Hamas treatment of older hostages 'one of most severe examples of elder abuse’

The researchers described the extreme “pre-morbid” vulnerability of older hostages along with the additional data on their clinical situation and extreme stresses to which they are being subjected.

By JUDY SIEGEL-ITZKOVICH NOVEMBER 10, 2024 03:08 Updated: NOVEMBER 10, 2024 08:00

ELMA AVRAHAM was nearly 85 when she was taken hostage by Hamas from her home in Kibbutz Nahal Oz. (photo credit: Rambam Maimonides Medical Journal)

With the many soldiers, young families living near the Gaza border, and Nova music festival attendees killed on October 7, 2023, there is the impression that the victims of the Hamas massacre were almost all young. 

In fact, among the 1,200 people – mostly civilians – who were murdered, 13% were 65 years and older, and a third of those were octogenarians. One was a 91-year-old Holocaust survivor – gunned down in front of his home.

Two Israeli physicians who researched case histories of three of those 80 years and older who were abducted, maintain that the terrorists were responsible for “one of the most severe examples of elder abuse documented in the modern era.” 

A. Mark Clarfield, an emeritus professor of geriatrics and head of the Center for Global Health at the Faculty of Health Sciences at Ben-Gurion University of the Negev in Beersheba, and Prof. Hagai Levine, a leading epidemiologist and public health physician at the Braun School of Public Health and Community Medicine at the Hadassah Medical Center and the Hebrew University of Jerusalem investigated the cases. 

They have just published their findings in the Rambam Maimonides Journal of Medicine under the title “Kidnapped but not kids: A case series of three octogenarian hostages held in captivity by Hamas.”

Hamas released a video of three elderly male Israeli hostages pleading for their release. December 18, 2023. (credit: Screenshot/Hamas Telegram)

Levine has headed the health team of the Hostages and Missing Families Forum since it was established.

In addition to those who were murdered on that day, an additional 251 people – Jewish and Arab Israelis, Americans, and other foreigners – were taken hostage (in addition to two soldiers and two civilians abducted before October 7 for a total of 255 hostages). Many of them have since died. The researchers presented case histories of three abductees over 80 years of age – two who have since been released and one still in captivity. 

The researchers described the extreme “pre-morbid” vulnerability of these older hostages along with the additional data on their clinical situation and the extreme stresses to which they are being subjected.

“There is no greater mitzvah than redeeming captives,” wrote Maimonides (Moses ben-Maimon, rabbi and physician, 1138-1204).

Fewer than half of the 251 hostages from October 7 (117) have returned –109 through an exchange and eight rescued by the IDF.

---

---

To date, 37 bodies have been retrieved, including six murdered more recently as Israeli soldiers were closing in on their rescue.

Evidence indicates that extensive sexual violence occurred during the initial attack and may still be ongoing, as acknowledged by the UN and reported in detail in the lay press. 

Following the attack on October 7, a fierce war broke out, resulting in the displacement of many hundreds of thousands on both sides of the border, within Gaza and including both southern and northern Israel, and the deaths of many hundreds of Israelis and tens of thousands of Gazans. 

THE WAR spread beyond Hamas’s attack on Israel to encompass assaults against Israeli civilians by Hezbollah terrorists from Lebanon in the north, Houthis from Yemen in the south, and Iran in the east. 

“The condition of some of the released child hostages was recently documented, indicating the terrible conditions in which all of the hostages are likely being held. However, to the best of our knowledge, there is very little in the medical literature discussing the health effects of long-term abduction on older persons. We found only one paper relating to the health of released captives that included older persons, but that paper did not specifically deal with the health effects on those over 65 years of age,” Clarfield and Levine declared. 

For its part, Human Rights Watch has produced a useful report on the vulnerability of older persons caught up in armed conflict but they didn’t specifically relate to the health status of hostages, either still in captivity or released, they wrote.

There are still 101 hostages in Gaza, most of whom are most likely being held underground and include children, men, and women of all ages, including disabled and older persons. “The ambiguous loss and the lack of certainty and proper burial are causing great anguish to their families and to the public.”

The eldest hostage is Shlomo Manzur, aged 86. 

“His life story includes a terrible irony: fluent in Arabic, as a toddler in Baghdad, Iraq, he witnessed atrocities and survived the infamous 1941 Farhud Pogrom, an event in which 180 Jews were killed and more than 1,000 injured; this outrage is part of the Holocaust that occurred in Arab countries. Today, in his old age, he has been kidnapped, and it is unknown if he is dead or alive.” 

Many of the elderly remain unaccounted for, and at least half are most likely dead due to the dire combination of the lack of medication for chronic diseases, the poor conditions (sanitation, ventilation), untreated trauma, and the diet of those who continue to be held underground – not to mention active torture, abuse, and murder, the authors wrote. 

“Understandably, surrounding this conflict, much has been published about victims of the war aboveground and the dire effects on their health. However, it is surprising that no reports could be found in the medical literature describing the clinical situation of, or active demands for the release of, those held underground in Hamas’s tunnel prisons. 

