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The start of the exchange of Palestinians imprisoned by Israel for hostages held by Hamas under a ceasefire deal has highlighted the need of those freed on both sides for immediate physical and psychological treatment.
There has been a flood of testimony of mistreatment and neglect by Israeli prison authorities of the first batch of 90 Palestinian detainees released early on Monday. Little has been reported so far on the condition of the three female hostages released from Gaza the previous day, due to strict conditions around media coverage, but Israeli doctors said they expect to see severe ill effects from their extended captivity in tunnels underground.
Fakhri Bari, 28, told The National that the health of his mother Israa, 52, who suffers from asthma, had deteriorated during her two months in prison.
Mr Bari claimed his mother did not receive adequate medical care while detained. “Israa was not provided with the medical treatment she needed. They only gave her Acamol medicine but not the medicine required for her condition,” he said.
Her health reportedly took a turn for the worse when a tear gas canister was released in the prison. “After the tear gas explosion, her condition deteriorated significantly. Another prisoner gave her an inhaler to help her breathe,” her son said.
Amani Sarahna, media co-ordinator for the Palestinian Prisoners Society, said the situation of those released was "tragic on all levels" and that they were being taken to government hospitals in the occupied West Bank for treatment.
"I have spoken to several of the detainees – their situation psychologically is terrible – and most suffer physically from malnutrition due to lack of proper food, which has severely impacted them,” she said.
“Even those who had been detained before said that this time was more brutal, with some reporting severe beatings and mistreatment, particularly after the events of October 7, 2023,” she said, referring to the Hamas attack on Israel that triggered the war in Gaza.
Israeli authorities, meanwhile, have put in place a complex health and rehabilitation procedure for the released hostages. They will receive an initial check-up in reception centres just outside the Gaza border with basic facilities, where they will be met by family members.
From there, they are to be taken by military helicopter to Israel’s best hospitals, such as Sheba Medical Centre in Ramat Gan where the first hostages freed on Sunday were taken. Footage released by Israeli authorities showed white-walled corridors with private rooms stocked with toiletry bags and quiet reception rooms to meet family members.
Dr Amir Blumenfeld, a paediatric surgeon and combat trauma expert, said a great deal was learnt from the hostages released during a brief ceasefire in November 2023. They posed an unprecedented challenge for Israeli doctors who had to scan medical literature to find the best approach to treatment.
There are major differences this time, said Dr Blumenfeld, who is part of the health department of the main forum for Israeli hostages.
“Previously it was mostly women and kids that were being released, so we asked for female staff to take care of hostages primarily,” he said. "This time we are probably going to change that, given the released will be mostly men."
Despite this comprehensive approach and the lessons learnt, Dr Blumenfeld said the recovery process for the newly freed hostages would be extremely complex, particularly because of the conditions of their captivity.
Underground tunnels, where many of the remaining hostages are held, have a particularly damaging effect on the body. “The brain, heart, lungs, gastrointestinal health, muscles, bones, hormones, everything is damaged in tunnels," he said.
“The most important factor is the time that passes. If it’s a few weeks in tunnels then it’s quite possible nothing serious goes wrong and they can go back to normal,” he added.
“After such a long time, 15 months, we pretty much expect many illnesses, physical and mental, from everyone. We can not differentiate between men and women, young and old. Everyone is in terrible shape.”
Dr Blumenfeld said most of the hostages would not survive a second winter in captivity.“They have no reserves, their weight is down 20 to 50 per cent,” he said.
“Their mental status is also majorly damaged. They don’t know what’s going to happen and the attacks from the Israeli military make all these conditions extremely unacceptable and very, very dangerous.”
Mr Blumenfeld said it was normal for captives to feel euphoria for the first few days of their release but that all the hostages freed in the deal in November 2023 “went downhill mentally” after that.
He expects the problem to be worse for the hostages being released now. “It will take longer for them to understand they are here back safe," he said. "Some people will only start feeling mental symptoms in a month, a year or even more, but I expect it to be lifelong rehab for all of them."
