‘Peeling away the layers of damage’

They have to learn how to live again—it’s like being reborn,” Tamar Pfeffer-Gik, a clinical dietitian at Rabin Medical Centre–Beilinson Hospital in Petach Tikvah, told JNS on Wednesday about hostages returned from Gaza after two years in Hamas captivity.

Five hostages freed on Monday—Evyatar David, 24; Guy Gilboa Dalal, 22; Alon Ohel, 24; Avinatan Or, 32; and Eitan Mor, 25 —are recovering on the third floor of Rabin Medical Centre’s Schneider Children’s Medical Centre. Pfeffer-Gik is part of the multidisciplinary team caring for them.

“Several helicopters landed right in front of us,” recalled Dr Michal Steinman, director of nursing at Beilinson Hospital. “The first arrived around 12:30 p.m., the last between 5 and 6. The unit had stood empty since earlier this year.

“We were prepared for acute cases,” she said. “We expected extremely weak and traumatised people—starvation leaves deep marks on the body and mind.

“I’m relieved they arrived in relatively stable condition—coherent and aware,” Steinman continued. “Just hours before, they were still in the tunnels. Now they’re surrounded by loved ones, food, clean water and comfort. The change is dramatic.”

The team, she said, is “peeling away the layers of damage.”

Prolonged starvation can harm internal organs, and some effects may emerge later, Steinman noted. “They have to share their stories—the injuries and untreated illnesses—so we can understand the full impact of captivity.”

Initial tests found the former captives in stable condition, and none required surgery or intubation.

Cycles of starvation

Pfeffer-Gik explained that malnutrition goes far beyond weight loss. “Anyone who loses 15–50% of body weight becomes malnourished, losing not only fat and muscle, but vital nutrients like iron and vitamins,” she said. “Forced, unmonitored weight loss leaves serious deficiencies.”

She noted that while some hostages’ faces appear less gaunt, swelling can make this misleading. “Their hands tell the real story—thin and frail. Many experienced cycles of starvation and were fed before being released,” she said.

“Some suffer from severe micronutrient deficiencies, including of vitamin C, which can lead to scurvy. Those deprived of protein must rebuild muscle mass—a slow process,” she continued.

“If they begin eating or moving too quickly, they risk injury,” Pfeffer-Gik warned. “We must restore both macronutrients and micronutrients carefully.”

Each patient is closely monitored, with tailored nutrition plans. A concern is refeeding syndrome, a life-threatening metabolic imbalance first observed after the Holocaust. “When starved people start eating again, electrolytes can shift dangerously,” she said.

“From a gastrointestinal perspective, eating too fast can cause pain, diarrhea and gas. Everything must be gradual.”

The hospital’s kitchen, Pfeffer-Gik said, works to honour each former hostage’s food requests—within the dietitians’ guidelines.

Steinman noted that many former hostages are struggling with disrupted sleep patterns after months spent in total darkness underground.

“Usually, it takes several days to a few weeks for the sleep cycle to readjust,” she explained. “But they’re young, they’ve started eating again, they’re exposed to sunlight, and they’re receiving psychological care. Once their biological systems stabilize and they begin to feel safe, the sleep disturbances will ease.”

Younger hostages, she added, are expected to recover more quickly, as they generally lack chronic health conditions.

Looking ahead, Steinman said there is little research on the long-term physical effects of prolonged captivity, given how rare such cases are. “There are some studies on hostages from Afghanistan and a well-known one on Israeli soldiers captured during the Yom Kippur War, who were followed for 40 years,” she said.

“That research showed that even after 25 or 30 years, many suffered from heart problems, high blood pressure and diabetes. The body has a metabolic memory—it remembers trauma. And because these hostages endured such deprivation for so long, they’re at risk of similar complications.”

The hospital’s support will continue for life, Steinman said. While many hostages will soon be medically cleared for day-care rehabilitation, their psychological recovery must be closely monitored.

“You can’t separate physical health from mental and emotional well-being,” she said. “They’re incredibly resilient and have shown remarkable survival instincts, but no one can experience captivity like this without carrying it for life.

“You learn to live with it and manage it,” Steinman said. “The right treatment can help them regain control—and move forward toward healing.”