Israel braces for pregnancies in captivity
Israelis attend a rally at “Hostage Square” in Tel Aviv calling for the release of hostages held by Hamas terrorists in Gaza, June 15,2024. Photo: Avshalom Sassoni/Flash90

A new study aims to guide medical teams in handling the ramifications of sexual assault on hostages.

By Maytal Yasur Beit-Or
June 21, 2024

The Israeli healthcare system is preparing to deal with pregnancies resulting from sexual assaults during captivity.

An article was published in the June issue of the Israel Medical Association’s journal “HaRefuah” to instruct medical teams on addressing this “sensitive, difficult-to-comprehend, yet unavoidable matter.”

The piece, written by Lt. Col. (res.) Dr. Leah Shelef, former head of the Air Force’s psychology department and current dean of Sapir College’s School of Social Work, and Professor Gil Zalsman, director of the Geha Mental Health Center, aims to prepare caregivers for any situation. This includes cases where emotional or religious factors might prevent pregnancy termination or instances where former captives struggle with the decision, requiring counseling.

The researchers emphasize that the study’s intent is preparatory, not prompted by concrete information about pregnancies during captivity. Its goal is to understand the ramifications in advance.

Sexual violence against captives has been a topic of public discourse, particularly following the courageous testimony of released hostage Amit Soussana about enduring sexual assault while in captivity, as well as the accounts of Aviva Segal and Agam Goldstein-Almog, and a U.N. report on the subject.

PTSD and dissociation

The limited research available, focusing on Yazidi women assaulted by ISIS in Syria and Iraq, as well as rape victims from conflicts in Yugoslavia, Rwanda and Ukraine, highlights psychological issues faced by those who became pregnant from captivity-related assaults.

These include a high prevalence of post-traumatic stress disorder (PTSD), anxiety, depression, suicidal tendencies, severe dissociation (detachment), body image disturbances and sexual dysfunction. Behavioral consequences such as alcohol and drug abuse were also noted.

The risk of developing PTSD after such an assault is 6.2 times higher than for women not victimized by crime. When the assault is compounded by other traumas such as physical attacks or torture, the incidence of depression, anxiety and body image disturbances increases further.

A German study of 296 Yazidi survivors found that 67% suffered from body image disturbances, 53% from depression, 39% from anxiety and 28% from dissociation. PTSD prevalence ranged from 39% to 57%, depending on the number of assaults endured.

However, women with higher education and no prior mental health issues exhibited better post-traumatic growth, aided by appropriate and sensitive treatment. Estimated pregnancy rates after rape are around 5%, though the actual figure could be higher.

The study on Yazidi women’s coping mechanisms emphasizes that caregivers must prepare for all eventualities and respond empathetically and non-judgmentally. It also notes that late-term abortions (after 24 weeks) could be traumatic.

Shelef and Zaltzman state, “It is crucial to respect the victim’s decision without paternalism or preconceptions. However, the transition from complete lack of autonomy during captivity to the freedom to decide about the pregnancy could be disorienting, necessitating counseling from the medical team if the survivor struggles with the decision.”

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