The premise of the film is that the world has been struck by a mysterious incident called the "Violent Unknown Event" or VUE, which has left a great many survivors suffering from a common set of symptoms: mysterious ailments, speaking new languages, dreaming of water and becoming obsessed with birds. A directory of these survivors has been compiled, and The Falls is presented as a film version of an excerpt from that directory, corresponding to the 92 entries for persons whose surnames begin with the letters FALL-. Not all of the 92 entries corresponds to a person - some correspond to deleted entries, cross references and other oddities of the administrative process that has produced the directory. One biography concerns two people - the twin brothers Ipson and Pulat Fallari.
In addition to the common VUE symptoms mentioned above, a number of themes run through the film. Among these are references to a number of bureaucratic organisations including the VUE Commission, the suggestion that birds may be responsible for the VUE (and that the film may thus be seen as a sequel to Hitchcock's The Birds), complex debates over the location of the epicentre of the VUE, and repeated references to Tulse Luper. Luper is a recurring off-stage character in Greenaway's early films, and would eventually appear on film in the epic series The Tulse Luper Suitcase (2003 onwards).
The Falls includes clips of a number of Greenaway's early shorts. It also anticipates some of his later films: the subject of biography 27, Propine Fallax, is a pseudonym for Cissie Colpitts, the central figure of Drowning by Numbers (1988), while the car accident in biography 28 prefigures that in A Zed and Two Noughts (1985).
The largely formal and deadpan manner of the narration contrasts with the absurdity of the content. The soundtrack is mainly by Michael Nyman and is partly based, like his later music for Drowning by Numbers, on the slow movement of Mozart's Sinfonia Concertante in E flat, K364.