Expert explains how the hostages are still standing after prolonged starvation

Doctors weigh how to evaluate and treat the recently released hostages.

By DR. ITAY GAL FEBRUARY 1, 2025 18:43 Updated: FEBRUARY 1, 2025 18:46

(L-R) Ofer Kalderon, Yarden Bibas, and Keith Siegel released from Hamas Captivity, February 1, 2025. (photo credit: Canva, screenshot, SECTION 27A COPYRIGHT ACT)

After nearly 500 days of extreme starvation and drastic weight loss, Keith Siegel, Yarden Bibas, and Ofer Kalderon returned home - walking on their own, communicating, and functioning. Their overall condition appears good, but only in the coming days will medical evaluations reveal their true health status and the long-term effects cause by months of severe malnutrition.

Still, in the initial footage, we were relieved to see the three functioning well - walking, waving, carrying weight, standing steadily, appearing alert, and even in high spirits.

"We have seen in previous cases that, before their release, some hostages were given large amounts of food, and in some cases, also medications - either sedatives or stimulants," explains Prof. Ronit Andlovitz, a clinical nutritionist from the University of Haifa and a nutrition consultant for the Hostage Task Force. "It appears that the returning hostages, both from today and previous, have experienced significant weight loss. The full effects will become clearer later, but the adrenaline from being released, along with the possibility that they were given large amounts of food or certain medications, could have contributed to their elevated mood and high energy levels."

According to Prof. Andlovitz, the recent release of five Thai civilians reinforced the theory that hostages are given large amounts of food before their release.

"When the Thai hostages reached the border, the Egyptians gave them an abundant amount of food, which can actually pose a life-threatening risk. After months of surviving on minimal food intake, suddenly consuming a large amount can trigger refeeding syndrome, which is extremely dangerous and even fatal."

Shmuel Harofeh Hospital (credit: Shmuel Harofeh Hospital Spokesperson)

Medical monitoring and recovery

Prof. Andlovitz further explains that historical evidence from Holocaust survivors demonstrates the devastating effects of prolonged starvation: "During the Holocaust, Jews sometimes surivved on just 300 calories a day or less. When a person lives on such a minimal amount of food for an extended period, their body adjusts, and like in cases of anorexia, the hunger signals stop. They simply don't feel hungry anymore.

"On top of that, these hostages were confined in tunnels or apartments, with no movement, critical systems deteriorate - muscle loss, heart damage, immune system collapse, and even cognitive impairment."

According to the Health Ministry guidelines, each returning hostage undergoes vital signs monitoring - including heart rate, blood pressure, and oxygen saturation - every four hours for the first 24 hours of refeeding.

Additionally, each hostage undergoes comprehensive blood tests. Based on the results and their body mass index (BMI), nutritional deficiencies are corrected gradually.

Under the Health Ministry's protocol, hostages are categorized according to their BMI: A BMI of 16 to 18.5 (the normal range starting at 20) is considered moderate risk. A BMI below 16 is classified as high risk and indicates severe starvation.

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Nutritional rehabilitation includes a daily multivitamin for at least 30 days, vitamin D supplementation due to prolonged deprivation of sunlight, and vitamin B12.

Hostages in moderate-to-high risk categories also receive fluid supplementation based on their body weight and caloric intake adjustments to compensate for deficiencies. Their progress is closely monitored, with the goal of increasing calorie intake by 33% of the target every one to two days. The ultimate objective is to restore full nutritional needs within 5 to 10 days.

Despite the relatively good outward condition for Bibas, Siegel, and Kalderon, only their blood test results will confirm the full extent of their physical state and the long-term effect of prolonged starvation and horrific captivity conditions. In addition to psychological rehabilitation, special forces will be placed on restoring essential vitamins, minerals, proteins, and fats to rebuild their skeletal, muscular, and organ systems.