By MELANIE LIDMAN, Associated Press

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.

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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.

Elkana Bohbot, an Israeli hostage released from the Gaza Strip waves walks off a helicopter at the Sheba Medical Center in Ramat Gan, Israel, Monday, Oct. 13, 2025. (AP Photo/Leo Correa)

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 fighters 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.

Ziv Berman, an Israeli hostage released from the Gaza Strip gestures from a minibus at the Sheba Medical Center in Ramat Gan, Israel, Monday, Oct. 13, 2025. (AP Photo/Leo Correa)

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.

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.”

Recently fired Centers for Disease Control and Prevention employees on Tuesday called the Trump administration’s recent mass layoffs an “intentional attack” on the agency and Americans’ health.

More than 1,300 CDC employees were abruptly terminated Friday, with about half reinstated within 24 hours. About 600 staffers remain dismissed, according to internal estimates, fulfilling the administration’s threats to slash government jobs during the ongoing shutdown.

Unions and court filings over the weekend indicate that an estimated 4,200 federal workers across at least seven agencies began receiving reduction-in-force notices on Friday. In addition to the Department of Health and Human Services (HHS), the CDC’s parent agency, which lost more than 1,100 staffers, the Environmental Protection Agency and the Education, Treasury, Commerce, Energy, and Homeland Security departments also faced significant cuts.

The Tuesday press briefing was hosted by the National Public Health Coalition, a group of terminated CDC workers and public health allies founded by former CDC public health adviser Abigail Tighe. During the briefing, an anonymous CDC scientist who was terminated Friday described the day’s events as stressful but unsurprising.

“It’s been emotionally and mentally and physically exhausting. It’s like being in a strange game where there’s no rules and we don’t know what’s going to happen next,” she said. “At this point … I’m pretty numb to it. I saw it coming. I wanted to stay as long as I could, but I knew they’d get me at some point.”

Tighe said many HHS employees were told the mass firing and rehiring stemmed from a technical coding error, but she and other former federal workers maintain that the terminations were deliberate. “These terminations were not a glitch,” she said. “It was not an innocent error.”

Former CDC officials John Brooks and Karen Remley warned that the cuts, especially to CDC, have eroded coordination between federal and state health departments, leaving the nation dangerously unprepared for future public health emergencies.

Tighe noted that about one-quarter of the agency’s workforce has been lost since the 2025 reduction-in-force process began, leaving few medical or public health professionals in leadership roles.

Among the CDC programs affected are the Center for Chronic Disease Prevention and the National Center for Health Statistics (NCHS), as well as the agency’s Washington office, human resources and library divisions.

Maryland impact, building on earlier cuts

The CDC division of the National Center for Health Statistics in Hyattsville, which runs the National Health and Nutrition Examination Survey (NHANES), lost all its staff on Friday, according to media reports. The office conducts research that guides public health policies on nutrition, oral health, and environmental risks.

NHANES is the nation’s main source of information on Americans’ health and nutrition, including birth and death rates, according to the National Library of Medicine. Brooks said it would be “very worrisome if these areas of vital statistics were lost.”

NCHS Director Brian Moyer did not respond to requests for comment. The National Public Health Coalition could not provide exact numbers of workers affected in this office or elsewhere in Maryland.

Remley warned that the local impact of cuts could be serious. “It has a significant ripple effect … you don’t know you need [public health] until you need it because it’s in the background,” she said. “All of those are eroded, and so I think at a state and local level, it’s very, very scary.”

Maryland had already lost about 12,700 federal jobs since the beginning of the second Trump administration, according to a state labor department spokesperson. HHS, which includes the CDC, accounted for the most layoffs in the first half of the year, primarily in Montgomery, Prince George’s and Baltimore counties, along with Baltimore City.

Have a news tip? Contact Mennatalla Ibrahim at mibrahim@baltsun.com.

By BRIAN INGANGA, NQOBILE NTSHANGASE and GERALD IMRAY, Associated Press

ANTANANARIVO, Madagascar (AP) — The leader of Madagascar’s military coup told The Associated Press on Wednesday that he is “taking the position of president” and that the armed forces would be in charge of the African island nation for up to two years before any elections are held.

Col. Michael Randrianirina, who led the rebellion that ousted President Andry Rajoelina on Tuesday following weeks of youth-led protests, said in his first interview with a global news outlet since taking power that he expects to be sworn in as the country’s new leader in the next few days.

“There must be an oath-taking” to make his position official, Randrianirina said at his unit’s barracks while flanked by fellow officers. “We are staying here for at least 18 months, at most two years.”

Randrianirina announced Tuesday that the armed forces were taking power in Madagascar, a sprawling country of about 30 million people off of Africa’s east coast that is the world’s leading vanilla producer and is known for its unique biodiversity. Since gaining independence from France in 1960, it also has a history of coups and political crises.

The latest military takeover capped weeks of protests against Rajoelina and his government led by youth groups calling themselves “Gen Z Madagascar.” The protesters, who also included labor unions and civic groups, have demanded better government and job opportunities, echoing youth-led protests elsewhere in the world. Among other things, the Madagascar protesters have railed against chronic water and electricity outages, limited access to higher education, government corruption and poverty, which affects roughly three out of every four Madagascans, according to the World Bank.

Although some suggest the military seized power on the backs of the civilian protesters, demonstrators cheered Randrianirina and other soldiers from his elite CAPSAT unit as they triumphantly rode through the streets of the capital, Antananarivo, on Tuesday, with one protest leader telling the AP “the military is listening to us.”

