TEL AVIV, Israel (AP) — They will be treated for malnutrition, lack of sunlight and the trauma of wearing leg chains for months. They suffer from unexplained pain and unresolved emotions, and they will have to relearn how to make everyday decisions as simple as when to use the bathroom.

The last 20 living hostages released by Hamas are beginning a difficult path to recovery that will also include rebuilding a sense of control over their lives, according to Israeli health officials. Along the way, each one will be accompanied by a team of doctors, nurses, specialists and social workers to guide their reentry to society after two years of captivity in Gaza.

All of the hostages were in stable condition Monday following their release, and none required immediate intensive care.

“But what appears on the outside doesn’t reflect what’s going on internally,” explained Dr. Hagai Levine, the head of the health team for the Hostages Family Forum, who has been involved in medical care for returned hostages and their relatives.

The newly freed hostages will stay in the hospital for several days as they undergo tests, including a full psychiatric exam, according to protocols from the Israeli Ministry of Health. A nutritionist will guide them and their families on a diet to avoid refeeding syndrome, a dangerous medical condition that can develop after periods of starvation if food is reintroduced too quickly.

Hostages emerged thin and pale

After previous releases, some hostages and their families chose to stay together in a hotel north of Tel Aviv for a few weeks to get used to their new reality. Others returned home immediately after their discharge from the hospital.

All of the hostages who emerged Monday were exceptionally thin and pale, the likely result of enduring long periods without enough food, Levine said.

The lack of sunlight and nutrition can lead to issues with the kidneys, liver and cognition, as well as osteoporosis. Many hostages wore leg chains for their entire captivity, which can lead to orthopedic problems, muscle waste and blood clots.

Elkana Bohbot told his family he suffers from pain all over his body, especially his back, feet and stomach due to force-feeding, according to Israeli television’s Channel 12.

“Ahead of his release, he received food in large portions so he will look a bit better for the world,” Rebecca Bohbot, Elkana’s wife, told reporters Tuesday from the hospital.

Some hostages who previously returned had minor strokes in captivity that were not treated, Levine said. Many also had infections and returned with severely compromised immune systems, which is why the number of visitors should be kept to a minimum, Levine said. He denounced politicians’ visits to the hostages as both unnecessary and potentially dangerous. Prime Minister Benjamin Netanyahu visited five hostages Tuesday evening and was diagnosed Wednesday with bronchitis.

“Previously released hostages were told they look ‘pretty good,’ but some needed surgeries that were very complicated. Some had constant pain. Many have all types of pains that they are not able to explain, but it’s really impacting their quality of life,” Levine said.

Levine said Israel also learned from the 1973 Arab-Israeli war, when more than 60 Israeli soldiers were held for six months in Syria. Many of them later developed cancer, cardiovascular problems and accelerated aging and were at risk for early death.

The war began when Hamas-led militants burst across the Israeli border, killing around 1,200 people and kidnapping 251. The fighting has killed more than 67,600 Palestinians, according to Gaza’s Health Ministry, which is part of the Hamas-run government. The ministry maintains detailed casualty records that are seen as generally reliable by U.N. agencies and independent experts. It does not say how many of the deaths were civilians or combatants.

Restoring a sense of autonomy

The most important step for returning hostages is to help them regain a sense of control, explained Einat Yehene, a clinical neuropsychologist and the head of rehabilitation for the Hostages Families Forum. Many of the hostages were brought straight from Hamas tunnels, seeing sunlight for the first time in nearly two years, she said.

“I’m happy to see the sun. I’m happy to see the trees. I saw the sea. You have no idea how precious that is,” Elkana Bohbot told his family, according to Israeli media.

“Stimulation-wise and autonomy-wise, it’s really overwhelming,” Yehene said. “Someone is asking you a question — do you need to go to the bathroom? Would you like to eat something? These are questions they never heard for two years.”

Hostages’ sense of autonomy can be jump-started by allowing them to make small decisions. According to protocol, everyone treating them must ask their permission for each thing, no matter how small, including turning off a light, changing bedsheets or conducting medical tests.

Some returned hostages are terrified of the physical sensation of thirst because it makes them feel as if they are still in captivity, Yehene said. Others cannot spend time on their own, requiring a family member to be present around the clock.

Among the hostages who have experienced the smoothest integration from long-term captivity were those who were fathers, Levine said, though it took some time to rebuild trust with their young children.

