Coming home: Health Ministry discloses strict protocols for treating freed hostages

After being handed to IDF by Red Cross, hostages will be sent to 6 Israeli hospitals, where staff will follow protocols on everything from avoiding overfeeding to documenting rape

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

The children and babies kidnapped on October 7 and held hostage by terrorists in the Gaza Strip. (Israel's official Twitter account)
The children and babies kidnapped on October 7 and held hostage by terrorists in the Gaza Strip. (Israel's official Twitter account)

The Health Ministry announced that it is ready to receive the hostages who will be released from captivity in Gaza in the coming days.

According to a deal brokered by Qatar along with Egypt and the US, Hamas is expected to begin releasing Israeli hostages on Friday. The deal involves the exchange of 50 Israeli women and children for 150 Palestinian women and teenage security prisoners in Israeli jails. A total of 238 Israeli and foreign nationals are currently being held by Hamas and other terror groups in Gaza.

If the agreement goes as planned, groups of 12-13 Israelis will be released each day throughout a four-day truce in the war between Israel and Hamas.

As early as October 7, when Hamas savagely attacked southern Israel, the Health Ministry and Welfare Ministry began preparing protocols for treating the released hostages. Medical and mental health professionals are primed to receive the hostages and hope they will finally be able to put the guidelines to use.

“We’ve been practicing and are ready for any scenario,” said Health Ministry director-general Moshe Bar Siman-Tov in a press conference on Wednesday.

After the Israeli hostages are handed by Hamas to the Red Cross, they will be transferred to IDF representatives at the Rafah border crossing.

Illustrative: A Red Cross vehicle in Gaza. (Abed Rahim Khatib/Flash90)

Following initial checks, the hostages will be sent to one of six Israeli hospitals: Soroka Medical Center, Sheba Medical Center, Wolfson Medical Center, Ichilov Hospital, Shamir Medical Center or Schneider Children’s Medical Center.

Medical staff from the Health Ministry will determine where each released hostage will go. Mothers and children will not be separated. The hostages’ close family members will be notified as to where their loved ones are being transferred and will reunite with them there.

The hostages and their families will be received in separate, specially designated areas of the hospitals so they can enjoy privacy. All medical evaluations will also be done in this area, away from other patients and staff.

Health Ministry Director General Moshe Bar Siman-Tov at a press conference about the coronavirus, in Tel Aviv, February 27, 2020. (Avshalom Sassoni/Flash90)

The media will not be permitted access to the hostages and their families initially. Bar Siman-Tov told a Hebrew news channel that families can make their own decisions about interviews later on. However, he and his colleagues believe it would be better for the hostages and their families to recover from their ordeal out of the limelight. This comes after a controversial press conference at Ichilov Hospital following the release of 85-year-old hostage Yocheved Lifshitz on October 24.

Medical files on each of the hostages have been compiled using information collected from Israel’s health maintenance organizations and by the medical and resilience team of the Hostages and Missing Families Forum headed by public health professor Hagai Levine.

As soon as hostages are confirmed as having been handed over to Israel, their confidential medical records will be released to the relevant hospital. Small suitcases of clothing, personal items and toys will be sent ahead, as well. Medical staff will also arrange for all required medications and medical devices, such as hearing aids, to be on hand.

Hagai Levine. (Screen capture: YouTube)

The Welfare Ministry has provided instructions for the IDF ensuring that the best possible care for the released hostages begins before they arrive at the hospitals.

The military has been advised to assign a single soldier to accompany each child or family. Soldiers should identify themselves and speak reassuringly to a child, but at the same time not hold their hand or carry them unless they agree. Should these actions be necessary, the soldier should explain exactly what they are doing and why.

Similarly, adult hostages may not want to be touched or may be sensitive to specific sounds. Assuming the hostages have been held underground for seven weeks, sunlight may be uncomfortable for them.

“If the children [who are without one or both of their parents] ask questions like, ‘Where is Mom?’ or “Where is Dad?’ soldiers should not answer these questions, even if they know the answers,” the Welfare Ministry guidelines say.

Avigail Idan (left) 3, here with her father Roee and brother Michael, was taken captive by Hamas terrorists on October 7, 2023, from Kibbutz Kfar Aza. Both of Avigail’s parents were murdered in front of her before she was kidnapped. (Courtesy)

The response should be along the lines of, “I’m sorry sweetie, I don’t know. My job is to bring you to Israel to a safe place where people you know can answer all your questions.”

The hospitals have arranged for female doctors, nurses and other medical staff to treat the hostages to be released in this first deal. Doctors will sensitively do full physical exams of the women and children and order any necessary blood or imaging tests.

The Health Ministry has instructed physicians to look for and document any signs of torture, rape or other war crimes. If evidence of rape is detected or the hostage speaks about it, appropriate professionals should be brought in to evaluate whether it would be possible to interview the woman and collect evidence without re-traumatization.

A screenshot from a propaganda video released by Hamas on October 30, 2023, showing three Israeli hostages: Rimon Buchshtab Kirsht (left), Danielle Aloni (center) and Lena Trupanov (right).

Among the protocols distributed by the Health Ministry is a detailed document on proper nutrition for the released hostages, who will presumably return to Israel undernourished.

The document aims to prevent Refeeding Syndrome, a potentially fatal condition, caused by giving an undernourished person too much food and fluids too quickly, leading to metabolic disorders and fluid and electrolyte imbalances. These can result in damage to the nervous and respiratory systems, heart function, muscles, and blood.

After a hostage is fully medically evaluated, their doctor will discuss with defense officials whether they are ready to be debriefed. Adults deemed healthy enough will be debriefed early on, but the debriefing of children will be delayed for some time.

Each hostage or hostage family will be assigned a social worker, or a psychologist or psychiatrist if necessary, to assess and treat them.

The hostages not only lived through hellish captivity but also do not know the full extent of what happened on October 7 and during the war that followed. They are unaware that the terrorists destroyed over 20 communities, murdered 1,200 people, and kidnapped some 240 Israelis and foreign nationals.

Many will receive the devastating news that their family members, neighbors, and friends were murdered, are still held captive or are missing.

A blood-soaked child’s bed in Kibbutz Kfar Aza seen in a photo shared by Prime Minister Benjamin Netanyahu on Oct. 11, 2023 in the aftermath of the Hamas assault on Israel on Oct. 7. (X/Netanyahu)

Levine from the Hostages and Missing Families Forum said that continuity of care is critical.

“If a mental health professional has supported a hostage’s family since the beginning of this ordeal, they should continue with them. And if someone begins working with a former hostage, then that relationship needs to continue for a considerable time,” he said.

Bar Siman-Tov emphasized the importance of the former hostages leaving the hospital as soon as they are medically stable to begin their recovery among family and the community.

Levine said that the best environment for recovery will vary from person to person and that listening to what each wants is key.

“Each person will be properly evaluated, but ultimately each must be treated as an individual,” Levine said.

He emphasized that this is a horrific, unprecedented event in Israeli history and that it has been a learning process for everyone working for the hostages’ freedom.

“The hostages are not all being freed together. We can learn from our experience and refine our protocols for each subsequent group released,” he said.

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