Medical Center Monument Unlock Guide (Cities: Skylines)

The Medical Center Monument in Cities: Skylines
Medical Center
Building Type Monument
Level/Category N/A
Build Cost ₡650,000
Upkeep Cost ₡14,400/week
Milestone Required Megalopolis
Noise Pollution 0

Treats ill citizens. Has a helipad so patients can be flown in.

Patient capacity: 1,000
Ambulances: 50

Buildings required
  • Lazaret Plaza
  • Mall of Moderation
  • Court House
  • Oppression Office
  • High Interest Tower
  • Sea-and-Sky Scraper

The Medical Center is a monument that you can build in Cities: Skylines.

To unlock the Medical Center, you’ll need to construct these 6 other unique buildings: Lazaret Plaza, Mall of Moderation, Court House, Oppression Office, High Interest Tower, and Sea-and-Sky Scraper

You’ll also need to reach the Megalopolis milestone and unlock all 9 map tiles as well.

But once you’ve met all of those requirements & once you’ve constructed all 6 of those buildings, you’ll be able to build the Medical Center from the Monuments tab for ₡650,000.

Note: All six buildings need to be standing at the same time in order to count towards the unlock.

Be warned that the Medical Center is a very challenging monument to unlock, as four out of the six prerequisite buildings will require you to create negative conditions in your city.

Here’s a basic guide for how to unlock each of the six unique buildings for the Medical Center.

Unlock: Lazaret Plaza

The Lazaret Plaza / Cities: Skylines
The Lazaret Plaza
Lazaret Plaza
Building Type Unique Building
Level / Category Level 1
Milestone Required Worthy Village
Build Cost ₡17,500
Upkeep Cost ₡192/week
Entertainment Value 80
Noise Pollution 25

The Lazaret Plaza requires your citizens’ average health to fall below 20%.

As this is a very undesirable condition for your city, you may want to use a throwaway save file for this, rather than your ‘good’ cities that you’ve spent lots of time on. Here’s how this works:

Step 1: Start a new city

Start a new game on any map, and grow your population as you normally would start a new city.

Do NOT build any medical centers (which you unlock at the Little Hamlet milestone).

Keep growing your population until you reach the Worthy Village milestone, which unlocks the level 1 unique buildings.

Step 2: Make your citizens ill.

There are a few ways you can do this, but the fastest one is by contaminating the water supply.

If your water comes from a pumping station, relocate it so that it’s downstream of the sewage drain.

On the other hand, if your water comes from a water tower, relocate it to polluted ground (e.g., next to a landfill or generic industry).

This ashy brown color represents polluted ground / Cities: Skylines
This ashy brown color represents polluted ground

In either case, don’t forget to reconnect it to your city’s pipes.

After a while, your citizens will start getting ill from the contaminated water and the average health rating will drop.

Once the number falls below 20%, you’ll unlock the Lazaret Plaza. The plaza will remain unlocked across your other saves even after you close the current game.

Unlock: Mall of Moderation

The Mall of Moderation / Cities: Skylines
The Mall of Moderation
Mall of Moderation
Building Type Unique Building
Level / Category Level 2
Milestone Required Tiny Town
Build Cost ₡19,900
Upkeep Cost ₡320/week
Entertainment Value 100
Noise Pollution 35

To unlock the Mall of Moderation, you’ll need an average garbage piling per building of at least 25.

Accomplishing this is as simple as just removing all garbage facilities (e.g., landfills or incinerators), or switching off any existing ones. Eventually, you’ll have enough garbage piling in your buildings to unlock the Mall of Moderation.

This is much easier to achieve (as well as recover from) early in the game, so it’s best to attempt this as soon as you hit the Tiny Town milestone.

However, if you’re much later in the game, you can instead create a restore point so that you won’t have to deal with the negative consequences of the garbage piling:

Step 1: Create a save file of your current game. Name it “before garbage” or similar so you know which one it is.

Step 2: Make sure that autosave is off.

Step 3: Disable any garbage facilities until you unlock the Mall of Moderation.

Step 4: Close the current game without saving.

Once unlocked, unique buildings remain unlocked across your other saves. So you’ll be able to build the Mall of Moderation even when you revert to your “good” save point.

Unlock: Court House

The Court House / Cities: Skylines
The Court House
Court House
Building Type Unique Building
Level / Category Level 3
Milestone Required Boom Town
Build Cost ₡55,000
Upkeep Cost ₡960/week
Entertainment Value 75
Noise Pollution 25

Unlocking the Court House requires your city to have a crime rate of at least 50% for 5 weeks.

Here are things you can do to increase the crime rate in your city:

  • Refrain from building police buildings, and temporarily switch off any existing ones.
  • Do not zone workplaces (industry and commercial) to increase unemployment. Unemployment plays a big factor in your city’s crime rate.

Like the other unique buildings in this list that require negative conditions, it’s best to attempt this in a fledgling city rather than wreak havoc on one of your flourishing metropolises.

The Court House unlock path goes well with the Oppression Office unlock, which requires high unemployment, so you may want to go for them at the same time.

Unlock: Oppression Office

The Oppression Office / Cities: Skylines
The Oppression Office
Oppression Office
Building Type Unique Building
Level / Category Level 4
Milestone Required Busy Town
Build Cost ₡80,000
Upkeep Cost ₡880/week
Entertainment Value 50
Noise Pollution 10

The Oppression Office requires you to have an unemployment rate of at least 50% for 5 weeks.

