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Health Body Parts Injury Disease Ailments

Humanoids, animals, and mechanoids sustain injuries from sources including melee weapons, weapons fire, explosions, ceiling collapses, and fire. Each source of damage comes with a specific Damage Type. Colonists, visitors, and prisoners can be operated upon and may suffer an injury from a surgical mistake. Each kind of injury has a value of pain, a description for its scar, and flavor text for being mended by medicine. A colonist in shock from extreme pain or incapacitated due to loss of movement becomes 'downed'. Doctors will automatically rescue downed colonists.

Health Difficulties

Main article: Health Difficulties

These are the general types of injuries that can be inflicted on a colonist. A bladed weapon would cut you, while a firearm would inflict gunshots, etc.

Name Pain[1] Old Pain[2] Old Label Combines?[3] Bleeding Infection Chance [4] Become Old Chance Naturally Heals Destroyed[5] Destroyed Out[6] Treated Inner Treated Solid Treated
Burn 1.875 0.5 Burn scar Yes 0.0 25% 1% Yes Burned off Burned out Bandaged Sutured Set
Crush 1.25 0.5 Scar Yes 0.4 10% 1% Yes Crushed Crushed Bandaged Sutured Set
Crack 1.0 0.5 Scar ?[7] 0.0 0% 0% Yes Shattered Shattered Healed Healed Set
Cut 1.25 0.5 Cut scar Yes 1.0 10% 1% Yes Cut off Cut out Bandaged Sutured Set
Scratch 1.25 0.5 Scratch scar No 0.1 10% 1% Yes Torn off Torn out Bandaged Sutured Set
Bite 1.25 0.5 Bite scar No 0.1 25% 1% Yes Bitten off Bitten out Bandaged Sutured Set
Stab 1.25 0.5 Stab scar No 0.8 10% 1% Yes Cut off Cut out Bandaged Sutured Set
Gunshot 1.25 0.5 Old gunshot No 0.92 10% 1% Yes Shot off Shot out Bandaged Sutured Set
Shredded 1.25 0.5 Scar Yes 1.0 10% 1% Yes Torn off Torn out Bandaged Sutured Set
Bruise 1.25 0.5 Old bruise No 0.0 0% 0% Yes Destroyed Destroyed Bandaged Sutured Set
Frostbite 1.25 0.5 Frostbite scar Yes 1.0 25% 1% Yes Lost to frostbite N/A [8] Bandaged Sutured Set
Missing Body Part[9] - - - - - - - - Gone Gone - - -
Misc[10] 1.0 0.0 Scar No 1.0 ? [11] 1% Yes Destroyed Destroyed Bandaged Sutured Set
  1. Pain per point of damage. See pain for how it works.
  2. Pain per point of damage. See pain for how it works.
  3. Whether or not this injury stacks to become something like 'Burn ×2'
  4. Base chance of getting infected if left untreated.
  5. Prefix for external injuries that result in body part loss (e.g. Shot off left arm).
  6. Prefix for internal injuries that result in body part loss (e.g. Torn out kidney).
  7. Not defined in the files whether or not it combines.
  8. Internal organs cannot be affected by frostbite.
  9. Only applies to missing limbs. No values provided besides a name. Cannot be treated except for limb/organ transplants.
  10. Default/debug damage type. Doesn't occur in the normal game.
  11. Undefined.

Feelin' the Pain

Main Article: Pain

Most biological creatures including colonists, raiders, and animals feel pain caused by injuries. A pawn's pain level ranges from 0% to 100% and is displayed on their Health tab's Overview. Pain levels are None, Little, Moderate, Severe, and Extreme. Even a little pain causes unhappy thoughts. Once pain passes 10%, it'll start to have an effect on consciousness. If a pawn's pain level meets or exceeds their Pain Shock Threshold they'll go into shock, unable to move. Pawns with the Wimp trait will be incapacitated with only minor pain of 20%.

Most pain is temporary, but scars and certain diseases can cause long-term pain. A painstopper implant will get rid of all a colonist's pain and negate any pain-related mood penalties. Note that colonists with the Masochist trait get a mood bonus from pain instead of a penalty, so it's usually better to leave them alone.


