Some Israeli hostages are coming home. What will their road to recovery look like?

Hamas has released over 100 of the more than 240 people it kidnapped from Israel on Oct. 7 as part of a hostage and prisoner exchange enabled by the weeklong cease-fire that ended on Friday. Those freed in Gaza were mostly women and children, including some foreign nationals.

At the same time, hundreds of Arab residents of the West Bank who had been held in prisons by Israel have been freed. This has created two sets of populations, including many children, in need of psychological support as they return to freedom.

How Israel is welcoming — and treating — the freed hostages

In Israel, as the freed hostages return home, Israeli and U.S. media have been awash with photos and videos of their emotional reunions with surviving loved ones (including some pets) as well as emerging details about their nearly two months in captivity.

Most hostages have not spoken with the media directly, though accounts from family members suggest at least some were given limited access to food, beds, bathrooms and medications. One 84-year-old woman was returned to Israel over the weekend in critical condition.

Some families say their relatives lost weight and came home with head lice. One man said his aunt had to readjust to sunlight after spending so much time in a tunnel. The families of two young girls said they only spoke in whispers upon their arrival because they had been told not to make noise in captivity.

Family members of several hostages of all ages described them as physically but not mentally OK in interviews with NPR. Many are returning home to learn that their loved ones were killed on Oct. 7 or are still being held in Gaza.

For many, feelings of relief are mixed with those of guilt and exhaustion. And relatives and experts have voiced concern about the potential long-term effects of the ordeal on hostages, particularly young children.

That's what the family of four-year-old Abigail Idan — a dual American-Israeli citizen whose parents were among the some 1,200 people killed on Oct. 7 — told NPR. Her great-aunt Liz Hirsh Naftali said Idan is "overjoyed" to be back with her siblings, but declined to elaborate on her condition.

"I think that we will only learn as the days go on, and for a long time, what really effectively will be the results of having been a hostage and having been in her father's arms when he was murdered," Hirsh Naftali said.

Experts told NPR that the road to recovery from such an experience can be long, but there are steps that caregivers, loved ones and professionals can take to help children who were held hostage navigate a path forward.

Physical health is the top priority

In anticipation of the release of hostages, Israel's health ministry worked with child trauma specialists to come up with a handbook for how people should interact with them.

Ayelet Noam-Rosenthal, a social worker at the Haruv Institute in Jerusalem and one of the authors of the guide, says it includes protocols for "everyone that will meet the child," from parents to pediatricians to teachers.

"Here in Israel after the horrific events of Oct. 7, where children were kidnapped after witnessing massacre and severe violence, we actually understood that we have to focus also on the day after," she told NPR. "That means the day after they return, and address both their immediate and long-term needs."

The Times of Israel reports that the new protocols cover best practices for both the hours and weeks after hostages are released.

It has instructions for the Israeli soldiers accompanying children on their way to the hospital, including how to introduce themselves and how to answer (or deflect) their questions, CNN reported.

Hostages are to be brought to one of six Israeli hospitals, where they can reunite with family members and receive a suitcase with some of their clothing, medications and personal items. They also receive a thorough medical exam, which the Times reports must be performed by female doctors.

The guide says those exams should check for evidence of rape or torture, and that if any is found, "appropriate professionals" should be consulted on whether it would be possible collect the evidence or interview the patient without re-traumatizing them.

There is also guidance on proper nutrition and avoiding potentially-fatal refeeding syndrome, which can happen when food is reintroduced to a malnourished person.

Liz Cathcart, the executive director of the nonprofit Hostage U.S. (which supports families of Americans taken hostage but cannot comment on which cases it is working on) says malnutrition is common among hostages.

That could be due to a lack of nutritious food and food in general or the inability to keep food down because of stress.

Other potential issues include vitamin deficiencies, diseases contracted in captivity and sleep disturbances, according to Hostage U.S.

The physical health of the hostages is the immediate priority, Cathcart tells NPR.

"Without the physical health checks and making sure that your physical health is up to par, you're not able to then take the next steps to recovery and reintegration," she says.

Rebuilding trust and autonomy are crucial and take time

Noam-Rosenthal says parents and professionals should take every precaution to avoid re-traumatizing children who were held captive.

"We must all work together to strengthen the child's resilience and work toward his or her adjustment to the new circumstances," she says.

For instance, the Times reports that while doctors can evaluate whether adults are healthy enough to recount their experience to law enforcement, the "debriefing of children will be delayed for some time."

Noam-Rosenthal says it's crucial to rebuild trust "because that's one of the things these children lost along the way."

One of the first things her team tells family members is that they need to give children their autonomy back — for example, letting them set the pace for physical touch, even if the parents are desperate to hug them immediately.

Longer-term, she says it's important for parents and professionals to work together in support of the child's well-being. She called for full coordination of "the military, the health and the social services as one system driven by the same goal."

Building resilience and coping skills are key to helping former captives adjust to their new normal, Cathcart says.

And it's not just the hostages themselves who need help. Families of hostages are coming off a "two-month marathon" of worrying about and fighting for their loved ones' release, Cathcart says.

Before they can shift their focus to that person's recovery, she says, they need to take care of themselves too.

"What I always encourage families to do when their loved one gets home is to focus on yourself, too, because it's so important that the families are mentally healthy, that they're fed, that they have energy," she adds. "Because if they don't, they're not going to be able to support their family member."

Hostage U.S. recommends that hostages and their families work to "establish a routine without being regimented," think through potential triggers (like loud noises or dark rooms), communicate openly and be patient throughout the reintegration process.

"The use of simple words and short sentences is important," the ministry advises, according to CNN. "It is important to convey that we are open and able to hear and talk about difficult things."

Children in Gaza are struggling with mental health too

As part of the temporary truce, Israel released 240 Palestinian prisoners, many of whom are minors.

Prior to Oct. 7, some 500-700 Palestinian children were subjected to Israeli military detention every year, in some cases without charge, trial or due process guarantees, according to Save the Children.

The organization welcomed the release of both Israeli and Palestinian children as part of the deal.

But Jason Lee, Save the Children's country director in the Palestinian Territories, called it "just the first step needed" in addressing a decades-old crisis affecting children in the region.

"A lasting ceasefire must be agreed immediately, all hostages in Gaza must be released, and the appalling emotional and physical abuse of Palestinian children in detention must end," he added.

More than 13,300 Palestinians — roughly two-thirds of them women and minors — have been killed since the war began, according to the Health Ministry in Hamas-ruled Gaza. The count does not distinguish between civilians and combatants.

The United Nations has warned that Gaza is becoming a "graveyard for children," while the World Health Organization has raised alarms about the spread of infectious diseases in the territory.

And researchers are worried about the toll the war will take on the mental health and development of the children who do survive.

Studies conducted before the current conflict documented especially high rates of mental and behavioral health issues among Gaza's youth, who make up nearly half of its population.

Copyright 2023 NPR. To see more, visit https://www.npr.org.