Iranian ballistic missiles struck Soroka Hospital in Beersheba in southern Israel and sites in the Tel Aviv area on Thursday morning, wounding 89, including three seriously.

A missile struck the hospital’s old surgical building, severely damaging it and causing what a Soroka spokesperson described as “extensive damage in various areas” of the hospital complex. The surgical building had been recently evacuated in light of the war, and patients and staff had been moved to areas with reinforced walls. Injuries from the strike were light, hospital representatives said.

Soroka is the largest hospital in the Negev, such that the strike left a large swath of Israel without a functioning major medical center. Other hospitals in the area, including Barzilai Medical Center in Ashkelon and Assuta Medical Center in Ashdod, prepared to take in patients from buildings that were damaged. Magen David Adom provided four intensive care buses, able to transport a total of 23 ICU patients and 50 lightly injured casualties.

Israeli Foreign Minister Gideon Sa’ar wrote that “The Iranian regime fired a ballistic missile at a hospital. The Iranian Regime deliberately targets civilians. The Iranian regime is committing war crimes. The Iranian regime has no red lines.”

Prime Minister Benjamin Netanyahu posted on X that “Iran’s terrorist dictators shot missiles at Soroka Hospital in Beersheba and the civilian population in the center of the country. We will make the dictators in Tehran pay the full price.”

Israeli Defense Minister Israel Katz said in a statement that the price would be to destabilize the Islamic Republic’s regime.

“The prime minister and I instructed the IDF to increase the force of the attacks against strategic targets in Iran and against governmental targets in Tehran to remove the threats to the State of Israel and undermine the Ayatollahs’ regime,” he stated.

Iranian news agency IRNA claimed that the target of the strike was an IDF intelligence outpost in Beersheba’s HiTech Park, which is over a mile away from the hospital. A television channel tied to the Islamic Revolutionary Guard Corps said that the missile was aimed at a “military hospital” in response to strikes on “civilian hospitals” in Gaza.

In the same 30-missile barrage, Iranian missiles struck a school in Holon. No children were present, because schools have been closed across Israel since Friday, but three elderly residents of adjacent buildings were wounded in serious condition, in addition to 62 others with minor to moderate injuries.

Another missile struck near the Ramat Gan Diamond Exchange, abutting Tel Aviv, causing minor injuries to 21 people and damage to 20 buildings in the neighborhood, which includes some of Israel’s tallest buildings.

Shrapnel struck Sheba Medical Center, Israel’s biggest hospital, also in Ramat Gan.

Overnight, the IDF intercepted several drones launched by Iran at Israel towards central and northern Israel. 

Jordanian authorities reported that an Iranian drone fell in a shopping center north of Amman, damaging a car and a bus station. Syrian media reported that an Iranian drone was shot down over the country.

The IDF struck an inactive nuclear reactor near Arak in Iran early Thursday after sending warnings to civilians in the area. The IDF Spokesperson’s Office said the strike included “the structure of the reactor’s core seal, which is a key component in plutonium production.”

“The strike targeted the component intended for plutonium production, in order to prevent the reactor from being restored and used for nuclear weapons development,” the IDF Spokesperson’s Office said.

The IDF also gave details of strikes on the active nuclear site in Natanz, which “contained components and specialized equipment used to advance nuclear weapons development and projects designed to accelerate the regime’s nuclear program.” 

In addition, 40 IAF fighter jets struck dozens of military targets in Tehran and other parts of the country, including factories manufacturing ballistic missile and air-defense components, as well as air-defense batteries, surface-to-surface missile storage sites, radar systems and other targets.

IDF Chief of Staff Lt.-Gen. Eyal Zamir sent a letter of encouragement to IDF soldiers and commanders on Thursday, saying that they are “writing a new chapter in history for the State of Israel and the entire Middle East.”

”Thanks to a decisive and impressive surprise opening strike, we have achieved tremendous goals: We eliminated the regime’s command echelons, delivered a deep blow to the capabilities used for the Iranian nuclear program, identified and struck missile launchers, and we are continuing and increasing the strength of our operations as necessary,” Zamir wrote.

Iranian news reported that the country’s military shot down a second Israeli Hermes Drome. The IDF confirmed that Iran downed the first UAV a day earlier.

Israel’s Home Front Command loosened restrictions on Israelis on Wednesdays, allowing people to return to workplaces with safe rooms and for up to 30 people to attend synagogue at a time. Schools and kindergartens remained closed.

A poll published by the Israel Democracy Institute found that 70% of Israelis support the campaign launched against Iran last week, while 10% support the campaign but think the timing is wrong and 13.5% oppose it. Among Israeli Jews, 82% support the strikes, whereas only 11% of Israeli Arabs do, according to the poll. Jewish Israelis across the political spectrum support the operation: 57% of those who self-identify as left-wing, 75% of centrists and 90% on the right.