The takeover was “an awakening of the people. It was launched by the youth. And the military supported us,” said the protest leader, Safika, who only gave one name as has been typical with the demonstrators. “We must always be wary, but the current state of affairs gives us reason to be confident.”

The map above locates Antananarivo, the capital of Madagascar. (AP Digital Embed)

The protests reached a turning point Saturday when Randrianirina and soldiers from his unit sided with the demonstrators calling for the president to resign. Rajoelina said he fled to an undisclosed country because he feared for his life.

Randrianirina explained that he is taking over as Madagascar’s head of state because the country’s High Constitutional Court invited him to do so in the absence of Rajoelina. He previously said the military had acted on behalf of the people and cast the coup as a move to “restore” the country.

“We had to take responsibility yesterday because there is nothing left in the country, no president, no president in the senate, no government,” Randrianirina said. The colonel said the military leadership was “accelerating” the appointment of a new prime minister “so that the crisis in the country does not last forever.” He didn’t give an exact time frame for that to happen.

Rajoelina, who first came to power as a transitional leader in a 2009 military coup, was elected president in 2018 and reelected in 2023. He fired his government last month in an attempt to appease the protesters after a crackdown by security forces left 22 people dead and more than 100 injured, according to the United Nations. Rajoelina’s government disputed those figures.

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The exiled Rajoelina, 51, has rejected the military takeover’s legitimacy.

But Randrianirina pushed back on that, telling the AP: “What is he saying is illegal? We have an order from the High Constitutional Court. We did not force the HCC or point a gun at it to issue this.”

Randrianirina’s claim that his authority to take over as president came from the country’s highest court seemed to contradict his announcement Tuesday that the military council that was taking power had suspended that court’s powers.

In a statement, Rajoelina’s office claimed that some of the high court’s judges had been threatened so they would sign off on the colonel’s ascendency.

There was no significant immediate reaction to the takeover by other countries or the African Union, which had called an emergency meeting of its security council.

Some analysts have described Madagascar’s youth movement as an expression of understandable grievances over government failures, and condemned the military takeover.

“Gen-Zers in Madagascar have been on the streets of the country protesting the lack of essential services, especially water and electricity, and the negative impact on their lives for almost a month,” said Olufemi Taiwo, professor of Africana studies at Cornell University. “This is a civil society uprising and its resolution should not involve the military.”

He called for the African Union to condemn “another coup” that Africa “does not need,” adding that no country should recognize the new military leadership.

Imray reported from Cape Town, South Africa. Associated Press reporter Sarah Tetaud contributed to this report.

More AP Africa news on Madagascar’s military takeover: https://apnews.com/hub/madagascar

The Texas National Guard sent home seven soldiers whose fitness levels seemingly “did not meet mission requirements” for their deployment to Illinois, a Texas Military Department spokesperson confirmed Tuesday.

In a statement provided to the Tribune, the spokesperson said the service members were replaced “during the pre-mission validation process” at the U.S. Army Reserve training center in suburban Elwood, where the troops have been garrisoned since last week.

“These service members were returned to home station,” according to the statement.

The decision comes after some soldiers were ridiculed on social media for their physical appearance upon their arrival in Illinois. Widely circulated media photographs showed heavier guardsmen at the Elwood base, prompting critics to question how the troops fit in with U.S. Defense Secretary Pete Hegseth insistence that all military members must meet height and weight standards.

Hegseth — who told top military leaders last month that it was “tiring” to see “fat troops” — signaled his support for the soldiers’ removal on social media Monday.

“Standards are back at The @DeptofWar,” he posted on X, along with a screenshot of a story about the Texas National Guard’s decision.

The Texas Military Department did not specify which standards the seven Guard members did not meet, but the statement said the department “echoes Secretary Hegseth’s message to the force: ‘Our standards will be high, uncompromising, and clear.’”

A federal judge in Chicago last week blocked the Trump administration from deploying National Guard troops to Chicago and the rest of Illinois as part of its ongoing immigration enforcement push. In response, the Trump administration requested an emergency stay of the order, which was denied by a federal appeals court in Chicago on Saturday.

The 7th U.S. Circuit Court of Appeals, however, did allow National Guard members already in Illinois to remain here during the appeal.

“Members of the National Guard do not need to return to their home states unless further ordered by a court to do so,” the court order said.

In her oral ruling from the bench, U.S. District Judge April Perry, an appointee of former President Joe Biden, said National Guard troops are “not trained in de-escalation or other extremely important law enforcement functions that would help to quell these problems,” and that allowing troops to come into Chicago “will only add fuel to the fire that the defendants themselves have started.”

The Department of Justice argued in a filing Friday night that Perry’s order “improperly impinges on the Commander in Chief’s supervision of military operations, countermands a military directive to officers in the field, and endangers federal personnel and property.”

There has been no visible presence of the Texas National Guard since last week’s ruling. Before the judge’s ruling, the troops were spotted at an Immigration and Customs Enforcement detention center in west suburban Broadview, but they did not interact with protesters.

The Pentagon has not clarified what the Guard members will be doing while the appeal plays out. Uniformed troops have been spotted a U.S. Army Reserve Center in recent days, with a few appearing to be carrying rifles as they walked around the 3,600-acre property about 50 miles southwest of Chicago.

ostevens@chicagotribune.com