The psychological harm of captivity was as great or greater than the intense physical harm suffered by the hostages, a report on the health impacts of captivity on the freed hostages found.
The report, compiled by the Hostage Family Forum's Medical Team, highlighted the psychological impacts of captivity, saying that post-traumatic stress disorder is common among released hostages.
Some are also showing symptoms of complex post-traumatic stress disorder following repeated exposure to violence and torture. This exposure also shattered the worldview of many of the hostages, leading them to lose faith, the report added.
"The survivors report intrusive thoughts, nightmares, hyper-alertness, avoidance, and numbness of feelings," the report said.
These symptoms are more significant among those who experienced violence or were separated from their families, the report added.
Survivors guilt and heavy anxiety
The children who were held hostage have an especially hard time processing their feelings, and some show regression and anxiety.
Hyper-alertness among the released hostages is made worse by the ongoing war in Israel, the report said, explaining that this is caused by sirens and other signs of danger.
Many released hostages and their families are also struggling with survivor guilt and ongoing trauma, the report added. This is especially true when their family members, friends, or those who were taken hostage with them remain in captivity, the report stated.
This emotional toll complicates the healing process of the released hostages, with many struggling to reconcile their freedom with the suffering of the remaining hostages, the report added.
The report also noted that many released hostages have joined efforts to advocate and raise awareness for the remaining hostages, a process that takes a physical and emotional toll and leaves little room for the hostages to care for themselves and go through rehabilitation.
The transition out of captivity has also posed freed hostages with challenges, the report noted, saying that many of the freed hostages were exposed to the devastation of Hamas' October 7 attack on Israel with their return.
Many of the released hostages also lost their anonymity and felt that their identity became tied to their experience as hostages.
"The public attention surrounding their release, although supportive, at times intensified their sense of alienation and made it difficult for them to return to normalcy," the report said.
Another factor that impacted the mental health of the released hostages was the impact on their family dynamics, the report noted.
Many families were not prepared for the reality of receiving their loved ones back from captivity due to short notice of their return. A lack of guidance and tools during this time left the families to cope with the unexpected responses of the returning hostages.
The report also outlined the physical implications of captivity on the hostages, saying that it caused malnutrition and weight loss, digestive issues and problems relating to the poor hygiene conditions of captivity, worsening chronic illness, and physical injury.
The report also touched on the injuries sustained by the hostages during their kidnapping, such as fractures that were not treated and nerve damage. These injuries have left long-term damage and disability.
"Many hostages require physical therapy, surgical interventions, and ongoing medical support to restore their functionality and manage chronic pain," the report said.
Not only did hostages lose weight, but the poor nutrition of the food they were given, which was mainly rice and bread, increased medical risk and required medical intervention to prevent refeeding syndrome.
Poor hygiene conditions and exposure to contaminated water caused digestive tract infections and chronic diarrhea, the report said, adding that the hostages also suffered from skin conditions, lice, and more.
Many of the released hostages are still contending with difficulties stabilizing their condition after chronic illnesses went untreated in captivity, the report said. Some have suffered irreversible damage.
The medical impacts of captivity have far-reaching implications for the hostages' ability to work and to get an education.
The report touched on the fight to free the remaining hostages, saying that in order for the healing process for the hostage families and for Israeli society to begin, all the hostages must be brought back.
Among the recommendations made by the medical team was the call to form a national plan for rehabilitation and to increase rehabilitative services for the freed hostages and their families, including psychological, physical, and social support.
"The struggle for the release of the hostages conveys a vital message to the families of the hostages and those who have been freed, providing them with support and helping them cope with their immense suffering," the report said.
"The Israeli public must continue and even strengthen these efforts through demonstrations and demands for the hostages' immediate release. It is essential to ensure that their situation remains at the top of the national agenda and central to the public and political discourse."
The report also highlighted that the international community and international aid organizations must work to free the hostages.
"Bringing all the hostages home is not only a moral obligation but also a necessary condition for the collective healing of the hostages' families, the released hostages, and israeli society as a whole," the report stressed.
The report was based on a number of studies and reports on the returned Israeli hostages, as well as medical assessments and interviews conducted by the hostage family forum with the released hostages and their families.