The game itself has shifted from the puzzle/adventure-horror genre of previous installments to a complete fear first-person-shooter game. The gameplay consists of exploration of various hallways littered with monsters and other targetable objects. Players will recognize various familiar creatures from previous titles as well as new creatures. The screens feature a mini-map that shows the player their relative position on the map. Aiming appears as a small set of crosshairs which is used to target monsters, but no distinction of whether the target is in range is given.

The game is available from Konami's i-MODE distributor. A subscription fee of 315円 (YEN), which includes sales tax, is applied for monthly usage, but subscribers are given access to premium content. (Konami says to check the game for details about the premium content.) The game can be accessed on the appropriate device models as follows: FOMA menu -> Menu/search -> Game -> Game Pack -> コナミネット DX.

In December 2008 Silent Hill: The Escape was released for iPhone and iPod touch.