File photo of relatives of hostages staging a demonstration —AP

Israel is preparing for the return of hostages from Gaza, anticipating severe, life-threatening complications after over a year in captivity. The Health Ministry and Hostages Family Forum are preparing for scenarios based on information from previously released hostages. About 250 people were abducted by Hamas militants during a cross-border attack on October 7, 2023, which also left 1,200 dead. Around 100 hostages remain captive, with Israel estimating that a third are deceased.

The war following the attack has killed over 46,000 Palestinians, according to Gaza health officials, with women and children comprising more than half. Hostages are expected to suffer from cardiovascular and respiratory issues, due to lack of ventilation in the tunnels, says Hagai Levine of the Hostages Families Forum. 

Among multiple other afflictions Levine expects are vitamin deficiencies, starvation, dramatic weight loss, vision problems due to a lack of sunlight, broken bones, cognitive impairment and mental health trauma. These complex medical needs surpass those faced by hostages released after a ceasefire in November 2023.

Doctors are particularly concerned about "refeeding syndrome," a condition where reintroducing food to individuals with prolonged malnutrition can cause severe complications. Strict guidelines govern what hostages can consume immediately after release. Six hospitals, including two near Gaza, are ready to treat those with acute medical needs.

Psychologist Dr. Einat Yehene warns the public should not expect joyful reunions like those seen following the last ceasefire, when released hostages ran through hospital halls into the ecstatic embraces of their loved ones.

"Given the physical and emotional conditions, we expect emotional withdrawal symptoms, such as maybe exhaustion, fatigue - and some will probably need assistance with their mobility," she said.anticipates that many hostages will exhibit emotional withdrawal, fatigue, and impaired mobility. Some may require speech therapy, particularly if isolated during captivity. Trauma and shock may render some hostages initially unable to speak. To minimize distress, officials aim to reduce sensory stimulation in hospital environments.

Temporary housing solutions are being prepared for hostages who may not feel ready to return home directly. The public is cautioned not to expect joyful reunions, as seen after previous releases. Rehabilitation will require significant medical, psychological, and social support, reflecting the prolonged and severe conditions endured by the hostages.