The Long Road Home: Medical and Psychological Challenges Facing Released Hamas Hostages

Tel Aviv:

The recently released Hamas hostages are facing a challenging recovery journey, dealing with malnutrition, lack of sunlight exposure, and trauma from extended leg restraints. They experience unexplained pain and complex emotions, while needing to relearn basic decision-making like when to use restroom facilities.

The final 20 surviving hostages freed by Hamas now embark on a difficult rehabilitation process that includes rebuilding their sense of personal autonomy, according to Israeli health officials. Each individual will receive support from a comprehensive team including doctors, nurses, specialists and social workers to facilitate their reintegration into society after two years of Gaza captivity.

All hostages were reported in stable condition following Monday's release, with none requiring emergency intensive care services.

"External appearances don't reflect their internal conditions," explained Dr. Hagai Levine, who heads the health team for the Hostages Family Forum and has been involved in medical support for both returned hostages and their families.

The newly liberated individuals will remain hospitalized for several days undergoing comprehensive testing, including complete psychiatric evaluations, following Israeli Ministry of Health protocols. Nutritionists will guide them and their families on appropriate dietary plans to prevent refeeding syndrome, a potentially dangerous condition that can develop after prolonged starvation periods if food is reintroduced too rapidly.

Following previous hostage releases, some individuals and their families opted to stay together at a hotel north of Tel Aviv for several weeks to adjust to their new reality. Others chose to return home immediately after hospital discharge.

All hostages released Monday appeared extremely thin and pale, likely resulting from extended periods of nutritional deficiency, according to Levine.

The prolonged absence of sunlight and proper nutrition can lead to kidney, liver and cognitive issues, as well as osteoporosis. Many hostages were restrained by leg chains throughout their captivity, potentially causing orthopedic problems, muscle wasting and blood clots.

Elkana Bohbot informed his family about experiencing widespread pain, particularly in his back, feet and stomach, attributed to force-feeding, according to Israeli television Channel 12.

"Prior to his release, he received large food portions to improve his appearance for public view," Rebecca Bohbot, Elkana's wife, told reporters Tuesday from the hospital.

Some previously returned hostages suffered minor untreated strokes during captivity, Levine noted. Many also had infections and returned with severely compromised immune systems, necessitating minimal visitor contact. Levine criticized politicians' visits to the hostages as both unnecessary and potentially hazardous. Prime Minister Benjamin Netanyahu visited five hostages Tuesday evening and was subsequently diagnosed with bronchitis on Wednesday.

"Previously released hostages were told they looked 'pretty good,' but some required complex surgical procedures. Some experienced constant pain. Many have various unexplainable pains that significantly impact their quality of life," Levine stated.

Levine mentioned that Israel also gained insights from the 1973 Arab-Israeli war experience, when over 60 Israeli soldiers were held in Syria for six months. Many later developed cancer, cardiovascular problems, and accelerated aging, facing increased risk of premature death.

The current conflict began when Hamas-led militants crossed the Israeli border, killing approximately 1,200 people and abducting 251. The fighting has resulted in more than 67,600 Palestinian deaths, according to Gaza's Health Ministry, which operates under the Hamas-run government. The ministry maintains detailed casualty records considered generally reliable by UN agencies and independent experts, though it doesn't distinguish between civilian and combatant casualties.

The most crucial step for returning hostages involves helping them regain a sense of control, explained Einat Yehene, a clinical neuropsychologist and rehabilitation director for the Hostages Families Forum. Many hostages were brought directly from Hamas tunnels, seeing sunlight for the first time in nearly two years.

"I'm delighted to see the sun. I'm happy to see trees. I saw the sea. You cannot imagine how precious that is," Elkana Bohbot told his family, according to Israeli media reports.

"From both stimulation and autonomy perspectives, it's extremely overwhelming," Yehene said. "Someone asking if you need the bathroom or if you'd like something to eat—these are questions they haven't heard for two years."

Hostages can begin rebuilding their sense of autonomy through small decisions. According to established protocol, everyone involved in their care must request permission for every action, regardless how minor, including turning off lights, changing bedding, or conducting medical examinations.

Some returned hostages experience terror at feeling thirsty because it reminds them of captivity, Yehene explained. Others cannot bear being alone, requiring constant family presence.

Among long-term captives, fathers generally experienced the smoothest reintegration, though rebuilding trust with young children took time, Levine noted.

"Fatherhood facilitates recovery because it forces them back into their parental role," Levine said. None of the women held in extended captivity were mothers.

During their initial days after release, hostages typically experience euphoria, although many feel guilty about their families' suffering, according to Yehene.

For those with limited media exposure who remain unaware of events in Israel, information should be provided gradually, she advised.

Yehene also observed immediate psychological responses from previously released hostages following Monday's release. Many former hostages who had been advocating for the return of remaining captives reported being unable to focus on their own recovery until now.

"I'm seeing movement from previously frozen emotions and trauma," Yehene said. "They no longer feel guilty or responsible."

Iair Horn, released from captivity in February, stated that his freedom didn't feel genuine until Monday when his younger brother Eitan was finally freed.

"About eight months ago, I returned home. But truthfully, only today am I truly free," Horn said emotionally from the hospital where his brother is undergoing evaluation. Only now that Eitan has returned "is my heart, our heart, complete again."

Liran Berman, brother of twins Gali and Ziv Berman who were also released, shared: "For 738 days, our lives were suspended between hope and fear. Yesterday that chapter concluded. Seeing Gali and Ziv again, embracing them after so long, felt like the world starting to move again."