Potential Long-Term Psychological Impacts on Released Hostages and Detainees, Warn Experts
Experts warn that recently liberated hostages and detainees may suffer from a wide range of severe psychological effects, such as anxiety, depression, disorientation, grief, post-traumatic stress, and survivor's guilt These symptoms can persist even after their return home and extend beyond the Israel-Hamas truce
As they return home and beyond the Israel-Hamas truce, experts say that newly freed hostages and detainees may experience a range of complex psychological effects, including anxiety, depression, disorientation, grief, post-traumatic stress, and survivors' guilt. The truce, initially scheduled to end Tuesday, has been extended for two days, marking the first major diplomatic breakthrough in the conflict. During the first four days of the truce, Hamas released 69 hostages, and Israel freed 150 Palestinians from prison, many of whom were detained without being charged. According to the terms of the agreement between Israel and Hamas, women and children up to the age of 18 were eligible for release.
In this handout video released by the Israeli army, we see 9-year-old Irish Israeli former hostage Emily Hand reuniting with her father at an Israeli hospital following her release by Hamas. This exchange operation of hostages against prisoners occurred on November 26, 2023. The previous day, Hamas had released a second group of Israeli and foreign civilians held hostage in the Gaza Strip in exchange for Palestinian prisoners, after an unexpected delay caused tension. Israeli authorities confirmed that 13 Israelis and four Thai citizens had returned to Israel. (Photo by Israel Army / AFP) / NO ARCHIVES -- RESTRICTED TO EDITORIAL USE - MANDATORY CREDIT "AFP PHOTO / ISRAELI ARMY" - NO MARKETING NO ADVERTISING CAMPAIGNS - DISTRIBUTED AS A SERVICE TO CLIENTS (Photo by -/Israel Army/AFP via Getty Images)
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First on CNN: Father describes how his young daughter Emily Hand survived Hamas captivity
Dr. Spencer Eth, chief of mental health at the Miami VA Healthcare System and a professor at the University of Miami, stated that the psychological and emotional consequences for hostages will likely be severe and vary greatly based on the individual's experiences and age. "Many of them are not just traumatized by the terrorist attack and taken prisoner, but they're also grieving," Eth said, citing the example of 4-year-old Israeli American hostage Abigail Edan, whose parents were killed by Hamas militants during the October 7 terror attack.
Upon their release on Saturday, Noam, 17, and 13-year-old Alma Or received the devastating news that their mother had been killed on October 7. Additionally, Emily Hand, 9, learned that her "second mom," Narkis Hand, her father's former wife and mother to her two half-siblings, had also been killed on the same day.
"So here we have not only the trauma but also the grief, and that compounds the psychological impact, the very pathologic impact, of those events," Eth said.
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Israeli clinical psychologist, Eth, commented on the return of hostages, stating that it is not a happy ending. He mentioned that while he has not been directly involved in their care, those who have been released may undergo thorough medical and psychological evaluations. These evaluations may include in-depth assessments for signs of traumatic brain injury, post-traumatic stress disorder, and other psychological conditions.
"Equally important to the initial evaluation is the necessity for continuous monitoring and support over time to assess their progress," Eth explained.
"Despite some appearing to cope well initially and showing resilience, it is possible for them to later develop severe symptoms, such as depression, particularly in those grieving. Substance abuse could also be a risk for some individuals," he added. "We are aware that there are various conditions that may surface in the aftermath."
Risk of post-trauma symptoms
It may take several years, or even a decade, to recover mentally from such a traumatic event, depending on the level of care received. The process is often prolonged for young children and the elderly, according to Ani Kalayjian, the founder and president of Meaningful World, an international humanitarian nonprofit organization affiliated with the United Nations.
From left, Noam Or and Alma Or.
Hostages Missing Families Forum
Teenage siblings freed from Hamas captivity, only to learn their mother had been murdered
In the post-trauma care and recovery process, it is important to pay attention to five key areas. These include physical health, emphasizing the importance of vitamins, proper nutrition, and exercise to strengthen muscles. Additionally, it is crucial to address emotional wellbeing, social interactions, and spiritual needs, including regaining faith and meaning. Finally, cognitive concerns, such as impaired memory and decreased concentration, should not be overlooked.
