Ghouls created in the Great War of 2077 are still alive during Fallout (2161), Fallout 2 (2241), Fallout 3 (2277), Fallout: New Vegas (2281) and Fallout 4 (2287). All ghouls live considerably longer than normal humans, though they are sterile. The reason for this longevity has to do with differences on the cellular level, and the ability of ghoul DNA to regenerate at a rate unmatched by normal human nucleic acids. Occasionally, in a ghoul, additional genetic material is added as a result of the mutation. The unnaturally long lifespan of a ghoul is also due to a mutation within the autonomic nervous system of certain individuals following exposure to specific combinations of ionizing radiation with wavelengths below ten picometers. Radiation that has such a short wavelength, less than ten picometers, is known as gamma radiation and is normally lethal to healthy humans in even moderate doses. The mutation in response to gamma radiation that produces ghouls disrupts the normal process of decay in the neurotransmitters along the spinal cord.
Ghouls were not created immediately after the Great War in 2077; the process took months or years for some. After a few weeks, their skin slowly started to flake off and crack, as well as partial or complete hair loss. In Fallout 3, Carolexplains that even after the War it took a while for the ghouls to start looking like they do now. However, there have been occasions when ghouls are made instantly by large doses of radiation. For example, Camp Searchlight, where an entire base of NCR soldiers were transformed into feral ghouls except for Private Edwards by a radioactive device used by Caesar’s Legion, and the ghoulification of Moira Brown after the warhead in Megaton was detonated by the Lone Wanderer (if the player chooses to do so).
Although lacking strength due to decayed tissue, ghouls have heightened senses making them more perceptive and lucky than other wasteland humanoids. As a result, chems like jet barely affect them. Doctor Barrows, when healing the player, bemoans the fact that “You humans are so fragile.”
Specifically, the neurotransmitters affected in a ghoul’s mutation are those responsible for cardiac and respiratory function in a healthy human being. These transmitters are continually regenerated at a greatly accelerated rate after the mutation sets in, carrying sufficient oxygen to sustain the life of the subject while being insufficient to retain dermal elasticity and avoid the resulting necrosis (much like the disease leprosy), the result of which is the decaying, corpse-like appearance of post-mutation humans. Old ghouls may also still suffer from some of the debilitating effects of old age, however, as some of the two centuries old ghouls like Raul Tejada and Dean Domino complain of knee problems when made to crouch, and both of them were far from elderly when they became ghouls. Raul also mentions how he’s no longer as swift and agile as he used to be in his youth, though this might be psychosomatic and caused by Raul’s continuous doubts about his age and place in the world. Still, these may indicate that their regenerative abilities’ problems with skin could extend to other soft tissues of their joints. Considering that ghouls are missing their noses, the pinna of the ear, and some complain about knee pain, it may be that the process of ghoulification severely damages cartilage in the human body.
In physical appearance, a ghoul’s flesh is constantly rotting off, appearing very raw and discolored from necrosis. Lips and eyelids are sometimes absent, and noses are in almost every case completely rotted off. Feral ghouls are typically heavily emaciated and hunched over (possibly due to malnutrition and lack of sunlight), while non-ferals typically have a healthier, more human-like build and posture. Another major difference between ferals and non-ferals is dress: while non-ferals dress like normal humans, feral ghouls wear little clothing other than tattered pants or sections of old armor, having long ago lost the mental capacity to mend or replace their clothes.
Ghouls, at least the non-feral ones, are generally as intelligent as normal humans. However, their physical repulsiveness makes the life of a ghoul difficult at best – only the most tolerant human communities accept them as anything more than monsters. Some ghouls eventually go mad and it remains unclear exactly what precipitates this change in neurobiology and psychology, but anecdotal evidence seems to indicate that non-social ghouls, or those in isolation, are more prone to the condition. It is also quite possible that this is a gradual process, meaning that eventually all ghouls would succumb to this condition. However, considering the number of ghouls who have lived for more than two centuries, it is quite possible that this is not so, or that the rate of degeneration is dependent on the individual affected and surrounding environmental factors. Ghouls that succumb to insanity are called “feral ghouls”: they are mindlessly aggressive and, having lost their ability to reason, driven entirely by their instincts. These feral ghouls strongly resemble zombies like those depicted in old horror films, and this misconception succeeds in alienating non-feral ghouls even more from humans. The term “zombie” has become an offensive racial slur to ghouls and “smoothskin” is a derogatory term for humans often used by ghouls.
Ghouls are immune to most forms of radiation that still remain in the Wasteland. Radiation poisoning cannot get worse for the ghouls, though it can hasten the process of decay and lead to their decline into the feral state as described above. However, many ghouls report feeling healthier when exposed to low-level radiation, and thus make their homes near locations with acute background radiation. The ghouls known as “glowing ones” actually enjoy large amounts of radiation, which they describe as being “comfortably warm.” They are even healed by it.
