Israel prepares for return of hostages without knowing their condition

TEL AVIV, Israel — Israel is preparing for the return of Gaza hostages with expectations that many of them are likely to suffer serious, even life-threatening, complications after more than a year in Gaza captivity.

While it is impossible to know the exact conditions in which the hostages were held, the Ministry of Health and the Hostage Families Forum, which represents the families of the hostages, are preparing for several different scenarios based on the information gathered with hostages previously released or rescued.

Hamas militants kidnapped around 250 people in a cross-border attack on October 7, 2023, which also left 1,200 people dead. Around a hundred hostages are still being held, although Israel estimates that a third of them are no longer alive.

The war that followed the attack has killed more than 46,000 Palestinians, according to Gaza health authorities, who do not distinguish between civilians and militants but say women and children make up more than half of those killed. .

Hagai Levine, who heads the Hostage Families Forum health team, said he expects hostages to return with cardiovascular and respiratory problems due to lack of ventilation in the tunnels. Among the multiple other afflictions Levine expects are vitamin deficiencies, starvation, dramatic weight loss, vision problems from lack of sunlight, broken bones, cognitive impairment and mental health trauma.

As a result, doctors expect the hostages to require longer and more complex medical and mental health interventions than those that returned after the last ceasefire in November 2023, said Dr. Einat Yehene, psychologist at the Hostage Families Forum who supervises the captives. ‘rehabilitation.

Complex medical challenges

Doctors are acutely aware of the challenges they face treating surviving hostages. One of these is “refeeding syndrome,” when exposure to certain foods or too much food can lead to serious health complications or even death in people with prolonged vitamin deficiencies. and nutrition, said Dr. Hagar Mizrahi, chief medical directorate of the Ministry of Health. .

The Red Cross team that will transfer the hostages from Gaza to Egypt and the small Israeli military medical team that will greet the hostages at the border as they cross into Israel have strict guidelines on what the hostages can eat at the border. during their first few hours, Mizrahi said. .

Six hospitals are preparing to receive hostages, including two in the south, closer to Gaza, which will treat people with acute medical problems, Health Ministry officials said.

Yehene said the public should not expect joyful reunions like those seen after the last ceasefire, when freed hostages ran through hospital corridors into the ecstatic embraces of their loved ones.

“Given the physical and emotional conditions, we expect some emotional withdrawal symptoms, like perhaps exhaustion, fatigue – and some will probably need help with their mobility,” she said.

Medical officials are also prepared for the possibility that returning hostages may need speech therapy, especially if they have been kept in solitary confinement, Yehene noted. She added that some may be so traumatized or shocked by the transfer to Israel that they will not be able to speak at all.

To minimize the hostages’ trauma and allow them to acclimate to their new reality, authorities will try to limit the number of people who interact with them and have taken steps to reduce their sensory stimulation, such as dismantling hospital rooms and change the lighting. .

Israel’s Ministry of Social Protection has also provided temporary housing solutions if hostages feel unable to return directly home from the hospital.

“The hostages owe you nothing”

Experts are imploring the media and public to provide privacy for the hostages and their families, despite intense interest in their fate.

“The first days of return are truly sacred, when a person can finally meet their family and everyone has to take a step back,” said Ofrit Shapira, a psychoanalyst who leads a group of medical professionals treating released hostages , their families. , and the survivors of the October 7 attack. The hospital wings housing the hostages should be “sterilized,” closed to all but immediate family and doctors, to keep the public and media away, medical officials said.

“No matter how much we care about them; they are their own people, they are not ‘ours,’” Shapira added. She noted that asking hostages direct questions about their experiences can force them to relive their trauma. She said it was best to allow them to release the information at their own pace.

“Our curiosity is really not important compared to what the hostages need,” she said. “No matter how much you volunteered or were active in this fight; They don’t owe you anything.

Support for families

Some of the previously released hostages and their families have volunteered to help counsel those now going through the same process, Levine said. He highlighted the strength of the bonds created between the hostages’ loved ones, and between the released hostages, who became like “psychological families” helping each other adapt and heal, he said.

Many freed hostages neglect their own rehabilitation because they are so absorbed in the fight to bring others home, Levine said.

One of the main priorities is also to provide support to the families of the hostages who did not survive.

Israel has confirmed the deaths of at least a third of the approximately 90 remaining prisoners. But Hamas has not confirmed the status of the 33 people expected to be released in the first stage of the ceasefire. Some may no longer be alive.

“That moment of release is an emotional and psychological trigger for something they were meant to experience, and will never experience, because this deal took too long,” Yehene said.