A year after the first and only hostage release deal, mental health experts are documenting increasingly complex psychological challenges among the released captives, especially children. This emerges from a comprehensive assessment conducted by four psychologists from the Hostages and Missing Families Forum, who have provided voluntary mental health services since October 7, 2023, particularly to hostage families and released captives.
Marking the agreement's anniversary, the specialists have documented their unprecedented experience treating released child hostages and drafted policy recommendations highlighting the critical need for government-funded trauma therapy. While 35 children and youth under 18 have returned from captivity in Gaza, two siblings – 5-year-old Ariel and 2-year-old Kfir Bibas – remain in captivity.
The burden of survival
Research findings reveal that the children exhibit multiple physical manifestations of emotional distress, including gastrointestinal problems and headaches, diminished frustration tolerance, profound survivor's guilt – particularly when a parent remains captive – and anxiety triggered by exposure to Arabic.
Their psychological trauma is further complicated by cognitive dissonance: in many cases, their captors both imprisoned and protected them, while IDF operations were perceived as life-threatening. The children in treatment also demonstrate a fundamental loss of faith in adult authority figures.
"The deepest psychological wound comes from the perceived failure of those meant to protect them. While it was clear why Hamas is bad, children struggle to understand why the IDF didn't rescue them and why the government hasn't secured everyone's release... it disrupts their entire moral framework," Professor Ofrit Shapira-Berman from the Hebrew University, who treats both former hostages and their families, explained.
"Some Hamas guards showed occasional moments of mercy – providing drawing materials, offering chocolate. They weren't simply monsters, and this complexity troubles the children deeply. The clear division between good and evil typically offers a sense of security. Rebuilding trust after its foundation has been shattered presents an enormous challenge.
"These children face significant academic difficulties and difficulty concentrating. Our greatest concern is their shattered trust in adult authority – military, government, parents – all perceived as having failed them. From their perspective, every adult tasked with protecting them fell short. Moreover, they spent their captivity witnessing adults around them break down, grieve, and experience paralyzing fear. These experiences will have lasting repercussions."
Public spotlight intensifies trauma
Professor Shapira-Berman highlights another challenge: the hostages' involuntary thrust into public prominence. "Their initial return was marked by overwhelming euphoria and relief, surrounded by intense – sometimes suffocating – support. Over time, this attention has become increasingly burdensome. Their unwanted celebrity status complicates recovery. They face constant approaches from strangers, unsolicited hugs, and invasive questions. Young women endure particularly insensitive inquiries about sexual assault and menstruation during captivity. These interactions are deeply troubling." She added that "some families have fractured under the trauma's weight. Unfortunately, this isn't uncommon."
However, the most pervasive challenge among all patients centers on guilt over those still held in Gaza – whether parents or community members. "This affects every single former hostage. Healing remains elusive while others remain captive. The combination of guilt, constant advocacy for those still held, and the pervading communal grief creates an overwhelming psychological burden. Those released within the first two months show promising potential for recovery, potentially returning to productive and creative lives. Later releases face a more complex journey. Full recovery hinges on the return of all hostages. Without this resolution, trust in state institutions cannot be restored."
Full recovery is possible only after all hostages return
"Captivity's psychological impact reveals itself gradually. The initial euphoric 'honeymoon period' upon return gives way to various symptoms that, without proper intervention, risk developing into severe post-traumatic disorders affecting all aspects of functioning."
Their recommendations emphasize allowing returning families (both children and adults) freedom to choose their treatment location and preferred specialist. They stress that therapists must possess advanced trauma treatment certification and advocate for private-sector treatment options to ensure consistency, privacy, and confidentiality. In any case, the public system for treating former hostages must include senior therapists who specialize in trauma treatment.
Regarding families with loved ones still in captivity, the experts emphasize that "meaningful therapeutic progress remains impossible while their family members are held in Gaza. As mental health providers working with these families, we confirm that current treatment focuses primarily on emotional support, helping them maintain resilience as they continue their advocacy efforts. True recovery for family members can only begin once their loved ones return from captivity."
The specialists express alarm that some children received no initial treatment upon return and remain without psychological support. Contributing factors include destroyed family structures due to parental loss, displacement from their homes, and mismatches with available therapists. "Many children resist treatment, unable to confront their trauma. This is particularly evident among those with parents still held hostage in Gaza."