“It’s a facilitator of recovery because it forces them to get back into the role of father,” Levine said. None of the women held in captivity for long periods of time were mothers.

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The world starts ‘to move again’

The first few days after being released, the hostages are in a state of euphoria, though many feel guilty for the pain their families have been through, Yehene said.

For those who saw little media and have no idea what happened in Israel, people should take care to expose them to information slowly, she added.

Yehene said she also saw an immediate psychological response from hostages who were released in previous ceasefires after Monday’s release. Many of the previously released hostages have been involved in the struggle to return the last hostages and said they were unable to focus on their own recovery until now.

“I see movement from frozen emotions and frozen trauma,” Yehene said. “You don’t feel guilty anymore. You don’t feel responsible.”

Iair Horn was released from captivity in February, but it did not feel real until Monday, when his younger brother, Eitan, was finally freed.

“About eight months ago, I came home. But the truth is that only today am I truly free,” Horn said, sobbing as he spoke from the hospital where his brother is being evaluated. Only now that Eitan is back “is my heart, our heart, whole again.”

Liran Berman is the brother of twins Gali and Ziv Berman, who were also released.

“For 738 days, our lives were trapped between hope and fear,” Liran Berman said. “Yesterday that chapter ended. Seeing Gali and Ziv again, holding them after so long, was like feeling the world start to move again.”

The Pakistani government and Afghanistan’s ruling Taliban on Wednesday agreed to a temporary 48-hour ceasefire after fresh clashes erupted this week and saw more than a dozen civilians and troops killed.

The terms of the ceasefire remain unclear, and neither the Pakistani nor the Taliban’s foreign ministries immediately responded to Fox News Digital’s questions, though reports on Wednesday suggested Pakistan’s foreign ministry was making efforts to engage in dialogue to resolve the complex conflict. 

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Both Pakistan and Afghanistan have pointed the blame at one another over why fighting erupted over the weekend on the shared border – resulting in the worst conflict both sides have seen since the Taliban took over Kabul in 2021, reported Reuters. 

Regular clashes have long occurred on the 1,600-mile-long border over land disputes, but since the 2021 Taliban takeover, Islamabad has accused the Taliban of providing safe-haven to anti-Pakistan militants. 

The Taliban on Wednesday claimed that Pakistani forces launched attacks in the city of Spin Boldak in Afghanistan’s Kandahar Province, which sits right on the shared border, and said more than a dozen civilians were killed and 100 others wounded. 

An Afghan Taliban fighter sits on a tank near the Afghanistan-Pakistan border in Spin Boldak, Kandahar Province, following exchanges of fire between Pakistani and Afghan forces in Afghanistan, Oct.15, 2025.  (REUTERS/Stringer)

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Pakistan also claimed that four of its civilians were wounded in attacks by the Taliban forces in Chaman, which is the district directly opposite of Afghanistan’s Spin Boldak, reported Reuters. 

Additional fighting between troops and militants apparently broke out in a second area in Pakistan’s Orakzai district to the north, where Islamabad said six Pakistani paramilitary soldiers were killed and two security officials were wounded. 

Nine militants were also reportedly killed after the violence allegedly broke out during a search by Pakistani forces in an area that was attacked by militants last week in which 11 Pakistani soldiers were killed.

Afghan Taliban fighters patrol near the Afghanistan-Pakistan border in Spin Boldak, Kandahar Province, following exchanges of fire between Pakistani and Afghan forces in Afghanistan, Oct. 15, 2025.  (REUTERS/Stringer)

Reports on social media also suggested that a Pakistani intelligence office was hit on Wednesday in an incident in Peshawar, a city just to the north of Pakistan’s Orakzai district, though Fox News Digital could not independently confirm this. 

President Donald Trump last week suggested he could help end the conflict between Afghanistan and Pakistan, though neither side has said he had a role to play in the current truce and the White House did not immediately respond to Fox News Digital’s questions on the subject. 

A growing number of NATO allies are calling for harmonising national caveats that hinder the alliance’s ability to respond quickly to threats such as airspace violations — but the task is likely to be arduous.

As defence ministers from the 32 member states gathered in Brussels for a meeting on Wednesday, most allies called for a reduction in the use of national caveats in northern or eastern Europe, where an increasing number of airspace violations has been recorded in recent weeks.

Swedish Defence Minister Pål Jonson said “there’s room for improvement within the alliance” and that his country’s model should “inspire others”.

