Earlier this week, medical experts from around the world convened to address the health challenges associated with prolonged underground captivity. The virtual conference featured the powerful testimony of Nili Margalit, a pediatric ER nurse and survivor of Hamas captivity. Margalit was kidnapped from Nir Oz during the October 7th massacre, during which her father was murdered. She shared her firsthand account of the harrowing conditions she endured during her 55 days in captivity, where she also provided medical treatment to her fellow hostages. Prof. Hagai Levine: "As physicians, health care workers and scientists, we don’t have good understanding and definitions of this unique condition, of being a hostage, which could be considered as living hell. Most of them are civilians, kidnapped brutally from their homes and a music festival. Most of them saw horrible scenes, when the people they loved were murdered. Some of them were wounded during captivity. Each one of us, and each one of the organizations, especially international organizations such as WHO and ICRC, should ask himself: What can we do for the hostages?" Nili: "I was in captivity for 55 days and I was held mostly in an underground tunnel. Most of the group that I was with were elderly people above 73 years old. So we had some major risks. One of them was the conditions in the underground tunnel itself, a lack oxygen and high humidity, making it really hard to breathe in this situation. Another risk for those elderly people was the risk of falling, because they, all of them actually, were without their glasses so they didn't see very well. I know that the risk of falling at this age is a major risk." There was a risk, since we sat almost all of the day with very small room for movement, of pressure wounds, and also a need to treat the chronic illnesses. Q. How did you treat the other chronic illnesses? Nili: I did a list of medications for each and every one of them, what they had been taking during the morning and during the evening, and from the list, I chose the most major risk conditions, like kidney disease and high blood pressure. There were also diabetics, but because of the lack of food, at that point, it wasn't a very major problem. I asked for those medications, I got some of the medications, not all of the things that I asked for. But, then I had to adjust them to each and every one individually, to explain to them what they need to take in the morning, what they need to take in the evening. I tried to provide each and every one of them with their own regime of medication from the very small amount of medications that I had. Q. Some of those hostages were injured. You had very limited resources, if at all. What did you do? Nili: "We washed the wounds and tried to dress them with a little iodine. But the wounds became infected. So I decided to give antibiotics so the situation wouldn't get worse. I remember that it helped a little bit but it wasn't enough. The wounds didn't heal for many, many days, for more than two weeks. Then I saw that we had honey. And I remembered that I used to dress wounds after surgeries with honey during my work, because it improves the healing of wounds. I just used the honey that we eat on the wounds. And prayed that it would help. And it did, it cleaned all the wounds." Q. The situation is very stressful and also with psychological terror from Hamas. I know you had a hard time with your friend Yarden Bibas. How did you deal with the mental health consequences of captivity? Nili: "That was the hardest part, the mental health issue. I tried to be positive, I always tried to encourage them, to keep the faith that we were going to make it and we were going to survive. That we're going to live each day and see what happens next. Hour by hour, day by day, this is what we have to live right now. And encourage them a lot in talks. If someone was really, really down, or really in a bad situation, I tried to do some encouragement talks." Q. You had to make some difficult decisions personally and professionally. How did you deal with the ethical dilemmas? Nili: "I think that for me, the major ethical dilemma was the fact that I'm not the one that should make those decisions. I don't have the authority to make these decisions to give either antibiotics or to decide what kind of medication to take or to give Clonex to help them sleep. So, being the one that has to decide all those questions without the equipment, the one who has to make those decisions without enough equipment - I had some, but not enough. It was a really big dilemma. But I always explained to them what I was doing. I always asked their permission. I always told them what the consequences would be, what will happen if we're not going to do that or if we're going to do that. And also personally, I always questioned whether I was doing the right thing, whether my decision was the right decision. Will it make their health better, will it make their health worse? It was always a dilemma; every day was a dilemma." Q. As a released hostage and health professional, what is your advice to health professionals who will treat released hostages in the future? Nili: "I was released after 55 days, so I believe that the ones who will be released after more than 227 days, will have much more difficult mental health and physical health issues than when I was released. Two things I can say to them: When I came to the hospital, I was really isolated. They evacuated the entire floor for us. It was the right decision at the time, to isolate us and to tell us what happened on October 7th in very small pieces of information, and not just expose us to everything, to the news, to the phones, to the television. And the second piece of advice I can give: To be prepared for all kinds of scenarios, for all kinds of physical conditions, all kinds of medical transitions, for all kinds of mental conditions. To just adjust treatment for each patient individually. Treat each patient individually, by himself and provide what he needs. Whatever problem comes to the surface, because the immediate problems, the health risks, come first." Q. You are a real inspiration to health professionals all over the world. Is there anything else you would like to add for our listeners from all over the world to hear from you? Nili: "I just wanted to emphasize strongly how important it is that they all be released now. Every day in captivity carries a risk of being killed. So, they have to be released and come back home now."