Pain follows a somewhat complex formula:

Pain = Number of Injuries ÷ [80.0 × Max Pain Level Multiplier[1] × Health Scale[2] + Extra Pain ÷ (80.0 × Max Pain Level Multiplier)]

  1. This is 1.0 for humans.
  2. This is also 1.0 for humans

Extra pain is determined by individual injuries:

Extra Pain = Injury Damage × Injury Pain Value

  • 50 crush damage would do 50 damage × 1.25 crush pain = 62.5 extra pain
  • 50 burn damage would do 50 damage × 1.875 burn pain = 93.75 extra pain

Non-Local Injuries


When a pawn's food meter reaches 0% they will begin to suffer from malnutrition, shown on the Health tab. When a colonist is starving they will prioritize eating over other activities, including firefighting and doctoring.

  • Malnutrition starts at 0%; upon reaching 100%, the pawn will die.
  • Malnutrition (trivial): consciousness -5%, 150% hunger rate
  • Malnutrition (minor): consciousness -10%, 160% hunger rate
  • Malnutrition (moderate): consciousness -20%, 160% hunger rate
  • Malnutrition (severe): consciousness -30%, 160% hunger rate
  • Malnutrition (extreme): consciousness max 10%
  • Malnutrition (100% severity): death

Blood Loss

Blood loss occurs when a pawn has untreated bleeding wounds. Bleeding wounds are identified on the Health tab by a blood icon and a tooltip shows the bleeding rate. Total blood loss is listed under Whole Body and its tooltip shows the total blood loss. Overall bleeding rate is shown at the bottom.

Once all bleeding wounds are healed the pawn will start recovering from blood loss. It takes up to 4 days to fully recover as of Alpha 17, up from 50 real-time seconds in previous versions.

  • Blood loss starts at 0%; upon reaching 100%, the pawn will die.
  • Blood loss (minor): consciousness -10%
  • Blood loss (moderate): consciousness -20%
  • Blood loss (severe): consciousness -40%
  • Blood loss (extreme): consciousness max 10%
  • Blood loss (100% severity): death


Caused by extreme pain, it incapacitates the affected target. There are no other causes of shock besides pain currently.

Pawns go into shock if their amount of pain is greater than 80%, except for wimps which are downed at 15%.


Heat stroke occurs when a pawn has prolonged exposure to temperatures well above their maximum comfortable temperature.

  • Heatstroke (initial): consciousness -5%
  • Heatstroke (minor): consciousness -10%, moving -10%
  • Heatstroke (serious): consciousness -20%, moving -30%, pain +15%
  • Heatstroke (extreme): consciousness max 10%, pain +30%
  • Heatstroke (100% severity): death


Hypothermia occurs when a pawn has prolonged exposure to temperatures well below their minimum comfortable temperature.

  • Hypothermia (shivering): consciousness -5%, manipulation -8%
  • Hypothermia (minor): consciousness -10%, manipulation -20%, moving -10%
  • Hypothermia (serious): consciousness -20%, manipulation -50%, moving -30%, pain +15%
  • Hypothermia (extreme): consciousness max 10%, pain +30%
  • Hypothermia (100% severity): death


Scars are permanent markers of injuries. They permanently lower the maximum health of the scarred body part, making it easier to damage the affected body part in the future. They also cause a character a small amount of pain, even if the relevant body part is fully healed. Pain from scars results in a permanent mood penalty for non-masochistic characters. For a colonist with the Masochist trait, scar pain will provide a continual mood bonus instead of penalty.

Scars can be caused by poor quality treatment or simply not treating wounds, though injuries have an inherently low chance to scar, as seen above. Sometimes colonists are generated with minor scars and old gunshots already in place. Some body parts also scar instantly upon injury.

It is possible to remove the pain from scars by surgically implanting artificial replacements. This is obviously only possible for limbs and eyes as there's no way to remove the torso, neck or head.

Scars can be treated by luciferium, however the cost of using it usually outweighs the benefit, unless used on numerous scars, or a permanent brain injury.

Another way to work around scar pain is to implement a Painstopper, preventing all ongoing pain. The downside to this, however, is that should the pawn with an installed Painstopper take serious damage - they won't go down until they either lose a leg (or have it heavily injured), or die. Therefore you should be extra watchful of their health as to decide whether to withdraw them from a controllable scenario (i.e. combat), as to prevent them from losing their life.

