a band-aid. You need to know what injuries you have and what remedies to apply.

Wounds can get infected, and if you don't maintain good hygiene, you might weaken your immune system and make recovery harder. The game also makes mood a key determinant of survival. When you go through pain, have serious injuries, and don't pay attention to your character's mental state, you can get depressed and experience other negative effects. Letting your character’s mental condition degrade to a serious extent can be deadly.

The Moodle system indicates these situations visually.

There are around 70 different moodles, each depicting different physical and psychological conditions and helping you understand what is happening to your character. Luckily, your genetically created character has strong regenerative powers. Many injuries that would otherwise cause permanent disability can be overcome over time with proper treatment.

Prosthetic limbs also provide another way to manage some injuries, meaning losing a limb isn't necessarily the end of your run. The mechanics make surviving tremendously rewarding. Feels like a real accomplishment after several breaks, illnesses, and major internal injuries. However, the medical system also has a learning curve that can be scary, especially when you run into uncommon problems you don’t know how to treat.

Casualties: Unknown doesn’t have a traditional experience-point system that rewards you with higher levels for killing more foes. Instead, advancement is about leveling up your character’s physical abilities, knowledge, and understanding of survival mechanics.

You can work out to boost stats like damage, digging power, and carrying capacity. These activities take time and resources, especially food and water, so you can’t spend endless time growing your character. The corporation also sets a time restriction on your excursion and will activate the fatal radiation system embedded inside your brain implant if you don’t make enough progress.

Strength, resilience, and intelligence are among the attributes that determine what your character can do.

Improving these capacities makes some operations easier and broadens your options. But progress calls for cautious planning, because spending too long preparing is as risky as racing ahead without equipment. Because it's a roguelike, every run is an opportunity to learn something new. You gradually learn which resources help, which medical procedures work, and how to handle unexpected problems.

Death is permanent in a single run, but you carry with you the wisdom you gain from earlier efforts and your understanding of the mechanics. The game also features three playable characters, each with various attributes. Milky and Dune do things differently, while your original character does things the normal way. Milky is petite and smart, and sometimes needs sleep, yet can wield guns with simple hotkeys.

Dune, nevertheless, is a stronger, cold-blooded species with various emotional and biological properties. You can also tweak the difficulty to make things less harsh if regular survival mode gets to be too much. Casualties: Unknown features a stylized pixel-art graphics style that is shockingly offset by the violent gameplay.

Their designs are kind of charming, and their strange features make them stand out visually in a good way. However, the settings themselves convey a significantly darker ambiance. The tunnels underneath are loaded with rocks, plants, weird biological stuff, and deadly critters, so it feels like an alien world, hostile and unpredictable.

The visuals also convey critical gameplay information. The elaborate interface graphically shows the character's injuries, mood, and physical condition. The medical panel can seem scary at first, but it quickly becomes a vital tool for understanding what's happening with your health. The juxtaposition of cute character designs with unsettling medical scenarios is striking.

Watching a cute-looking creature suffer from serious ailments creates a strange visual identity that sets the game apart from more traditional survival games.

The interface can get a bit crowded at times, especially when you have multiple moodles and medical warnings up at once. A simpler presentation could make some scenarios easier to understand without losing the game's intricacy. The atmosphere comes to life through sound design. Casualties: Unknown doesn’t only employ music to build suspense. It adds audio cues to signal danger, making survival scenarios increasingly difficult.

The audio changes to reflect the urgency when your character is in a life-or-death scenario. Your heartbeat becomes more pronounced, the music gets louder, and other auditory elements reinforce the sense that something is terribly wrong. These moments, along with the blurry vision and a barrage of medical warnings, can trigger real panic.

The soundtrack is especially worth mentioning, as a solo developer created it and drew inspiration from Rain World. The atmospheric style fits the enigmatic underground locales well, without being too much all the time. The music also helps create emotional contrast between exploration and danger. Quiet moments give you a chance to look around, sort supplies, and prepare for the next challenge.

But when something goes wrong, the audio conveys how quickly your position can deteriorate. Overall, the sound design works in tandem with the game’s survival algorithms, making even the most mundane encounters feel stressful when your character is already struggling.

Casualties: Unknown is an ambitious, exceptionally complex survival roguelike that makes even the slightest choices feel vital. Its greatest asset is the medical simulation, which turns simple survival scenarios into complex dilemmas that require observation, preparation, and testing. When anything assaults you, you don't just lose health; you need to know exactly what happened to your character and decide how to recover before another problem pops up.

The crafting system, generated surroundings, limited inventory, and permanent death mechanisms combine to create an experience where knowledge often matters more than equipment. Your first few tries will certainly end comically: a fall that’s too unfortunate, a medical issue you don't recognize, or packing the wrong supplies. Those failures, however, slowly teach you how to tackle the following mission.

That’s not to say everything works flawlessly.

The movement and physics can feel clunky, inventory management can be complex, and some hazards can be hard to spot. The medical interface also requires patience, especially when several diseases show up at once. These problems can be irritating, especially when an unexpected mistake costs you a few hours of progress.

But the developer has acknowledged several issues and outlined fixes, including clearer traps, less frustrating combat, and quality-of-life tweaks. The game has far more replay value than its basic premise suggests, thanks to extra characters, alternate endings, prosthetic limbs, and configurable difficulty.

In the end, Casualties: Unknown is not going to be everyone’s cup of tea. This experience could get overwhelming quickly if you like simple survival mechanics, lenient checkpoints, or simple combat. If, however, you prefer complex systems, difficult roguelikes, and the feeling of overcoming what first seems insurmountable, there is a lot to love here.

It’s special because it feels like something you won by surviving. You are not just getting stronger by defeating adversaries. You're learning how your character works, learning about the environment, learning which scenarios are dangerous, and learning how to deal with challenges with limited resources. A curious blend of brutality and satisfaction gives every successful voyage a memory.