Within series lore, ghouls are originally humans, many of them survivors of a global nuclear holocaust, who have been severely mutated by the residual radiation, which greatly extends their lifespans but deforms their physical appearance into a zombie-like presentation.

Critics have lauded their use as either antagonistic figures or as supporting non-player characters throughout the series, with some even calling for ghouls to play a more central role in future sequels or adaptations of the franchise.

In the 2024 American post-apocalyptic dramatic television series Fallout, pre-war actor turned ghoulified bounty hunter Cooper Howard, known simply as The Ghoul, is portrayed by Walton Goggins.

[8][1] Feral Ghouls often roam together in packs and shamble around areas they are familiar with, such as a supermarket or a drive-in movie theatre, often with a form of muscle memory which vaguely drive them to relive aspects of the life they once knew, and trinkets looted from their corpses often provide hints or glimpses into their forgotten identities.

[10] Media such as Forbidden Planet by Fred M. Wilcox and I Am Legend by Richard Matheson, along with real-life accounts of radiation poisoning, were cited as inspirations behind the concept of mutated creatures like ghouls and their exposed flesh for the early Fallout games developed by Interplay Entertainment.

[11] The visual design for ghoul characters in Fallout 4 is somewhat different, though they also have a pronounced lack of nose, lips, and skin; the texture of their faces was described by Kate Gray from Kotaku as resembling melted Peeps in appearance.

[5] In the 2024 American post-apocalyptic drama television series Fallout, the first and oldest Ghoul is introduced as former Western actor and Vault-Tec ambassador Cooper Howard, portrayed by Walton Goggins.

[16] Kate Gray considered John Hancock to be a compelling and interesting character, with praise for his nuanced characterization as an anti-hero, romantic dialogue, and lack of judgmental attitude or behavior towards the player's actions.

[12] Samuel Horti praised the writing behind the New Vegas side quest "Come Fly With Me" and its use of an eccentric cast of ghoul characters, including the charismatic Glowing One Jason Bright, as the game's best and most memorable.

[20] Jordan Forward from PCGamesN is fascinated by the idea of playing a ghoul archetype for the next mainline installment of the Fallout video game series, and deliberated the associated mechanics and limitations surrounding such a character at length.