Severe malnutrition and psychiatric care: Here is the protocol for receiving hostages in hospitals

Health Ministry has detailed a protocol to provide returning hostages with medical evaluations, psychological care, nutritional support and trauma documentation; Hospitals will ensure personalized treatment and privacy, with long-term follow-up to support recovery and reintegration

Ahead of the implementation of the hostage release deal, set to begin Sunday, the Health Ministry distributed a detailed protocol for receiving freed hostages. The protocol released on Thursday includes medical care, necessary testing, mental health treatment, and documentation of traumatic experiences endured during captivity.
According to the guidelines issued by Dr. Hagar Mizrahi, head of the ministry's Medical Division, to directors of hospitals, "care for returning hostages will take place in separate facilities, isolated from other patients receiving treatment at the hospitals." Mizrahi also suggested that some freed hostages may require mental health hospitalization.
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בית החולים איכילוב נערך לקבלת החטופים
בית החולים איכילוב נערך לקבלת החטופים
Awaiting their return
(Photo: Sourasky Medical Center)
Six hospitals have been prepared for the reception of the hostages: Sourasky Medical Center, Rabin Medical Center, Sheba Medical Center, Shamir Medical Center, Barzilai Medical Center, and Soroka Medical Center. Each hostage will undergo an initial medical examination immediately upon arrival to rule out urgent medical conditions.
"The initial examination will, as far as possible, include the presence of at least one family member or a representative of the hostage, with their consent. A follow-up examination will be conducted after the family meeting, in coordination with security personnel, to complete the necessary medical evaluations based on the initial findings," Mizrahi said.

Specialized medical examinations

The returning hostages will be evaluated by an emergency medicine specialist and a nurse, and, if needed, by an age-appropriate specialist. In cases involving women, examinations will prioritize female doctors and nurses. Based on the medical history and physical examination, the attending physician will determine the need for laboratory tests, imaging, or consultations to rule out immediate concerns. "A wide panel of infectious disease tests should generally be considered, tailored to the medical history and coordinated with an infectious disease specialist. This includes testing for sexually transmitted infections, with further consultations as needed to expand the panel of laboratory tests," according to the protocol.
The protocol notes that, in previous hostage releases, cases of deep vein thrombosis were identified, so "relevant diagnostic tests should be considered." Additionally, "urine and blood toxicology tests are recommended, if possible, before administering medication. For adolescent girls and women of childbearing age, a BHCG pregnancy test is recommended. If the test result is positive, further steps, including forensic recommendations, should be followed."
Additional professional consultations may be considered based on clinical evaluations, including gynecology, geriatric care, dentistry, ophthalmology, vision and hearing assessments, and other health specialties. Hearing aids will be provided to returning hostages who need them immediately upon arrival in Israel, with personalized hearing aids to be supplied by health funds.

Mental health and psychiatric evaluations

All returning hostages will undergo a psychiatric evaluation within 24 hours of arrival at the hospital. Any signs of psychological distress will require collaboration with the attending physician to rule out physical conditions presenting as psychological symptoms. The Health Ministry urged hospitals to maintain continuity of mental health care, avoiding unnecessary changes in therapists. Social workers or psychologists who accompanied the hostages prior to hospitalization should, as much as possible, continue to provide care during hospitalization and after discharge into the community.
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מסוק צה"ל
מסוק צה"ל
Welcoming hostages freed from Gaza in first releases
(Photo: Moti Kimhi)
Mizrahi acknowledged the possibility of mental health hospitalization in this round of releases, noting: "We expect this situation to be more complex, including mentally, and there may be a need for settings resembling psychiatric hospitalization. This can be accommodated within the designated recovery facilities to a certain extent. Each hospital is equipped with a team of professionals, including mental health experts, who will allow for extended stays to provide maximum mental health care, even long-term hospitalization."

Nutritional assessments

Each returning hostage will undergo a full nutritional assessment, including tests for malnutrition and deficiencies (e.g., blood count, biochemistry, vitamins and electrolytes). Families will receive guidance on feeding their loved ones, as there is a risk of dangerous "refeeding syndrome" due to potential severe malnutrition.
"This is a phenomenon known from the Holocaust, where consuming large amounts of food, especially carbohydrates, all at once can cause electrolyte and fluid imbalances, potentially leading to medical emergencies," explained Mizrahi. "We don’t know what they ate during captivity, and not all hostages were held in the same conditions or received the same nutrition, so this will be highly individualized." Hospital dietitians will establish daily nutritional plans based on test results and the hostages’ overall condition.
Care for the hostages will take place in separate facilities within the hospitals, including emergency rooms. "It is strongly recommended to separate general areas, which allow for group gatherings, from personal areas, including private rooms for rest and small meetings," the protocol states.
The number of individuals in the facility will be minimized, and it will remain off-limits to visitors and journalists. Access will be restricted to the hostages’ families, medical staff, Health Ministry representatives, officials from the Hostages and Returnees Directorate, and accompanying security personnel. Families and visitors will also be instructed not to take photos or upload materials to social media to protect the returnees.
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הגעת החטופים לצלב האדום
הגעת החטופים לצלב האדום
First hostage release deal, November 2023
(Photo: Ibraheem Abu Mustafa/Reuters)
The protocol emphasizes the importance of documenting and collecting forensic evidence of atrocities experienced during captivity. Forensic teams will ensure proper documentation of findings, and legal medical experts will examine the hostages to record any evidence related to their time in captivity. In preparation for potential cases of sexual assault, specialized professionals have been engaged to address such issues.

Long-term follow-up

After hospitalization, decisions will be made regarding continued hospitalization or discharge, with follow-up care provided in the community. "Given the circumstances, which in some cases disrupted support systems (community, family), we recommend that the hostages and their families remain in the hospital for at least four days to organize and stabilize," said Mizrahi. "While this may not align with their preferences, we will respect their wishes, but our experience from previous cases shows that early discharge often felt premature for those involved."
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Hospitals will provide hostages with basic supplies, including clothing, footwear, glasses, hearing aids and other items as needed. A designated nurse from the relevant health fund will oversee the transition to community care, ensuring continuity of medical, mental health and nutritional support. Hospital staff will maintain follow-up with the returnees for up to a year, including scheduled check-ins at two weeks, one month, and every three months thereafter.
Mizrahi recommended establishing multidisciplinary outpatient clinics in hospitals for comprehensive follow-up care. "While responsibility for long-term care lies with health funds, continuity with the hospital's multidisciplinary team should be prioritized where feasible and desired by the returnee."
Psychological care should also continue uninterrupted, with trauma-informed professionals providing ongoing support. Hostages wishing to transition to community-based care will receive assistance to ensure a smooth handover and preservation of privacy.
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