Ghouls or necrotic post-humans are decrepit, rotting, zombie-like mutants. They are victims of heavy radiation poisoning which results in their skin decaying and, paradoxically, greatly extends their individual lifetime. They are found throughout post-WarAmerica, including the Midwest in 2197.
Consistent exposure to concentrated levels of background radiation for an extended period of time will randomly result in humans undergoing a mutation/transformation into the ghoul species. Camp Searchlight would also show that quick, perhaps even instantaneous transformations are not unheard of or out of the question. Nevertheless, for typical humans, any serious exposure to background radiation levels results in sickness, shortly followed by death.
Most known ghouls in New California were created from vault-dwellers living in Vault 12 under Bakersfield, California (known as Necropolis after the Great War). As part of the vast Vault Experiment Program, the Vault 12 door was designed to be dysfunctional, to be unsealed. Radiation from nuclear detonations and the subsequent fallout contaminated the vault, resulting in the death or mutation of every occupant. The survivors can be found scattered throughout this region, mostly in Gecko, a town established near an old, half-functional Poseidon Energy nuclear power plant. Many could also be found in Broken Hills, an old town located near a uranium mine, typically inhabited by humans, super mutants and ghouls. However, the uranium was eventually depleted and the town was abandoned sometime after 2242.
Ghouls from other regions most likely originated from opportune or home-made shelters. Such shelters were not adequate to fully protect against all the effects of nuclear fallout. Radiation levels in some areas were such that they were low enough not to kill people, but high enough not to leave them unscathed. There are ghouls in the Midwest, most notably a nuclear weapon-worshiping cult in Kansas City. Both Quincy and Springfield also have at least some ghoul occupants. In Texas, many of the former residents of Los Ybanez (known as Los after the Great War) became ghouls, probably when blocked at the entrance of the Secret Vault. Later, in the same city, the Church of the Lost was created by former vault-dwellers that had become ghouls.
In the Capital Wasteland, many ghouls currently alive were born long after the Great War of 2077, and succumbed to radiation poisoning much later, due to the high levels of radiation in Washington, D.C. and its surroundings for decades following the fall of the bombs. In some cases (e.g. Charon), however, there is evidence of pre-War ghouls. The majority of intelligent ghouls in the Capital Wasteland have chosen to settle in Underworld, a settlement established in the Museum of History in the ruins of The Mall. The settlement got its name from an exhibit on representations of afterlife mythology in which the ghouls established their town.
In the Mojave Wasteland, they can be found in small amounts throughout the region, but no town is completely dedicated to them. There are usually a few ghouls living among humans in various communities performing jobs in order to survive, such as the guard Beatrix Russell and the comedian Hadrian, both of which are in Freeside. The only known community of ghouls in the region is the Bright Brotherhood, a religious faction located in the REPCONN test site, founded and led by an intelligent glowing one named Jason Bright, who wants to leave Earth and go into space to find a "new world," a promised land foretold by Bright himself. There are also several ghoul rangers occupying Ranger station Echo, implying some level of acceptance of ghouls serving in the NCR.
Ghouls, or necrotic post-humans, are decrepit, rotting, zombie-like mutants. They are victims of heavy radiation poisoning which results in their skin decaying and, paradoxically, greatly extends their individual lifetime. Exposure to radiation for an extended period of time sometimes causes humans with an unknown genetic characteristic to transform into ghouls, although rare cases, such as the one of Camp Searchlight, show that faster transformations are not unheard of. Exposure to radiation typically results in sickness followed by death for the average human being; however, the genetic x-factor that will lead to mutation into a ghoul upon exposure, instead of the typical deadly outcome, remains unknown. Ghouls are highly resistant to radiation because of their long exposure to it.
↑Carol: I don't know how it happens. Doctor Barrows says it was radiation. All I know is that people kept showing up here in the museum. After things calmed down above ground, we tried to live down here as best we could. After a while, things got strange. My skin started to get dry and flake off. Everyone's did. It took a while, months, maybe a year. But sooner or later, everyone ended up like this. Some of them went crazy. Some of us just accepted it. After a while, other ghouls would find their way in here and Underworld just sort of grew.