How do we provide the best care for the mental health of freed hostages?

Just two weeks after Hamas kidnapped some 240 people into Gaza, following the massacres of October 7, the best minds in the country got together to prepare two extremely detailed documents on how to receive and treat released hostages, both physically and emotionally.

The focus was on infants, children, and teens, but most of the guidelines are also relevant to adults. The suggested protocols were then sent to other experts for comments, following which the online training of medical professionals and social workers was launched.

The guidelines, thousands of words long, are now slated to be implemented as children and some of the women are about to be freed.  

Since Israel had never faced such a traumatic situation – dozens of hostages of all ages being freed after weeks of suffering and neglect – these guidelines had to be composed from scratch.

Both the team involved in redacting the guidelines and the consultants declined on Wednesday to be interviewed by The Jerusalem Post or other journalists on the grounds that it was premature, saying that they first wanted to make sure that Hamas was in fact releasing captives – and then to focus their efforts on beginning immediate treatment of the returnees.

If a soldier is the first person to greet the child during the handover, one soldier should be assigned to each youngster or each family unit.

When the soldier meets a child who is old enough to understand, he or she should introduce themselves in the following way: “Hello, my name is ____, I am a soldier in the Israel Defense Forces and I am accompanying you home. You are in a safe place. I am here to take care of you. You are safe.”

The child should not be picked up or held without his/her permission. Even if it’s a baby who can’t walk – before being picked up, he/she should be addressed: “Come, I’ll take you in my arms, okay?”

If the child asks questions such as “Where’s Mom? Where’s Dad?” the soldiers must not answer these questions, even if they know the answers.

Every question must be answered along the lines of “Honey, I’m sorry, I don’t know. My job is to bring you to Israel to a safe place where people you know will be waiting for you and will answer all your questions.”

The child should be addressed by name as much as possible, in order to strengthen his/her sense of familiarity and confidence.

The abducted children are of varying ages and at different stages of development, and include those with disabilities and unique developmental needs. Individual adjustments must be made for each child in relation to his/her age and developmental level, they wrote.

All the abducted children have gone through complex and severe interpersonal trauma, so team members assigned to take care of them must learn about each child’s individual pain and suffering in order to be able to interact with them in the best possible way. The situation of each child’s parents, siblings, extended family, and community must also be clearly understood by the carers.

Recommended methods for caring for traumatized children

The guidelines cover the process from the reception phase during the first 24 hours, the first week, and the first six months after their return.

The children’s familiar and significant figures, if they are alive, should welcome the children upon their return to Israel. The carers must be made aware that the child lost a parent, sibling, grandparent, or other family member, so they can be prepared to “announce bitter news” and to contact significant figures in the child’s life – anchors that still remain – and understand how they can participate in the treatment and healing process at the appropriate points.

If the child has a pet that is alive, it is of utmost importance to reintroduce the pet to the child at the earliest possible stage – even during the initial medical examination, if possible.

Special-needs children must be treated with great sensitivity and skill. If the child suffers from a chronic illness and has not received medication, he/she may behave in an uncharacteristic way.

All their basic needs – from a toothbrush and toothpaste to clothing and eyeglasses must be provided for. If significant objects belonging to the child were destroyed by the terrorists, new ones that are similar to the originals should be bought and given to the child.

In the first hours after the return of the hostages, if they return as a group, medical professionals must ensure that they are received together in the same place. In all cases the reception in Israel must take place somewhere that is warm and visually pleasant, organized, and uncluttered, with cozy blankets, pillows, and toys.

THE MAIN AIM is to restore a sense of control to the children by giving them choices throughout the process. The child’s wishes and requests must be heard and respected. The carers should make it their business to find out what the children’s favorite foods are and provide them – but not overwhelm them with food or candy.

Invasive medical interventions – and even showers – should initially be avoided as much as possible. Bathing can be offered within the first 24 hours, but the issue should not be forced. During medical examinations, it is important that throughout the examination the doctor explains to the child what he/she is going to do.

For example, the doctor must ask the child if he can lift his shirt and listen to his lungs. Throughout the entire process, the child must be told constantly what is going to happen and offer him a choice.

Any meeting of the children with the media, in any form, must be absolutely prohibited – at the very least during the first 24 hours after their release – and preferably for much longer.

Distant relatives, neighbors, and the like who ask to meet the child immediately upon his/her return should not be allowed access during the first days, and the child must have the right to choose if there is someone whom it is important to see, such as a friend.

The child must be constantly told that he/she is safe and protected.

The returning captives must be told: “You have been through such difficult experiences, it saddens me, but I’m glad you’re here now... You’re so brave to share what you went through.”

A significant lack of food can cause metabolic disorders as well as serious disruption in the fluid balance and the electrolytes that may have serious clinical consequences, including damage to the nervous and respiratory systems, cardiac function, and muscular and blood systems.

The biochemical characteristics include a decrease in phosphorus, potassium, and magnesium; disturbance in the sodium and fluid balance, changes in the metabolism of sugar, protein, and fat, and lack of thiamine (vitamin B1).

Rapid initiation of refeeding after a period of undernutrition can cause the potentially fatal disorder, Refeeding Syndrome. To prevent danger to the health of the freed hostages, all the security forces involved in their recovery must be told not to feed them anything except water. Within minutes, they will reach a hospital, where they can be given a sweetened hot drink, applesauce without added sugar, and a few cookies.

Babies up to 12 months old - there is one -  should drink up to 120 ml. of baby formula.

Further advice on subsequent feeding of children and adults is provided in the guidelines, with detailed menus.