The Sack Girl is the most common enemy in Silent Hill: Twilight being found in at least five different areas.
They appear as human-like figures with raw reddish features like they are skinned. They are feminine in shape with a bald head and a burlap sack as a sort of dress. The Sack Girls' faces have no nose, a slit for a mouth and pure black eyes like those on a soft toy. Each of their limbs have a large needle or spike stuck in a random spot, the area around them is stained with black blood. When moving they are stiff and frequently stretch and twist as if cramped or perhaps writhing in pain, these motion are accompanied by horrible cracking noises.
They represent the dolls Henry made as a child, which were made from burlap sack hence the name and clothing. Their facial features also resemble those of the dolls. He made the dolls in the crude resemblance of some bullying girls and he would stab them with needles and pins. The skin of these creatures is a representation of the torture such treatment embodies.