“It’s the mandate of the pilot, or commander of the surface vessels to make the call and that’s good,” he added.

His Dutch counterpart similarly lamented that different regulations among allies “make(s) it complicated when things get tough.”

“When the F35s are up in the air, you need to make sure that for everyone it’s very clear what the regulations are, the rules of engagement, and how then to also get to an agreement with the authorities,” Ruben Brekelmans said.

“We support the efforts by SACEUR by making sure that those regulations are harmonised and that we have one set of rules for this,” he added.

The two ministers echoed the US ambassador to NATO, Matthew Whitaker, who told journalists earlier this week that “it’s no secret that the more ‘national caveats’ there are on — especially our fighter jet assets — the harder it is for SACEUR to respond immediately.”

“Those are conversations that we’re going to continue to have within the alliance and to make sure that … where they can be reduced, they can be reduced,” he said.

‘Holding us back’

In effect, these caveats are limitations each nation places on the use of its forces during NATO missions.

In Afghanistan, for instance, some allies placed restrictions on where their forces could be deployed, what kind of weapons they were allowed to use and under what circumstances they could use them.

Another recurrent caveat is the requirement that the top national officer deployed to the NATO mission must first secure authorisation from their home country before taking part in any new operation.

When it comes to rules of engagement for airspace violations, one nation may allow an object to be shot down based on radar readings, whereas another may require visual confirmation first. They may also have different rules on what weapons their fighter jets can be equipped with.

This makes it very difficult for the Supreme Allied Commander (SACEUR), NATO’s top military authority, to act quickly in times of crisis.

NATO officials are nonetheless saying that national caveats were not a problem last month when nearly 20 drones violated Poland’s airspace, prompting NATO to deploy multiple fighter jets to neutralise some of them.

Mark Rutte, NATO’s secretary general, told reporters on Wednesday that allies responded “as we should have”. But he conceded earlier this week in Slovenia that national caveats “are holding us back” and “making us less effective”.

‘A greater appetite’ to resolve the issue

Complaints about how national caveats are hindering the alliance’s effectiveness are not new. NATO leaders already discussed reducing their use at a summit in Riga in 2006, in the context of operations in Afghanistan. These talks didn’t yield much.

In part, that’s because caveats are first and foremost political decisions, Rafael Loss, a senior policy fellow at the European Council on Foreign Relations (ECFR), told Euronews.

“Ultimately, it’s about citizens of those countries either dying or killing in the name of NATO and so that is the highest sort of sovereign decision that governments hold on to,” Loss said.

What they show, he added, is that “NATO in the end still consists of 32 different countries.”

But the global geopolitical landscape has vastly changed since the early 2000s, and the sense of urgency in Europe is much more acute due to Russia’s belligerence.

Airspace violations, some of them blamed on Russia, were also observed in Estonia, Romania and Denmark in rapid succession last month.

“I think given that the current security environment is much more immediately threatening and requires an urgent response, there is a greater chance that this time around, relating to air defence on the eastern flank, NATO has some greater appetite to really work through this difficult issue,” Loss said.

However, he added, the idea that national caveats could soon become a thing of the past is “far-fetched”.

‘Shoot them down’

Some leaders, like Hungarian Prime Minister Viktor Orban, have said the issue is simple.

“If you have drones which do not belong to your state, shoot them down,” he said earlier this month from Copenhagen where EU leaders discussed the possibility of erecting a so-called drone wall.

But while, in theory, countries may have the right to down drones or fighter jets that violate their airspace, in practice it’s not as clear-cut, especially for NATO allies.

Some countries, including those on the eastern flank, may just not have the capabilities to do so and therefore rely on NATO missions for air policing. And then there is the political element.

“Even if you’re capable of unilaterally shooting down a potential threat, you still have to wrestle with the fact that if this is not a somewhat coordinated response, you face the risk of other NATO allies not agreeing with your course of action and thereby your actions fracturing alliance cohesion,” Loss said.

Rutte on Wednesday said he disagreed with calls for Russian planes to be systematically downed if they enter NATO airspace.

“I think you have to make sure that you are absolutely convinced whether yes or no it is posing a threat. If it is posing a threat, we can do everything needed to make sure the threat will not materialise,” he said.

But if it is not posing a threat, he continued, allies should ensure the plane “will gently be guided outside of our airspace.”