Cities: Skylines Sick Citizens (6 Main Causes & Fixes)

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Getting news of an occasional sick or deceased citizen is a normal part of your work as a Cities: Skylines mayor. But when a large number of your citizens start getting ill and dying at the same time, it sets off a few alarm bells.

So just to help you whittle down this problem, your citizens could be getting sick for any of the following reasons:

  1. Sewage backing up
  2. Contaminated water
  3. Ground pollution
  4. Noise
  5. No access to healthcare
  6. Aging

In this guide we’ll explain how to address these problems & get your city’s health back on track.

 

Cause #1: Sewage Backing Up

Sewage backing up is one way for a large number of your citizens to get ill.

 
A notification warns us that the sewers are backed up and citizens may fall ill if we don’t address it. / Cities: Skylines
A notification warns us that the sewers are backed up and citizens may fall ill if we don’t address it.
 

Check that your water pipes are connected to a properly operating drain pipe. The drain needs electricity, so don’t forget to hook it up to your power grid.

 
This wastewater drain pipe has water pipes underneath but isn’t actually connected. Easy mistake to make! Keep an eye out for that broken pipe icon. / Cities: Skylines
This wastewater drain pipe has water pipes underneath but isn’t actually connected. Easy mistake to make! Keep an eye out for that broken pipe icon.
 

You’ll also have to make sure you build enough sewage drain capacity as your population grows.

 
The Water info view (water drop icon on the info views panel) has information on both water availability and sewage treatment capacity. / Cities: Skylines
The Water info view (water drop icon on the info views panel) has information on both water availability and sewage treatment capacity.
 

Cause #2: Contaminated Water Source

It’s crucial that your pumping stations and water towers are taking in clean water.

Your citizens will get sick if their water source gets contaminated by pollution.

 
All these houses have sick residents due to a contaminated water source. / Cities: Skylines
All these houses have sick residents due to a contaminated water source.
 

The most common cause for this is if a water pumping station is taking in wastewater from a nearby drain pipe. Gross!

You must make sure that your drain pipes (wastewater going out) are downstream from your water pumping stations (clean water going in). The water pumping station and drain pipe are visually similar, so it’s easy to confuse the two.

 
As you place water facilities like water pumps and drain pipes, arrows in natural bodies of water will tell you which way the water flows. / Cities: Skylines
As you place water facilities like water pumps and drain pipes, arrows in natural bodies of water will tell you which way the water flows.
 

Water pollution spreads a bit (especially if you have several pipes in one area), so as much as possible, keep your water intake pumps as far away from the drain pipes as possible.

 
Click on Pollution view on the info views panel to check the extent of water pollution. The darker the brown in the water, the more polluted it is. / Cities: Skylines
Click on Pollution view on the info views panel to check the extent of water pollution. The darker the brown in the water, the more polluted it is.
 
As more wastewater gets drained out to your bodies of water, it will also show up in normal view, turning your water murky brown. / Cities: Skylines
As more wastewater gets drained out to your bodies of water, it will also show up in normal view, turning your water murky brown.
 

If you’re using water towers instead of pumping stations, it’s ground pollution that you need to check for.

Placing your water towers on polluted land will contaminate the water in it.

 
Don't do this! Never put your water tower anywhere else where the ground is this ashy brown color. Your citizens will get sick. / Cities: Skylines
Don’t do this! Never put your water tower anywhere else where the ground is this ashy brown color. Your citizens will get sick.
 

Cause #3: Ground Pollution

On the subject of ground pollution — your citizens can get sick if ground pollution affects their homes.

 
The unfortunate citizens of this horribly situated house are getting nauseated from the pollution where they live. / Cities: Skylines
The unfortunate citizens of this horribly situated house are getting nauseated from the pollution where they live.
 

Clicking the Pollution info view will show you the affected areas.

 
Just like with water, the Pollution view will also show ground pollution in varying shades of brown depending on severity. / Cities: Skylines
Just like with water, the Pollution view will also show ground pollution in varying shades of brown depending on severity.
 

Among the buildings that generate ground pollution are:

  • Generic industry
  • Garbage facilities
  • Coal and oil power plants

So keep these away from your residential zones!

A good tip is to zone offices next to your residential zones instead, as offices don’t generate ground pollution.

 

Cause #4: Noise Pollution

While citizens aren’t as sensitive to noise as they are to water or ground pollution, they can still get sick from noise pollution if it’s bad enough in their homes.

 
Imagine the headaches these citizens have from living next to a loud wind turbine. The icon of a sick person wearing headphones indicates illness caused by noise pollution. / Cities: Skylines
Imagine the headaches these citizens have from living next to a loud wind turbine. The icon of a sick person wearing headphones indicates illness caused by noise pollution.
 

The noise pollution view (the orange headphones on the info views panel) will let you see the noisiest spots, indicated by an orange color.