Heart Attack

Heart Attacks can randomly occur on any pawn/animal at any time, but they become more frequent as they pass half of their life expectancy (e.g. 40 years in Humans), triggered by Birthday event. There must be more than 2 colonists on your colony for this to occur.

The average interval between heart attacks is curved as follows (in days).

0-50% of LE: 99,999,999 - 99,999,999
50-60% of LE: 99,999,999 - 2,500
60-100% of LE: 2,500 - 300

Examples of intervals and chances:
55% of Life Expectancy (e.g. 44 in humans): 50,001,249.5 days (approx. 0.00000002% per day)
80% of Life Expectancy (e.g. 64 in humans): 1,400 days (approx. 0.000714% per day)


A heart attack has 3 stages.

Painful: 0 - 59% severity

  • Consciousness x50%
  • Pain +40%

Debilitating: 60 - 99% severity

  • Consciousness max 10%
  • Pain +60%

Fatal: 100% severity

  • Death


Heart attacks always start at 40% severity. Every 5,000 ticks (83.33 secs) the heart attack severity will randomly change by a value between -40% to +60%. This means that it is possible for a heart attack to treat itself on its own, but usually the heart attack progresses to fatal severity.


Like injuries, medicine can be used to treat a heart attack.

Doctors treating heart attacks will administer treatments rapidly, consuming medicine in the process. Each treatment has a chance to succeed, reducing the heart attack severity by 30%. Successfully reducing severity below 0 will completely treat the heart attack.

The maximum chance a particular treatment can succeed is 65%.

Old Age

Strictly speaking, these aren't truly injuries but the result of old age taking its toll on a colonist's body. Chronic diseases are significantly more likely to occur past a pawn's life expectancy. All occurring ages are based on humans, and will obviously be different with animals dependent on life expectancy. Humans stop getting birthdays past the age of 99.

Alzheimer's (From Age 36)

  • Consciousness
    • -5%/-10% (Minor)
    • -15%/-20% (Major)
  • Thoughts will be removed occasionally
  • Occasional Confused Wandering, like with Dementia
  • Curable only with luciferium

Artery Blockage (From Age 21)

  • Blood Pumping
    • -5%/-10% (Minor)
    • -15%/-35% (Major)
    • -60% (Extreme)
  • Death upon reaching 100%
  • More Frequent Heart Attacks (on average every ... days)
    • 600/500 (Minor)
    • 300/200 (Major)
    • 120/Death (Extreme)
  • Curable with prosthetic heart, heart, bionic heart, or with luciferium

Asthma (From Age 2)

  • Breathing
    • -5% (Minor)
    • -15%/-25% (Major)
  • Applied to both lungs giving double the harmful effects
  • Can only be cured with luciferium or replacement lungs.
  • Can be treated, which will prevent progression and limit severity.

Bad back (From Age 41)

Carcinoma (From Age 25)

  • Pain (Note: 30% chance not to cause pain)
    • 10%/20% (Minor)
    • 35%/50% (Major)
    • 60%/70% (Extreme)
  • Part Efficiency Loss
    • 10%/25% (Minor)
    • 50%/80% (Major)
    • 90%/Destroyed (Extreme)
  • Curable by luciferium, replacing the affected organ, or surgically removing it if non-essential

Note that Carcinomas always start at 0.3 severity, meaning 20% pain and 25% efficiency loss. The only way a Carcinoma is at its least severe is if it's been in remission for long enough.
This is when below 0.15 severity.

Cataracts (From Age 49)

Dementia (From Age 69)

  • Consciousness: -15%
  • Talking: -40%
  • Hearing: -40%
  • Occasional 'Confused Wandering' Mental Breaks
  • Curable only with luciferium

Frail (From Age 51)

  • Movement: -30%
  • Manipulation: -30%
  • Curable only with luciferium

Hearing Loss (From Age 49)

Trauma Savant

A pawn may become a trauma savant upon taking and surviving an injury to the Brain. Certain capabilities will rise and some will fall.

Trauma Savant currently removes all ability to socialise and opinions of others, capability of Talking and Hearing (both capped at 0%), but increases Manipulation by 50%, and restores full brain functioning (meaning consciousness and other functions will be normal) - this is great for doctors and general workers, but it'll make affected wardens or traders a write-off in that aspect.

There is a 12% chance of any pawn becoming a trauma savant upon receiving brain damage. It does not have to be a humanlike, and can sometimes be seen applied on animals.