It took director Christophe Gans five years to obtain the rights to make the film. He was given the rights after he sent Konami a video of an interview describing how much Silent Hill meant to him. Along with the interview, he sent scenes that he filmed on his own dollar cut up and overlayed with music from the games.
The strange stumbling movements of the Dark Nurses when they first "come alive" was created by filming them walking backwards, and then running the film in reverse.
Around 100 different copies of Rose's outfit were made. This started out with soft summery colors, and as the movie progressed, this became grayer and eventually blood red. The change in the outfits were so subtle that this was barely noticeable.
Many of the creatures in the film were played by dancers so they could be flexible enough to create the required disturbing movements.
Centralia, Pennsylvania, was the inspiration for the movie adaptation of the game Silent Hill. In researching the different elements of Silent Hill, screenwriter Roger Avary came across the town of Centralia, Pennsylvania, an almost abandoned town with a 40-year-old coal fire burning underneath it. Centralia planted the seed for what developed into the cinematic version of the town of Silent Hill.