TEL AVIV, Israel — Israel is gearing up for the anticipated return of hostages from Gaza, bracing for the possibility that many of them may face serious, life-threatening medical complications after spending over a year in captivity.
While the precise conditions of their detention remain uncertain, the Health Ministry, alongside the Hostages Family Forum representing the families of those abducted, is preparing for a range of scenarios. These considerations are based on insights obtained from hostages who have been previously freed or rescued.
On October 7, 2023, Hamas militants launched a cross-border attack, leading to the kidnapping of around 250 individuals. This assault also resulted in the deaths of approximately 1,200 others. Currently, it is estimated that around 100 hostages are still being held, with Israeli officials believing that about one-third of them are likely deceased.
The ensuing conflict has claimed the lives of more than 46,000 Palestinians, according to health officials in Gaza. These officials do not differentiate between civilians and combatants in their reports but indicate that women and children comprise over half of the casualties.
Hagai Levine, who leads the health division at the Hostages Families Forum, anticipates that the returning hostages will likely suffer from various health issues, including cardiovascular and respiratory problems resulting from inadequate ventilation in their confinement. Other expected health concerns include vitamin deficiencies, severe malnutrition, significant weight loss, vision impairment caused by limited exposure to sunlight, broken bones, cognitive decline, and mental health challenges.
Medical professionals are preparing for the likelihood that the hostages will require extensive and intricate medical care, including mental health support, which is expected to be more complicated compared to the needs of those who returned after the last ceasefire in November 2023, noted Dr. Einat Yehene, a psychologist working with the Hostages Families Forum.
Treatment Challenges
Medical experts are acutely aware of the complexities involved in caring for the returning hostages. One of the main concerns is “refeeding syndrome,” a potentially fatal condition that can arise when individuals with long-term nutritional deficiencies are given excessive amounts of food or certain types of food upon their return, explained Dr. Hagar Mizrahi, who heads the medical directorate at the Ministry of Health.
The Red Cross team responsible for transferring the hostages from Gaza to Egypt, along with the small Israeli military medical team poised to greet them as they enter Israel, are following strict dietary guidelines designed to navigate this period safely, Mizrahi stated.
Six hospitals are readied to accept the hostages, including two facilities located in the southern region near Gaza, dedicated to addressing urgent medical cases, as per health ministry officials.
Yehene cautioned that the public should not expect scenes of joy akin to those witnessed after the previous ceasefire, as many returning hostages may not be in a celebratory state. “We foresee withdrawal symptoms that can manifest as fatigue, emotional exhaustion, and some may require support with mobility,” she shared.
Healthcare workers are also preparing for the likelihood that some returning hostages may need speech therapy, particularly if they have been held in isolation. Yehene mentioned that certain individuals could be so traumatized or shocked from their transfer to Israel that they might struggle to communicate altogether.
To help ease the transition and reduce potential trauma, officials intend to limit interactions with the hostages and modify their surroundings to reduce sensory overload, such as simplifying hospital room environments and adjusting lighting.
Temporary housing arrangements have been established by Israel’s Ministry of Social Welfare to support hostages who may find it difficult to return straight home from the hospital.
Respecting Privacy
Professionals are urging both the media and the public to respect the hostages and their families’ need for privacy as interest in their experiences remains high. “The initial days after returning are extremely significant when individuals reconnect with their families, and everyone else should maintain distance,” emphasized Ofrit Shapira, a psychoanalyst who leads a team caring for released hostages and their families.
Hospital areas designated for the hostages are expected to be “sterilized,” limiting access strictly to direct family members and healthcare providers, to ensure privacy from media and public scrutiny, medical officials have indicated.
Shapira remarked, “Regardless of how invested we may feel in their story, they are individuals unto themselves and are not accountable to anyone else.” She added that pressuring hostages to disclose their experiences can prompt them to relive painful memories, and they should be allowed to share when they feel ready.
“Curiosity should not take precedence over what the hostages need,” she articulated. “No matter the extent of one’s involvement in efforts on their behalf, they do not owe anyone anything.”
Support for families of hostages
Some previously released hostages and their relatives have stepped forward to assist in counseling those currently undergoing captivity experiences, according to Levine. He highlighted the deep connections formed among the families of hostages and between released individuals, who have come to function as supportive “psychological families” fostering mutual healing and adjustment.
Many released individuals are neglecting their recovery in order to focus on efforts to bring their fellow hostages home. There is also an urgent need to extend support to families who lost loved ones in captivity.
Israel has acknowledged the deaths of at least one-third of the remaining approximately 90 captives. However, Hamas has not yet confirmed the status of 33 individuals expected to be released in the initial phase of the ceasefire, with some possibly no longer alive.
“This release can trigger emotional and psychological responses related to losses families are enduring, especially those who are coping with what should have been a joyful return that won’t happen due to prolonged negotiations,” Yehene concluded.