 
The orange is darkest around the roads and in the generic industry area on the right. / Cities: Skylines
The orange is darkest around the roads and in the generic industry area on the right.
 

Here are a few ways to mitigate noise pollution in your towns:

  • Zone generic industry away from your residential zones. Office spaces can provide a good buffer between the two since they don’t generate noise.
  • Opt for highways with sound barriers and don’t zone residences too close to them
  • Garbage facilities and power plants generate a lot of noise so keep them away from homes as much as possible!
  • Unique buildings and monuments can produce various amounts of noise, so check the tooltip for each one before placing it.
 
Check how much noise an attraction or unique building generates before putting it near a residential area. / Cities: Skylines
Check how much noise an attraction or unique building generates before putting it near a residential area.
 
  • You can safely zone commercial buildings right next to your residential zones as long as you do so sparingly, and not in large clusters. Think one or two corner shops every couple of blocks.
  • Adding trees can reduce the amount of noise in an area if used in large numbers.
 

Cause #5: No Access to Healthcare

Even if your city is generally clean and quiet, you will still get the occasional sick citizen. This is normal, and shouldn’t be a problem for you — as long as you have healthcare facilities to take care of them.

If your citizens don’t have access to healthcare, disease can spread in an area, so make sure they’re covered.

The most basic healthcare facility that you can unlock is the medical clinic, which you unlock upon reaching the Tiny Town milestone. Sick citizens can walk or be brought there by ambulance.

 
Stop the spread by building a medical clinic. You'll find it in the Healthcare build menu, indicated by the medical symbol. / Cities: Skylines
Stop the spread by building a medical clinic. You’ll find it in the Healthcare build menu, indicated by the medical symbol.
 

Later in the game you can unlock the hospital, which is expensive, but serves a much larger number of patients and has more ambulances.

Building Milestone to Unlock Build Cost (₡) Patient Capacity Ambulances
Medical Clinic / European Medical Clinic Little Hamlet 10,000 100 8
Hospital / European Hospital Busy Town 65,000 500 30

Note: The differences between the Medical Clinic/Hospital and their European counterparts are purely cosmetic.

 

Cause #6: The “Death Wave”

The dreaded “death wave” is when a high number of your citizens start to die, presumably of old age, at around the same time.

 
Sometimes you’ll get a spike in the number of dead person notifications at the same time. Make sure you have the death care capacity for it! / Cities: Skylines
Sometimes you’ll get a spike in the number of dead person notifications at the same time. Make sure you have the death care capacity for it!
 

It happens even in fairly well-managed cities, usually as a result of having had a large number of citizens move into your city at the same time (say, if you zoned a large amount of residential while demand was high).

If this happens in your city, the only thing you can really do is ride it out and make sure you have enough death care facilities to handle the sudden demand. You’ll find cemeteries and crematoriums under the Healthcare build menu as well.

If your existing cemeteries and crematoriums are overwhelmed, consider building one or two additional facilities just to handle the wave, if you have the cash. You can just switch off the new extra facilities (to avoid the upkeep costs) or move them to a new part of the city, once the current death wave settles down.

Death Care Facility Milestone to Unlock Build Cost (₡) Capacity Hearses
Cemetery Boom Town 8,000 3,000 10
Crematorium Big City 25,000 105 7
 

Tip: Health Boosting Facilities

Apart from the clinics and hospitals to take care of the sick, the game also has buildings meant to boost the health of your citizens.

You’ll find two in the base game, three in the Green Cities DLC, and one in the Snowfall DLC.

Building DLC Required Milestone to Unlock Build Cost (₡) Effect
Child Health Center none Boom Town 18,000 Increases birth rate within its radius

Health benefit to children and teens

Visitor capacity: 50

Elder Care none Boom Town 22,000 Increases lifespan of elderly within its radius

Health benefit to the elderly.

Sports Hall and Gymnasium Green Cities Tiny Town 120,000 Health benefit to area

Visitor capacity: 180

Community Pool Green Cities Busy Town 75,000 Health benefit to area

Visitor capacity: 120

Yoga Garden Green Cities Small City 90,000 Health benefit to area

Visitor capacity: 90

Sauna Snowfall Big Town 25,000 Health benefit and happiness boost to nearby area

Visitor capacity: 60

 

Healthy City Checklist

Here’s a quick recap of the things you need to do to take care of your citizens’ health!

  • Check that their sewage is draining properly
  • Keep an eye out for any contamination in their water supply
  • Keep residences away from polluting buildings and industries
  • Make sure it isn’t too noisy where people live
  • Provide adequate access to healthcare facilities
  • Have cemeteries or crematoriums ready for people dying of old age
  • Boost your citizens’ health with child care, elder care, and fitness facilities
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Liz Villegas

Liz is a writer and photographer with a love for building and strategy games. Her spare time is often split between lifting, reading, drawing, annoying her dog Mr. Porky Butt, and squinting at stat tables on the wiki pages of whatever game she's currently playing.