You’ll need a city that’s over the Busy Town milestone for this unlock (1,200 – 5,000 population, depending on the map). So it may be best to use the restore point technique to avoid wasting a city of several thousand.

Step 1: Create a save of a city that is at the Busy Town milestone or higher. Name it “before unemployment” or similar.

Step 2: Make sure autosave is off.

Step 3: Create conditions for unemployment until you hit 50%. (You can check your current unemployment rate by clicking on the Population view in the info views panel.)

Step 4: Maintain it for 5 weeks until the Oppression Office is unlocked.

You can cause unemployment by not zoning any workplaces (industry, office, and commercial).

You can also de-zone your existing industry, office, and commercial areas to eliminate the workplaces in those buildings.

As high unemployment rates encourage crime, it may be a good idea to attempt to unlock the Oppression Office at the same time as the Court House, which requires a high crime rate.

Unlock: High Interest Tower

The High Interest Tower / Cities: Skylines
The High Interest Tower
High Interest Tower
Building Type Unique Building
Level / Category Level 5
Milestone Required Big Town
Build Cost ₡125,000
Upkeep Cost ₡1,600/week
Entertainment Value 90
Noise Pollution 25

The High Interest Tower is the easiest to unlock among this group. It only requires you to have at least ₡2,000 in debt.

You simply need to take out a loan by going to the Loans tab of the Economy panel.

The Loans tab / Cities: Skylines
The Loans tab.

If you do not actually need to borrow money, you have the option of repaying your loan immediately.

Unlock: Sea-and-Sky Scraper

The Sea-and-Sky Scraper / Cities: Skylines
The Sea-and-Sky Scraper
Sea-and-Sky Scraper
Building Type Unique Building
Level / Category Level 6
Milestone Required Capital City
Build Cost ₡20,000
Upkeep Cost ₡320/week
Entertainment Value 100
Noise Pollution 25

The Sea-and-Sky Scraper requires you to build two things: a passenger harbor and a cargo harbor.

For this to be possible, you’ll need to play on a map with an external ship connection. The following official (non-workshop) maps do NOT have an external ship connection:

  • Two Rivers
  • Northwood Hills
  • Wolf Creek
  • Marble Canyon
  • Woodgarden
  • Biomes Valley
  • Farmland Flats
  • River Valley Plain
  • Desert Pass
  • Prussian Peaks
  • Pine Rivers
  • Crater Falls
  • Desert Oasis

All other maps are fair game.

You’ll find both the passenger harbor (named only “harbor” in the menu) and the cargo harbor in the Ship tab of the transport menu.

Place each one along the coastline, in a location that allows for a straight, unobstructed line to the outside ship connection.

Note: A “Cannot connect to route!” error will appear if there is no direct path.

Once placed, connect each building to your road network and utilities. There is no need to create routes or assign lines to either of these.

  • The harbor costs ₡80,000, and allows cruise ships to come in and out of your city, transporting citizens and tourists in large numbers.
  • The cargo harbor costs ₡60,000 and allows cargo ships to bring goods and mail in and out of your city.

Reaching the Megalopolis Milestone

You’ll only be able to build the Medical Center, as well as other monuments, upon reaching the final population milestone, Megalopolis.

This can be anywhere from 20,000 to 90,000 citizens.

Generally, the more buildable land a map has, the higher the required number of citizens per milestone.

Unlocking 9 Tiles

You get a single tile at the start of each game and can expand up to 9 (if playing without mods).

You unlock each of the 8 remaining tiles at different milestones:

Tile Milestone
1 N/A (game start)
2 Worthy Village
3 Boom Town
4 Big Town
5 Big City
6 Capital City
7 Colossal City
8 Metropolis
9 Megalopolis

Each time you hit one of these milestones, you can choose a new tile to purchase by going to the Areas panel.

The Areas panel where you can purchase new tiles / Cities: Skylines
The Areas panel where you can purchase new tiles

You may only purchase a tile that is right next to any of the ones you already own. And each succeeding tile is more expensive than the previous one.

Tile prices can also vary depending on the map and the amount of buildable land.

Tips for Unlocking the Medical Center

Five out of the six unique buildings for the Medical Center require you to create very undesirable conditions in your city. So here’s a couple quick tips to help out with this process:

Tip #1: Secure a “good” save point

If you’re using one of your good cities for these unlocks, make sure to first create a save file that you can revert to.

Add “before unlock” or something to its name so you remember which one it is.

Next, save that game again under a different name (e.g., “unlocking”) and use that new file going forward.

This means you’ll leave your “before unlock” city untouched by these awful unlock paths.

Tip #2: Lazaret Plaza, Mall of Moderation, Court House, and Oppression Office are best unlocked early

These unique buildings all require you to reach a city-wide metric:

  • Lazaret: average health below 20%
  • Mall of Moderation: garbage piling at least 25
  • Court House: crime rate at least 50%
  • Oppression Office: unemployment at least 50%

Each of these is easier to achieve with a smaller city. For example, it’s much easier to contaminate the water of a small town enough to make a large portion of the population ill.

Try to unlock them as soon as any necessary milestones are met.

Liz Villegas

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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.

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