Though in past polls, most Jewish Israelis did not think Israel should strike Iran without help from the U.S., this week 69% thought it was the right decision. In addition, 68% of Jewish Israelis thought that Netanyahu’s motivation behind launching the operation against Iran was security-related, while 68% of Arab Israelis thought it was political.

The poll was conducted this Sunday-Tuesday among 594 Israelis, with a 3.61% margin of error.

When Israelis held hostage by terrorists in Gaza are released, there is a flurry of attention. Members of the media descend on the hospitals to which the newly freed hostages are sent. Dozens of photos of the former hostages and their families are disseminated from the hospitals. Siblings and other relatives give interviews about the returnees’ medical conditions and what they said about their treatment in Gaza. 

Soon after, however, the public no longer hears much from most of them. To be sure, some gave high-profile interviews, while others found themselves on red carpets. Some were cheered by whole soccer arenas. The divorce of one former hostage from her husband has turned into gossip fodder in Israel. But for the most part, their day-to-day struggles are not on the public’s radar, even as the former hostages’ recoveries from their physical and mental injuries continues.

Beilinson Hospital in Petah Tikva, in central Israel, has treated and continues to treat hostages released in the ceasefire that took place earlier this year: female soldiers Naama Levy, Karina Ariyev, Agam Berger, Liri Albag and Daniella Gilboa, as well as Tal Shoham, Omer Wenkert, Eliya Cohen and Omer Shemtov.

Dr. Michael Bahar, director of the Rehabilitation Unit at Beilinson, who has been overseeing their recovery, told Jewish Insider in the hospital this week that his department “built rehabilitation programs based on each patient’s specific needs. It’s a multidisciplinary process, working with physical therapists, occupational therapists, dieticians, nurses and psychologists. For the rehabilitation of the female soldiers, “we work with the IDF,” he added.

“It’s been three months, and for some it continues, and we’re always thinking about the next stage,” Bahar said. “Every day of treatment has a schedule, matching each patient’s needs — physical, cognitive and beyond.”

The returnees come to the hospital multiple times a week for treatments that range from more traditional medical appointments to working with dieticians to ensure they are eating properly after over 500 days of malnutrition to exercises that strengthen injured limbs and improve aerobic activity. 

Some of the treatments are in groups and include enjoyable but rehabilitative activities, such as cooking and dance classes. The returned hostages exercise using virtual reality headsets, and a ping-pong table was brought in at the request of one of the hostages, who then played with his family.

“They are accompanied by their psychologist, who plays a central role, because they can say when it’s too early to do something or if it’s the right time … They are starting to deal with participation in active lives in society, in school, with family,” Bahar said. The former hostages have had to consider whether the time is right to start working or studying, what kind of social activities they feel comfortable doing, whether they can drive and more.

The Rehabilitation Unit at Beilinson also treats many wounded soldiers, and Bahar said they and the former hostages have found it meaningful to undergo joint treatment and exercises together, including in the department’s pool.

“The soldiers felt that they were fighting to free the hostages, so we connected between them,” Bahar said. “One evening the [female soldier hostages] went to visit the wounded soldiers in the department. It was an indescribable moment. They couldn’t speak, they were so excited … It was very significant, very powerful for the soldiers and the returnees.”

Some of the hostages are still undergoing complex medical procedures, which they were given the option to delay. Freed hostage Romi Gonen, who was treated at Sheba Medical Center in Tel Hashomer, shared this week that she is undergoing a second surgery on her hand.

Dr. Noa Eliakim-Raz, head of the Returnees Ward and one of Beilinson’s six internal medicine departments, said that the staff has made sure to treat the returnees as “free people with the right to choose” after a year and a half in which their freedom was violently taken from them.

“Medically, we thought it was good to postpone some procedures and to give them the right to decide. If they say they want to postpone in order to go abroad, we can let them prioritize and decide for themselves. It’s clear to them that we are here for them, whenever they need us,” she said.

Beilinson set up the Returnees Ward on a floor of the Schneider Children’s Medical Center, which is in the same complex as the larger hospital. The entrance is through a corridor decorated with a cartoon dinosaur mural, with glass sliding doors that few hospital employees are able to access. They open up to signs that say “Now you’re home,” “We’ve waited for this moment,” and feature psalms thanking God for their return.

The department was set up after the November 2023 ceasefire, in which 105 hostages — mostly women and children — were released. Beilinson treated seven adult returnees — six mothers and a grandmother — while their children released from captivity were cared for at Schneider, all in the same department.

“Once that ended, we realized that everyone else who would come back would be adults and we started to prepare to receive them,” Eliakim-Raz said. “We hoped we would not have much time, but we had a lot of time to prepare.”

