The Republic of Costigar is a country in Africa, where the first chapter of Trauma Center: Under the Knife 2 takes place. At the game's start, the country is recovering from a decade-long civil war between the two native tribes, the Razu and the Dal. Though peace negotiations are underway, Costigar is still unsafe due to land mines and guerilla warfare. Child soldiers were kidnapped from their villages and forced to fight in the war. The country's native language is Costigese.

Derek Stiles and Angie Thompson spend six months in Costigar are the beginning are posted to a Dal camp, Camp Zakara, with a mission to investigate a new disease dubbed the "Costigar disease" and supply medical treatment to anyone present. There, they meet Adel Tulba, a young Razu doctor who soon joins the two, as he wishes to learn from Derek. The team treats Sylvia, a Zakara worker who suffered injuries from a mine explosion, and the camp is attacked by Razu guerillas.

Soon after the attack, Derek and Angie find a boy who has come down with the Costigar disease, which causes a high fever and bleeding under the skin. As the bleeding worsens, Derek resorts to using the Healing Touch in order to fully treat the disease. Adel wishes to learn more about the Healing Touch, and follows Derek and Angie to Caduceus USA when they are called back.

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