Tel Aviv, Israel—— Israel is preparing for the return of hostages from the Gaza Strip, many of whom are expected to develop serious life-threatening complications after more than a year in captivity there.

While it is impossible to know the specific circumstances under which the hostages are being held, the Ministry of Health and the Hostage Family Forum, which represents the families of the hostages, are preparing for several different scenarios based on information gathered from previously released or rescued hostages.

Hamas militants kidnapped approximately 250 people and killed 1,200 in a cross-border attack on October 7, 2023. About 100 hostages remain, but Israel believes a third of them no longer exist.

The fighting since the attacks has killed more than 46,000 Palestinians, according to Gaza health officials, who did not distinguish between civilians and militants but said women and children accounted for more than half of the victims.

Hagai Levin, health group leader for the Hostage Families Forum, said he expects hostages to suffer cardiovascular and respiratory problems when they return due to the lack of ventilation in the tunnels. Levine is expected to suffer from a variety of other afflictions, including vitamin deficiencies, starvation, dramatic weight loss, vision problems due to lack of sunlight, broken bones, cognitive impairment and mental health trauma.

Doctors therefore expect the hostages will need longer compared to those who returned after the last ceasefire in November 2023, said Dr. Einat Yehene, a psychologist at the Hostage Family Forum who oversees the hostages. time, more complex medical and mental health interventions. 'Recovery.

Doctors are acutely aware of the challenges they face in treating surviving hostages. Dr. Hagar Mizrahi, Director of the Medical Directorate of the Ministry of Health, said one of them is "refeeding syndrome," in which exposure to certain foods or excessive intake of foods can lead to serious health complications, even in those who are chronically deficient in vitamins and nutrients. People die. .

Mizrahi said Red Cross teams would move the hostages from Gaza to Egypt, and a small Israeli military medical team would meet the hostages at the border as they entered Israel, and they had strict rules on what the hostages could eat in the first few hours. guidelines. .

Health ministry officials said six hospitals, including two in the south near Gaza, were preparing to receive the hostages and would treat those with serious medical problems.

Ye Heng said the public should not expect joyful reunions like those seen after the last ceasefire, when freed hostages walked through hospital halls into the ecstatic embrace of their loved ones.

"Given physical and emotional conditions, we expect to experience symptoms of emotional withdrawal such as exhaustion, fatigue, and some people may need help with mobility," she said.

Yeheney noted that medical officials are also prepared for the possibility that returning hostages may need speech therapy, especially if they are quarantined. Some may be so traumatized or shocked by the transfer to Israel that they cannot speak at all, she said.

To minimize the hostages' trauma and allow them to adjust to their new reality, officials will try to limit the number of people who interact with the hostages and take steps to reduce their sensory stimulation, such as removing wards and changing lighting.

Israel's Ministry of Social Welfare also plans temporary housing solutions if hostages are unable to return home directly from the hospital.

Experts implored the news media and the public to grant the hostages and their families privacy, despite their deep concern for their plight.

"The first few days back are really sacred, when one can finally see family and everyone else needs to take a step back," said psychoanalyst Ofrit Shapira, who leads the and a team of health professionals treating released hostages and their families. and survivors of the October 7 attack.

Medical officials said the hospital wing housing the hostages was expected to be "disinfected" and closed to all but immediate family members and doctors to prevent access to the public and news media.

"It doesn't matter how much we care about them; they are their own people, they are not 'ours,'" Shapira added. She noted that asking hostages directly about their experiences could force them to relive the trauma. She said it's best to let them release information at their own pace.

"Our curiosity is really unimportant compared to the needs of the hostages," she said. "It doesn't matter how much you volunteer or are active in this fight; they owe you nothing."

Levine said some previously freed hostages and their families have volunteered to provide counseling to those going through the same process. He noted that the bonds formed between relatives of the hostages and among the released hostages were so strong that they had become a "psychological family" helping each other adapt and heal from trauma.

Levin said many of the freed hostages neglected their own recovery because they were preoccupied with the fight to bring others home.

An important priority is also to provide support to the families of the hostages who died.

Israel has confirmed that at least a third of the approximately 90 remaining prisoners are dead. But Hamas has not confirmed the identities of the 33 people expected to be released in the first phase of the ceasefire. Some may no longer be alive.

"The moment of release was an emotional and psychological trigger for something they should have experienced but they never would because the deal took too long," Yeheney said.