ANOMALITH opens with a short tutorial, then sends Reona into the Kirishima Central Hospital alone, and then into a sealed shopping street where a boss-class Anomaly hunts her. This walkthrough covers those first three main missions in order: what each one asks you to do, where the route turns, and which fights actually gate your progress.
At a glance
Mission order: tutorial, then Kirishima Central Hospital solo investigation, then the shopping street field investigation.
Hospital boss: Shirayamigata, in the operating room. Its back lights are the target, not its body.
Shopping street boss: the Girl-type Anomaly first appears as a timed chase, not a fight to the death.
Keep the drone scan on in the hospital: it shows roughly where nearby items are.
Scope: this is a route walkthrough, not a collectible list. Ending conditions are deliberately not covered here.
Last verified: November 3, 2026, against the published Japanese mission index and the hospital chart.
1. Joint duty for new investigators: the tutorial
The tutorial teaches the four things the rest of the game keeps testing: kill enemies, keep moving forward, parry an incoming attack, and finish an enemy with a mutation attack. After that, leave the room, head to the Workshop, talk to Kyoka Sudo, approach the Doomsday Clock, and enhance the handgun. Nothing in this mission is a boss fight; it is a checklist, and the handgun upgrade at the end is the point, because every later mission assumes you know how to spend materials on a weapon.
2. Kirishima Central Hospital: solo investigation
Deploy from the truck at the sortie gate and enter through the main entrance. The inner door ahead is shut, so go upstairs to the second-floor reception, then work through the special-disease ward, the connecting corridor, and the nurses station to reach the operating room. Two habits pay off across the whole mission: run the scan so item positions show up, and use a Portal to send materials back to storage when the backpack fills, rather than leaving loot behind because you cannot carry it.
Two ordinary Anomalies teach weak-point discipline before the boss. Yurahidama: the head is the weak point, and once it goes down, follow up with melee. Uchisusari: the orange-glowing spots on the left shoulder and right knee are the weak points, and its charge is avoided by running sideways. After Uchisusari, do not walk past the shotgun in the back of the room: it is the weapon the boss fight below is built around.
In the operating room you meet Shirayamigata. Shooting its body does little damage, so aim only at the lights on its back: destroying every light drops it and opens a window for heavy damage, and a shotgun is reported to break a light in one shot. When pillars appear, hide behind one and wait the attack out; incoming ranged shots can be shot down with the submachine gun. Full boss tactics, including what changes in later encounters, are in the companion boss guide.
3. Shopping street: field investigation
The shopping street zone has been sealed for about ten years, and the mission brief warns that its sealed, enclosed state has turned it into a high-density Otherworld that could expand fast if left alone. The drone probe starts following Reona from this mission on, which matters because the route is wider than the hospital: check the map, investigate the playground equipment, and look for the spatial anomalies blocking the way and the Landmarks behind them. One caution reported by the chart: breaking a capsule machine in this area draws the Girl-type Anomaly to you, so if that happens, retreat along the road you came in on rather than pushing deeper.
Midway through, the Girl-type Anomaly ambushes you and the objective becomes surviving for a set time, not killing it. Most of its attacks can be parried if you trust the timing, and other Anomalies in the area can be staggered with gunfire to slip past. When the operator advises aiming for the head, landing enough hits staggers it and buys distance; after more time passes, it withdraws. Later in the same mission, armed unidentified soldiers patrol the underpass area: they are hostile, so either move unseen or take them out with sniper headshots from behind cover, such as a car.
4. Before the next mission: a short checklist
Enhance the shotgun before the hospital boss if you have not: the fight is tuned around breaking back lights fast.
Send materials through a Portal before the backpack forces a choice between loot and ammo.
In the shopping street, treat Landmarks as the objective and the Girl-type chase as a timer, not a damage race.
Talk to base staff between missions: side missions open from the Workshop counter board after the shopping street mission.
Next in this series: ANOMALITH Main Quest Walkthrough Part 2: Housing Complex, Subway, and the Kaede Mori Capture — https://vaagame.com/en-US/guides/anomalith-main-quest-walkthrough-part-2 and ANOMALITH Boss Guide: Shirayamigata, the Girl-Type, and Kaede Mori — https://vaagame.com/en-US/guides/anomalith-boss-guide . For the full achievement list, see ANOMALITH All Achievements Guide — https://vaagame.com/en-US/guides/anomalith-all-achievements-guide .