As one of the more common consequences of ghoulification seems to be sporadic or even complete hair loss and loss of their normal voice: few ghouls retain enough hair on their heads to actually maintain a haircut, and ghouls with facial hair seems to be even more rare. Also, ghouls with clear voices are very uncommon; most possess raspy voices. Desmond Lockheart from Point Lookout and Raul Tejada from Fallout: New Vegas are two of the few examples of ghouls with facial hair, and Plik from Point Lookout and Jason Bright from Fallout: New Vegas are two examples of ghouls with a clear voice. While the exact cause of their hoarse voices is unknown, it is more than likely caused by partial decay of their vocal cords.
According to M.A.R.Go.T., the “unidentified persons” (feral ghouls) in the Presidential metro area “possess no internal body heat and emit lethal levels of radiation.”
Feral ghouls are among the more unfortunate mutants whose minds have deteriorated from prolonged radiation poisoning, becoming instinct-driven savages, attacking anyone and anything relentlessly, save for other ghouls. Wearing the ghoul mask in Fallout 3 makes all feral ghouls ignore the player unless directly assaulted. Despite what Roy Phillips says, no matter how close you get to a feral ghoul when wearing the ghoul mask, they will not “Sniff you out,” and become hostile.
Feral ghoul roamer
Roamers are less common feral ghouls dressed in worn-out sections of old combat armor, giving them greater damage resistance. The armor does not, however, slow them down; in fact, they are slightly faster than regular ferals. They typically can be found alongside two or three ferals, and attack in groups. Alone they are still weak and easily brought down with most weaponry, but they can easily flank the player during a group attack.
Feral ghoul reaver
This rare flavor of ghoul, dressed in the rusty remnants of metal armor, appears in both Mojave Wasteland and the Capital Wasteland through the Fallout 3 add-on Broken Steel. They also appear frequently in the swamps of Point Lookout. A greenish smoke issues from their scars, and their flesh appears to be melted and even bubbling in some areas, as if being “cooked” by the radiation they have absorbed. In Fallout 3 they are among the toughest enemies in the game, able to take a direct hit from a Fat Man and survive. Besides being incredibly fast and having a deadly swipe, they can pull chunks of radioactive gore from their guts and hurl it at the player with deadly accuracy. In Fallout: New Vegas, reavers are much weaker and lack the ability to throw gore, making them much easier to handle.
These ghouls have absorbed so much radiation they glow a ghastly green color in the dark. They are known as “glowing ones,” and are often considered outsiders even by other ghouls. The glowing ones can sustain a lot more damage than other ghouls, second only to reavers (see above). They also emit radiation from their whole body, and can even release a devastating blast of energy from their bodies at will, healing nearby ghouls and harming unlucky attackers caught in the blast radius.
People have seen on more than one occasion a feral glowing one fighting or being chased by “normal” feral ghouls. Although very rare, it is possible for a glowing one to retain their intelligence and cognitive functions, such as Jason Bright.
Intelligent ghouls have suffered far less mental degradation from their condition and retain their full faculties from before their transformation. These ghouls possess the ability to talk, and they normally wear clothing, as well as carrying and using weapons. Some may have hair on their head, but not a lot. Some male ghouls, such as Raul Tejada, may even be lucky enough to retain some semblance of facial hair, similar to Desmond in the Fallout 3 add-onPoint Lookout, with hair on both his head and face. They normally have a low, gravely and rather raspy voice, most likely due to damage to their vocal chords from a combination of radiation and necrosis. Jason Bright, an intelligent glowing one, from Fallout: New Vegas has a normal voice, although it has an odd echoing quality to it. If Megaton is destroyed in Fallout 3, Moira Brown has a similar, but notably different voice effect. Regular ghouls walk normally, unlike ferals, which hunch over. The majority of them are not hostile and will not attack without provocation. Ghouls often refer to humans as “smoothskins.” These ghouls also find terms such as “shuffler” and “zombie” to be offensive. Hostile intelligent ghouls, violent even without provocation, do exist, however; most noteworthy are the Chinese remnant, Chinese spies, soldiers, and special forces units trapped in the United States following the Great War. Remnant forces are wholly unaware (or perhaps in denial) of the worldwide nuclear destruction that has occurred and believe that they are still in a state of war, continuing to follow old objectives sent to them pre-war by the People’s Liberation Army. Remnnant forces have retained much of their intelligence and training, and attack all those they encounter without hesitation. Remnants only appear in Fallout 3.
Skinned alive by the winds of the Divide (via a failed Big MT experiment), and turned into ghouls by the radiation of the exploded underground missiles, marked men suffer from a unique form of ghoulification only seen in the Divide. The injuries they suffer from would mean the death of an ordinary ghoul, and the radiation of the Divide is believed to be the only thing keeping them alive. Despite still being cognitive enough to carry weapons and utilize advanced tactics such as constructing outposts and utilizing guard towers, they are still immediately hostile to any and all outsiders that ventures into the Divide.