The Psychological Needs of Freed Hostages

If you were a therapist, what’s the first thing you would do when faced with a clinical situation you’d never seen before? If you’re like most of us, you’d turn to the psychological literature for guidance.

That’s what Naama de la Fontaine, Ph.D., did. She’s a leading psychologist at Sheba Hospital in Israel and among the first professional staff to receive hostages released from Gaza.

But there was no clinical literature to advise her.

As de la Fontaine realized, the extraordinary nature of the events on and after October 7th meant that no medical or psychological literature existed on treating cases such as those she witnessed. De la Fontaine and her staff were on their own. They would need to innovate treatment for many new, tragically unprecedented psychological situations suffered by released hostages, some as young as 3 years old.

The team at Sheba Hospital had a great deal of experience with trauma, but this was a mass casualty event of unknown dimensions that had no precedent. They emphasized flexibility and interdisciplinary cooperation.

Here are some examples of what they did.

They began to prepare early, with teams consisting of a psychologist and a social worker assigned to families waiting for their loved ones.

A section of the pediatric emergency unit was separated to provide privacy, with rooms designed to create a home-like atmosphere, backed by the availability of acute care services, that included psychiatry and other medical specialties, such as gynecology.

Since their captors were male, every effort was made to have mostly female staff.

While waiting for the hostages’ arrival, the staff rehearsed with trauma experts and actors in simulation centers, protocols to deal with known trauma issues, such as children who had been violently separated from their parents, and learning of the murder of family and friends. The hostages had all been exposed to sudden, widespread extreme violence, and all had been held captive, without knowing when or if they would ever be free.

Some training protocols were used to build the staff’s resilience since they were affected as professionals and intimately affected by the ongoing conflict. Mutual caretaking was emphasized, as some of the staff had spouses called up for reserve service and were suddenly single parents, or had other family members serving in harm’s way.

The first step in healing trauma is knowing that the trauma is over, that it is behind you, and that you are safe. The healing process for the former hostages is further complicated by the knowledge that other hostages are still in captivity, and their fate remain unknown. The trauma for those families and the wider circles of friends, and all people who care, is ongoing—until either negotiation or rescue brings the remaining hostages home.