Walter Busuttil, director of research and training at Combat Stress, the UK's leading charity for veterans' mental health, has observed that hostages and prisoners of war often experience disorientation upon their release. He noted that they never knew for certain if they would be released, leading to initial feelings of joy and relief. However, they also grapple with a sense of guilt, particularly the adults, who realize that other hostages still remain in captivity."Busuttil shared his insights with CNN's Kim Brunhuber.
"Signs to watch for include: Are they sleeping well? Are they feeling fearful or anxious? Are they vigilant? How is their appetite? Is their mood stable? How are they adjusting?" he explained. "Not everyone will experience these symptoms, and many may not experience any at all."
He noted that while some people may undergo post-traumatic growth, others may experience post-traumatic stress.
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Watch Palestinian teen who was detained without charges reunite with his family
PTSD, or post-traumatic stress disorder, is a mental health condition that can develop in individuals of any age following exposure to shocking, frightening, or life-threatening events. Symptoms typically manifest within three months of the event, but may appear later. People with PTSD often experience co-occurring conditions, such as depression, substance abuse, or anxiety disorders.
Common signs and symptoms of PTSD in adults include experiencing flashbacks or recurring memories of the traumatic event, having distressing thoughts or dreams, exhibiting physical signs of stress, avoiding reminders of the event, being easily startled, struggling with sleep, feeling irritable, or having difficulty recalling key aspects of the event.
According to the National Institute of Mental Health, children may react to trauma in ways that differ from adults. In children under 6, symptoms can include bedwetting, speech issues, clinginess, and reenacting the trauma during playtime. Therefore, mental health professionals should watch for aggressive or withdrawn behavior in children.
Younger children are actually most fragile
According to Daphna Dollberg, a clinical and developmental psychologist at the Academic College of Tel Aviv-Yaffo, it is likely that many of the Israeli hostages who have been released will exhibit symptoms of PTSD, particularly the children, with the youngest being only 2 years old.
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Doctor speaks about the impact of captivity on released hostages
Young children are actually the most vulnerable and fragile when it comes to traumatic events. Despite what we might believe, they do remember these experiences. However, because their language skills are not well-developed and they are not equipped to express what they have gone through, they may exhibit signs of distress through physical reactions such as refusal to eat or sleep, or they may become physically ill. They may also display their distress through behavioral issues, developmental regression, and at times, even developmental arrest, as explained by Dollberg during an interview with CNN's Laila Harrak.
These children are likely to feel confused, scared, and fearful for a prolonged period, even when they are in a safe environment. They may be particularly hypervigilant and struggle to trust the adults around them, including their parents. This lack of trust can lead to signs of PTSD (post-traumatic stress disorder) and it will take a long time to help these young children re-establish a sense of safety, protection, and trust.
The Ministry of Welfare and Social Affairs in Israel has issued comprehensive guidelines for the care of recently liberated child hostages. The Israel Defense Forces (IDF) has been given advice on how to approach and interact with the children, some of whom have been held in Gaza for over seven weeks, before they are transferred to hospitals.
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The guidelines recommend assigning a soldier to each child or family unit and emphasize that soldiers must seek permission from the children before touching or picking them up. According to the guidelines, soldiers should refrain from answering questions about the whereabouts of the child's parents, and instead reassure the child that their job is to bring them to a safe place in Israel where familiar individuals will be waiting to address their concerns.
It is important to establish a routine that includes rest, balanced meals, and outdoor physical activity in the first week. It is also crucial to create a safe space for the child to talk about their experiences. The advice emphasizes the importance of avoiding overwhelming the child with too many questions or detailed discussions about what happened. Using simple words and short sentences is key, and it is essential to convey that we are open and willing to discuss difficult topics.
CNNs Lauren Izso and Alex Stambaugh contributed to this report.
