Early on in A Plague Tale: Innocence, you’re controlling a young girl, holding hands with her scared little brother, while running down a city street full of people trying to kill them both. It might be the most stressful experience I’ve ever had in a video game. It’s also the norm in the game, which is about two siblings trying to survive absolutely horrible circumstances. Unlike most video games, in A Plague Tale, you rarely have moments when you feel powerful. It’s a struggle, especially when it seems like everything you encounter — whether it’s scared adults or swarms of diseased rats — is out to get you. Its grisly nature can make it a challenge to play through, but it’s also one of the most arresting games I’ve experienced in some time.

A Plague Tale stars Amicia, a young girl who lives on a large estate with her family in medieval-era France. (She also looks remarkably like Aloy, the lead in Horizon Zero Dawn.) Her relationship with her family is curious. While she’s close with her father — an early scene shows the two out hunting together — she rarely sees her mother, who spends her time trying to find a cure for Amicia’s brother, Hugo, who suffers from a mysterious illness. Still, it seems a mostly peaceful life — until very early on in the game when the Inquisition lays siege to the estate in search of Hugo. The siblings eventually escape, but they are forced out on their own where they have to figure out how to survive while also trying to find out why, exactly, the Inquisition wants Hugo.

The world outside is not a nice place. The plague has ravaged the country, and the lucky few who haven’t succumbed to the illness have become mad with paranoia. Early on, when Amicia and Hugo head to a nearby village in search of help, everyone they encounter immediately tries to kill them. It’s a terrifying, panicky race to safety. Even worse, at night, swarms of deadly rats come out, and Inquisition guards are constantly on the lookout for the siblings. The world feels almost entirely hostile to your presence.

A Plague Tale is probably best described as a stealth game, though how you interact with it depends on the situation. With humans, it’s a lot of sneaking around, using distractions like smashed pots to divert attention so you can get past. When it comes to the rats, they’re terrified of light, so you’ll find yourself using fire to make pathways through the diseased swarms. Sometimes, you’ll have to deal with both simultaneously: a guard wielding a lantern might be prowling around, keeping the rats at bay. It’s a slow experience right until it isn’t — and then you find yourself in a panicked run for survival.

The game is mostly a straightforward path, but you do have a lot of freedom for how you solve problems. Amicia’s main tool is a sling she can use to fling rocks, but over the course of the game, you’ll unlock new tools that let you do things like extinguish a flame or summon a group of rats. The one thing you can’t get around, though, is doing horrible things to survive. Initially, Amicia is hesitant to kill, and the first time she does, it’s a traumatic experience. She goes so far as to pray in a church afterward. But that doesn’t last long.

Ultimately, she’s forced to kill many times, and A Plague Tale offers some truly disturbing ways to defeat enemies and solve problems. Most involve utilizing the rats to kill for you; it never feels good seeing a guard swarmed, even if they are pretty terrible people. In general, A Plague Tale is just a brutal game. You’ll walk past massive piles of corpses, both human and animal, sneak through huge pools of blood, and there are all manner of gruesome murder animations. Unfortunately, you’re going to see Amicia get stabbed to death a lot before the final credits roll. It can be a bit much to take at times, and I had to take regular breaks while playing.

While it can feel overwhelming, this grisly tone is largely necessary for the darker story the game tells. And the best part of A Plague Tale is the way it weaves gameplay and storytelling together. There are cutscenes, but the most powerful narrative moments are ones that happen in game, as you watch Amicia and Hugo — and, later, some helpful friends — work together through terrible situations. They talk and strategize, and the siblings almost never stop holding hands throughout it all. The few moments when you lose track of Hugo are among the most stressful in the game.

A Plague Tale spans a fairly lengthy 17 chapters, and, for the most part, it manages to keep up that excellent blend of stealth problem-solving coupled with a dark, mysterious story. I kept pushing on through the uncomfortable moments because I loved the characters and wanted to know what the grand secret turned out to be. Unfortunately, the game loses some momentum toward the end when its challenges feel more like trial-and-error than actual puzzle-solving. At times, it even devolves into a simple action game. There are a number of moments when you have to die repeatedly in order to understand the patterns necessary for getting to safety, and this is especially true of a grand final boss battle that really sucks some of the momentum out of the game.

Ultimately, it’s not enough to dampen what A Plague Tale sets out to do. While many elements of the game, like its focus on stealth and crafting, can feel familiar, it’s wrapped up in a story and world that are like nothing I’ve played before. There’s a sense of urgency and danger that never really goes away. You can never truly relax. It’s a dark world, but watching a group of kids figure out how to thrive makes it worth exploring.

A Plague Tale: Innocence is available now on PC, PS4, and Xbox One.

Vox Media has affiliate partnerships. These do not influence editorial content, though Vox Media may earn commissions for products purchased via affiliate links. For more information, see our ethics policy.