The harrowing images of the hostages released over the weekend reveal the severe physical toll of more than a year in captivity. Senior nutrition experts warn about the dire health condition of those who returned, having lost approximately a third of their body weight and suffering from extreme malnutrition, which affects all bodily systems. Meanwhile, while the hostages endure deliberate starvation, humanitarian aid to Gaza continues to provide an abundance of food to the civilian population.
"You don't need to be an expert to recognize that the condition of the hostages who returned on Saturday is critical. Just from their outward appearance, it's clear they are in the worst possible state," says Professor Ronit Endevelt, a nutritionist, former head of the Nutrition Department at the Health Ministry, a lecturer at the University of Haifa's School of Public Health, and an advisor to the Hostages' Families Headquarters.
Malnutrition affects all bodily functions
"Even in the first hostage deal, we saw that older women released had lost 10-20% of their body weight. But after more than a year of food deprivation, the weight loss is not just cosmetic, it's physiological. This level of weight loss results in muscle tissue damage, including the muscles of vital bodily systems such as the heart and digestive system. It's an extremely distressing sight. Malnutrition affects all bodily systems," she explains.
However, Professor Endevelt also offers a glimmer of hope. "Fortunately, those who returned are relatively young. The younger a person is, the better their ability to recover from malnutrition. At ages 70-80, recovery is much more difficult. But recovery is also a function of mental state, and discovering losses upon returning from captivity could impact the healing process."
"There is a comprehensive protocol prepared by the Health Ministry on the subject of refeeding syndrome, a 'live' protocol that has been updated with each hostage release as we learn more about the nutritional deficiencies they suffered. One of the key goals in supervised nutrition is restoring protein and electrolyte balance in the body, allowing muscle tissue to rebuild gradually. If refeeding is too rapid, bodily systems can malfunction, which is why it must be done under medical supervision."
According to Professor Endevelt, the released hostages have lost about 30% of their body weight. "You can see that their facial muscles have vanished. This is extreme emaciation. The first impression when watching them walk and communicate is of remarkable resilience. Walking is perceived as a sign of strength. But you can also see their fragility, it's evident in the muscle depletion."
A clear pattern of starvation
She notes that there is a noticeable difference in the condition of the hostages depending on where they were held. Those kept in apartments and exposed to daylight returned in relatively better condition. "The men who were released were mostly held in tunnels. Anyone confined underground, without movement, suffers severe damage to their musculoskeletal system, not to mention the psychological toll. From what I understand, they were almost never exposed to daylight. This has a direct impact on bone weakening and vitamin D deficiency."
She emphasizes that the deliberate starvation is clear in light of a study conducted by her and colleagues from the Health Ministry, Ben-Gurion University, the University of Haifa, and the Hebrew University, which will be published this week. "Our research shows that humanitarian aid to Gaza provides approximately 3,000 calories per person per day. This means that in terms of food for the population, we ensured there was no hunger. They are deliberately causing the hostages to suffer from malnutrition. It's not that they weren't given food because there was none available."
During the previous hostage deal, it was Professor Endevelt who informed the Health Committee that there was evidence suggesting hostages had been given antidepressants and anti-anxiety medication before their release to improve their condition.
"It's possible they were given medication again this time to physically and mentally stabilize them. Maybe even a bit more food. They have experience in trying to appear humanitarian. But you can't hide the effects of more than a year of starvation by giving food just a few days before release. I hope we won't see even worse sights, and it's crucial that all the hostages are brought back as soon as possible. There's no doubt that hostages could also die of starvation there."
