Hell is quite literally named, full of fire and other unpleasant things.
You are brought there by getting Sabitsuki's head cut off, flanked on either side by hooded figures carrying scythes. Once you are taken to Hell you see her bloodied severed head before you go wandering considering you can not go back the way you came.
Finding and interacting with a denizen will lead you to the Starry Pier.
- The guillotine seems to be a reference to how the Severed Head Effect is found in Yume Nikki
- This is furthered by seeing Sabitsuki's head on the ground.
- The Spikes on the ground are reminiscent of that of the Sacred Grounds in Cave Story
- A smaller version of Hell is accessible by falling off the Starry Pier
- This may be what Sabitsuki has been taught to or came to believe about what would happen to people who commit bad deeds in life.
- Given that the guillotine was inside the prison, speculated to be Sabitsuki's hospital, and close by is the Machine effect, this could symbolize Sabitsuki's emotional death from being bedridden for so long, or continuously "flowing" and repeating the process.
- The fisherman is likely a reference to the River Styx ferryman, or how a fisherman is used for teleportation similarly in Yume Nikki.