“All 251 kidnapped individuals are victims of war crimes, as defined by international law and outlined by the International Committee of the Red Cross (ICRC). Yet, calls for their release seem pro forma, muted, or even worse – absent.”

For example, Levine and Clarfield went on, “A UN press release focusing only on the state of the Gazan people is all too typical.” 

Families of older hostages provided the team with data on their loved ones’ ailments common in advanced age, such as diabetes, hypertension, and cardiovascular, respiratory, and kidney diseases, as well as mental health problems. 

“For proper control of their conditions, such people need a steady supply of their medications and ongoing medical attention.”

The first case study

THE FIRST case study involved Israeli-born Yocheved Lifshitz, who was 85 when she was kidnapped along with her husband, Oded, from their home in Kibbutz Nir Oz. She has worked as a photographer and taught both photography and physical education. 

About a quarter of the 400 members of her kibbutz were murdered or abducted. The couple had lived there for many years and worked hard to develop good relations with their Gazan neighbors. 

She had long suffered from several chronic conditions including diabetes, back pain due to herniated disks, renal failure, arrhythmia (requiring a pacemaker), cardiac valvular disease, and pulmonary hypertension. 

To control this variety of diseases, she needed to get 17 different medications (including beta-blockers, proton-pump inhibitors, anti-coagulants, empagliflozin, metformin, and levothyroxine). Although she did receive some medications from her captors, she was not offered all her required drugs, and it was doubtful that she had been administered the correct medications in their proper doses. 

The second case study is Yocheved’s husband, 83-year-old Oded, who was also born in Israel. He is a renowned journalist and one of the founders of their kibbutz; for many years, he drove Palestinians from the Gaza border to Israeli hospitals for medical care as a volunteer with the Road to Recovery Foundation.

His medical condition is even more complex than that of his wife and includes serious respiratory and cardiovascular disease. Among other medications, he was taking Trelegy, an ACE inhibitor, acetylsalicylic acid, carbocysteine, a statin, iron, and vitamin D. 

When last seen by his wife, he was lying unconscious outside of their looted house during the violent abduction. Although she had thought he was dead, it was only later when another released hostage reported seeing him alive in the tunnels but in very poor shape, that she realized he had not been killed – at least not initially. 

However, it is unlikely he could survive for long without a steady supply of most of his medications and proper medical follow-up.

The third case study is Elma Avraham, who was nearly 85 when taken hostage and was later among the handful who were released. Before being abducted, she was living independently in her home in Kibbutz Nahal Oz, in a stable medical condition, despite suffering from several illnesses. Her medical history includes hypothyroidism, cutaneous vasculitis, ischemic heart disease, and a transcatheter aortic valve implantation five years before her capture. 

Medications prescribed include levothyroxine, aspirin, ramipril, lercanidipine, rosuvastatin, and amitriptyline. She lacked the medications she needed from her captors but was able to grab some of her pills when abducted. This resourcefulness likely saved her life. 

Upon her return as part of a prisoner swap, she was found to be in a myxedema coma – a dire clinical picture rarely observed in modern practice. After eight days in an intensive care unit, she was transferred to the hospital’s geriatric ward for rehabilitation. After several months, she was discharged from the hospital to a geriatric hospital. 

During recent interviews with the authors, both women have declared that they would be unable to recover completely until all the remaining hostages return home – the living for rehabilitation and the dead for burial. 

“These older people shine a new light on the word ‘resilience.’ The three octogenarian hostages described herein all exhibit various manifestations of these more generalized phenomena. Each of them made it into old age, having lived for decades on kibbutzim very close to the Gaza border, two having survived abduction to Gaza.” 

Clarfield noted that as a young physician almost half a century ago, he treated veterans of the First World War. To him, it was indeed an honor to be able to pay his “last respects.”

Levine was inspired by knowing his great-grandfather had himself been a physician during this same conflict. More recently, both have had the privilege of looking after the last remaining survivors of the Holocaust as they, too, are reaching the end of their long and traumatized lives. 

“But these hostage cases in Gaza are different. Their captivity is ongoing and continues in real-time, and these vulnerable people are all victims of severe elder abuse – to the best of our knowledge the likes of which have not previously been documented in the literature. 

“What has been done, outside of Israel, to advocate for the medical needs of the remaining hostages – old and young? Unfortunately, very little. For example, the International Committee of Red Cross mandate to provide humanitarian protection and assistance to victims of armed conflict, and to ensure adherence with international humanitarian law, has been less than proactive. 

“In the view of many observers, the ICRC has not utilized all of their available tools to gain access to hostages and provide them with the necessary aid. Although the ICRC has indeed asked Hamas for information about the remaining hostages, none has been forthcoming.

“The World Health Organization, other UN bodies, and many humanitarian nongovernmental organizations – while quick to condemn Israel for injuries to Gazans – appear to offer limited or only lip service in support of an immediate release of all those illegally abducted by Hamas,” the authors concluded.