When female hostages—many of them surveillance soldiers—returned from captivity, there was widespread surprise. Not only did they project emotional resilience, but their physical condition, at least outwardly, seemed better than feared. Then, male hostages were released. Some appeared in severe physical decline—painfully thin, showing signs of extreme malnutrition. Beyond the shock and anger, a deeper realization emerged: in the brutal test of physical and psychological endurance, men may actually be more vulnerable than women.
Research has shown that gender differences in coping with trauma, starvation, and isolation are not merely shaped by social constructs but are deeply embedded in biological and physiological mechanisms. While conventional wisdom often perceives women as the more vulnerable group, evidence suggests that women may have a survival advantage in extreme conditions.
The science of survival
When the body experiences prolonged nutritional deprivation, it activates adaptive survival mechanisms. Initially, it depletes glycogen stores in the liver to provide energy to vital organs. Within days, as glycogen runs out, the body shifts to burning fat reserves and eventually begins breaking down muscle tissue to sustain the heart, liver, and brain. Simultaneously, prolonged deprivation of sunlight leads to vitamin D deficiency, weakened bones, and an increased risk of fractures. After a year in captivity, the damage to vital organs, including the nervous system, can become irreversible.
Studies indicate that women tend to endure prolonged starvation more effectively than men. This advantage lies in body composition—women, on average, have a higher percentage of body fat than men. Fat serves as a more efficient and long-lasting energy source than muscle, allowing women to sustain themselves longer while preserving muscle mass. Additionally, while men experience a rapid breakdown of muscle protein during starvation, women’s bodies regulate this process more conservatively. Female sex hormones like estrogen also contribute to survival by reducing inflammation and protecting the heart, lungs, and liver.
This survival edge is not theoretical: during the Holocaust, women endured prolonged starvation better than men under equivalent conditions. A similar pattern was observed during the Dutch Hunger Winter, where female survival rates were consistently higher across all age groups. The same findings emerged from Japanese prisoner-of-war camps in World War II.
The psychological factor
Captivity, however, is not just a physical ordeal—it is a mental one. In conditions of extreme isolation and darkness, the body’s internal clock is disrupted. While women report higher levels of depression under such circumstances, they also demonstrate greater psychological flexibility. This is partly due to their tendency to maintain social bonds and seek emotional anchors that help them cope with prolonged uncertainty and fear. Men, by contrast, often exhibit psychomotor agitation, withdraw emotionally, and focus on concrete survival tasks.
These differences extend beyond captivity itself to the post-release phase. Studies on Vietnam War POWs found that male captives exhibited significantly higher rates of post-traumatic stress disorder (PTSD) compared to women who had experienced similar traumas. While women sought social support and engaged in group therapy, men were more likely to attempt to cope alone, sometimes turning to alcohol or substance abuse.
Perception and treatment
Beyond physiological differences, deeply ingrained social perceptions likely shape the treatment hostages receive from their captors. Men are often perceived as stronger, making them appear more threatening to their captors—an enemy to be “broken” through starvation, torture, and humiliation. Women, on the other hand, may be seen as less harmful, which could result in less severe physical mistreatment. Yet, when abuse is not merely a means to an end but also an ideology, these differences may blur.
Captivity, then, is not a test of brute strength but a complex interplay of factors, including gender, psychological flexibility, adaptability, and emotional resilience. Understanding this distinction is critical, especially now, as Israel’s medical and mental health professionals face the immense challenge of rehabilitating released hostages.
After more than 500 days in captivity, every hostage is a humanitarian imperative. There are no “strong” or “weak” and no “less urgent”—only human beings, fading with every passing second. There will be no “absolute victory” here. The only solace lies in the lives that can be restored, in the faces we will see again, and in the voices that will reunite with their loved ones. Only when all are home—both the living and the lost—will the circle close, and perhaps then, healing may begin—for them and for us.
Dr. Tamara Kolitz is an internal medicine specialist and endocrinologist at Tel Aviv Sourasky Medical Center and the founder and CEO of LeMa’anam – Physicians for Holocaust Survivors Non-Profit Organization.
Prof. Yael Lebenthal is the director of the Institute of Pediatric Endocrinology, Diabetes & Metabolism at Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center.