The department has room for up to 12 hostages, though the most it has treated simultaneously is nine. Two hospital rooms were designated for each returnee, one for the former hostage and another for family to sleep next door. Lounges were set up for the returnees to spend time together and to receive guests, including one with a sweeping view of the hospital campus, including the helipad on which the freed hostages arrived. A closet was filled with supplies the families may have forgotten to bring them: sweatsuits and pajamas, fluffy towels, slippers and flip-flops, stuffed animals, markers and paper — and lice removal shampoo.

Over time, Eliakim-Raz and her team compiled a medical protocol of hundreds of pages to prepare for the hostages’ return, listening to the testimony of those who already returned and poring over medical papers about other hostage situations, like in the Yom Kippur War, and Holocaust survivors. They also performed simulations of handling a group of freed hostages.

“So much changed, because being a hostage for 50 days is not like being there for over a year,” she said. “The preparation was complex. Soldiers male and female have different needs, there are other areas of care for young women, and much older adults have totally different problems. We prepared for every population and every scenario we could think of.” 

“Every discipline involved needed to know what to prepare for, what it means psychologically and physically. The dieticians had to think about what they would encounter in someone who spent 550 days underground … What effect does a lack of stimuli have on younger and older people,” Eliakim-Raz said. 

Dr. Michal Steinman, director of nursing at Beilinson, said that they also considered what being kept underground for long periods of time would mean, and whether the returnees would need dimmer lights or special glasses. They also thought they may need to help the returnees adapt to a more normal sleep schedule, though she found that “each one managed to keep track of time in their way. It was an amazing survival instinct, but it had psychological and bodily consequences.”

Steinman said she is “used to working on evidence-based medicine, but here we had to work based on clues. We examined the stories we heard and read and had to think of different variations to prepare. It was detective work.”

“We were well-prepared, but the real moment was indescribable,” Steinman said of the hostages’ arrival.

Each time hostages landed on the helipad in Beilinson, Eliakim-Raz said she “tried to give them a feeling of a home, more than a hospital. It’s a sort of warm capsule between captivity and home … It gives a lot of security. They are protected here. We didn’t let media in, and only people they wanted to see could be here. It was very closely managed.” 

Steinman said the hospital’s treatment also extended to the hostages’ relatives, who in some cases had neglected their own health and underwent examinations by the doctors at Beilinson. Steinman and a mental health professional held nightly group meetings with the parents of the hostages when they were staying in the hospital, to answer questions about their children’s health.

“The public is excited about the hugs and kisses” when the hostages are reunited with their families, Eliakim-Raz said, “but the real difficult stage is at the end of the process when they have to go home.”

The continued outpatient rehabilitation program gives the returnees “continuity,” Bahar said. “They went back home but are still in this very safe environment.” 

The medical literature about Holocaust survivors and Yom Kippur War prisoners of war who returned to Israel shows that those who are back from Gaza are likely to have long-term risks to their health.

“We see [in the literature] PTSD [post-traumatic stress disorder], depression and dangerous behaviors,” Eliakim-Raz said. “The body remembers and we don’t understand how, but it is in a more inflamed state than their peers. That can impact metabolic symptoms and cause a higher rate of strokes … I hope that they will have nothing and be healthy and happy, but the literature says that chances are that is not what’s going to happen.”

“If we don’t continue to reach out [to the hostages] now, maybe no one will make that connection in the future. They deserve that someone will examine them. We want to continue — they deserve that … We are going to actively invite them to checkup days and bring them in as a group to try to catch things early,” she said.

Like many Israelis, Steinman continues to try to follow what her patients are up to through the media. 

“When I see them on TV, I’m so excited,” she said. “The group we met are inspirational. They went through a very difficult captivity and returned with a strong enough foundation to be rehabilitated and build a quality life. The scars will remain, but they all have great mental strength.” 

That being said, the hostages who stayed at Beilinson all expressed forms of survivors’ guilt.

“They don’t feel ready to be fully rehabilitated until their friends get out” of Gaza, Eliakim-Raz said.

Meanwhile, the team at Beilinson is preparing in case they are entrusted with the care of some of the 20 remaining living hostages when they are released. Nurses check the medications in the department every week to make sure they aren’t expired, and the clothing to see that it fits the season.

Steinman said that recent hostage talks and the hope that the remaining hostages will be freed “takes me back to the long time we waited before … We’re back in the days of anticipation, and I don’t know when it will happen. For the 500 days of preparation before [the ceasefire that began in January], it was an emotional time. Sometimes we despaired.”

Steinman and Eliakim-Raz said that they put off travel plans because they don’t want to miss the hostages coming home: “This is where I need to be,” Steinman said.

“Everyone is waiting to see them return — though you can’t compare it to the families. For us, as a medical team, there is anticipation … We knew what to do and we did it well, and we want to do it again,” she added.