Handcuffed and dazed, she struggles to exit the trunk of the Jeep. She's barefoot and limping. She's bleeding near her temple. Her ankle is cut.
Her grey sweatpants are bloodied. At gunpoint, she is dragged by her long brown hair into the vehicle. A crowd looks on. The car speeds off.
That is the last time, captured in a video taken on Oct. 7, that Naama Levy, 19, was seen alive. She is among 17 female hostages aged 18 to 26 still held by Hamas somewhere in Gaza.
Their families fear the worst.
"Time is running out for Naama," said Levy's mother Ayelet Levy Shachar. "Time is running out for the vulnerable young women being held hostage at the hands of those who torture and abuse them."
Shachar was referring to the mounting evidence of rape, sexual violence and mutilation of women and men during the Hamas attacks in southern Israel on Oct. 7.
But sexual assault appears not to have been confined to Oct. 7. Two Israeli doctors, who have been treating released hostages, and an Israeli military official familiar with the matter confirmed to USA TODAY that some released hostages revealed they suffered violent sexual assaults in captivity.
All three spoke on the condition of anonymity.
One of the doctors assessed that "many" of the released Israeli female hostages aged 12 to 48 − there are about 30 of them − were sexually assaulted while held by Hamas in Gaza.
The doctor did not want to elaborate on the specific nature of the assaults out of concern for survivors. The doctor said that people who have been sexually abused typically have a mortality rate four times higher than someone who has not been sexually abused.
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The second doctor said many of the freed hostages exhibited signs of PTSD and "came to us as patients with the trauma of those who witnessed very severe sexual assaults."
The first doctor said that all of the freed hostages of reproductive age have been given pregnancy tests and screened for sexually transmitted infections.
The Hostages and Missing Persons Families Forum, a group that represents the families of those held by Hamas, recently released a selection of anonymous quotes it said were from a meeting between some of the released hostages and their families with Israel's war cabinet.
"First of all, they touch our girls," said one freed hostage in the meeting.
"My mother almost fainted here (during the cabinet meeting), because she knows what's going on there. She saw what was done to men," said the daughter of another freed hostage.
The Israeli military official said that, just as authorities know that many women were sexually assaulted during the Supernova music festival and at their homes on Oct. 7, "we know they were raped in Hamas captivity."
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The official said that "we know" that the remaining female hostages are being kept in "very bad mental and physical conditions." The official said the hostages are being beaten, don't have access to enough food, water and medicines, and are held in southern Gaza, where they are transferred from house to house, sometimes over the ground and sometimes through tunnels, to avoid detection.
The official said some of this information comes from testimony from the released hostages and other parts of it from Israel's intelligence gathering network, which the official would not comment on.
President Joe Biden, who has tried to balance support for Israel’s retaliation against Hamas with concern for Palestinian civilians, has forcefully denounced Hamas’ reported use of sexual violence against Israeli women and girls. He’s called it “appalling and unforgivable.”
“We all have to condemn such brutality without equivocation, without exception,” Biden said at a Hanukkah holiday reception at the White House this month.
Thirty-three American senators wrote a letter in mid-December to U.N. Secretary General António Guterres urging the international body to launch an immediate independent investigation into Hamas' use of sexual assault on Oct. 7. Volker Turk, the U.N.'s high commissioner for human rights, has claimed that Israel has blocked his team's investigators.
Five volunteers and first responders who collected and helped identify the bodies of those killed during the attacks on Oct. 7 said they observed multiple signs of obvious and incontestable sexual assault. This included women naked from the waist down, with their legs splayed or underwear torn. USA TODAY was shown photographs and video that appeared to corroborate these assertions, which have been backed up by forensic pathologists.
"We went from house to house and never knew what were going to find," said Nachman Dickstein, a volunteer for ZAKA, a search and rescue group that works close with Israel's military and government.
Israeli medical professionals and morgue workers said many women who died on Oct. 7 were found with broken legs and pelvic bones. They said that the severity of the mutilations they examined were such that it was not always possible to distinguish female from male victims. At least one survivor of the attack who was at the Supernova music festival on Oct. 7 near Gaza has told Israel police that she witnessed a gang rape.
Despite this evidence, Hamas has consistently denied accusations it used sexual violence on Oct. 7. It has claimed the allegations are part of an attempt by Israel to distract from its mass killings of civilians in Gaza. International human rights groups waited two months before finally condemning the sexual violence.
The evidence of sexual violence on Oct. 7 is “overwhelming and irrefutable,” said Carly Pildis, director of community engagement at the Anti-Defamation League, an advocacy group that works to fight antisemitism and extremism.
“The voices of so many of these women and girls were stolen by Hamas, but their bodies tell the tale,” Pildis said. “Broken pelvises. Mutilated genitals. Brutalized bodies. Then we have eyewitnesses coming forward with stories of gang rape, of torture, of murder."
Anti-Jewish bias makes it easier for some people to refuse to believe these accounts of sexual assault, Pildis said.
“We are living in this believe-all-women era, and somehow that philosophy vanished very quickly when we're talking about Israeli women,” she said. “It’s really hard not to see that as ingrained antisemitism, ingrained bias that leads people not to want to believe these voices.”
Still, one of the doctors treating the freed hostages said establishing whether sexual assault has taken place is not a straightforward exercise. For a start, physical evidence in the form of body fluids, cuts and bruises can disappear quickly while verbal testimony from victims can take months, years and even decades to materialize.
"The first few days after the hostages were released, they mostly talked about how they lacked adequate food. Then they started to talk about how kids were separated and left in isolated rooms on their own. Then they talked about the aggressiveness of Hamas and how some of the sick and elderly were refused their medications. Finally it was physical violence. It was step-by-step, which is usually how sexual violence testimony goes."
The doctor said it took decades in Israel before soldiers who were abducted and sexually assaulted during the 1973 Yom Kippur War between Israel and a coalition of Arab countries led by Egypt and Syria started talking about their experiences.
It’s not uncommon for sexual assault victims to go for significant periods without remembering what happened to them only to recall details later, said Jim Hopper, a U.S.-based clinical psychologist and nationally recognized expert on psychological trauma.
Sexual assault is so horrific that some victims basically check out while it is happening, he said. Some may feel as if they’re floating on the ceiling or that they’re dreaming or in a movie and thus may not have a conscious awareness of what is actually happening to them, Hopper said.
Later, they may encounter something – a particular place, person or event, for example – that acts as a trigger and enables them to recall specific information that has been stored away in their brain about the assault, Hopper said.
Defense attorneys will often point to a victim’s delayed memory recall or inconsistencies in those recollections to try to cast doubts on the victim’s credibility. But research suggests that as few as 5% of reports of sexual assault are false, Hopper said.
Chen Goldstein-Almog, a freed hostage who was held by Hamas in Gaza, told Israeli broadcaster Kan that three women held hostage with her told her stories of being sexually abused by their captors.
However, Goldstein-Almog, 48, did not indicate whether she herself was sexually assaulted.
One of the doctors treating freed hostages said one of the clearest pieces of evidence for how the hostages who remain in captivity may be being treated by Hamas is Levy, the bloodied 19-year-old woman who was caught on video being bundled into the back of the Jeep at gunpoint.
Shachar, her mother, said she struggles to watch the video of her daughter, who she has described as a "joyful" sweet-natured character who likes to dance with her friends, enjoys athletics and dreams of a career in diplomacy.
Each moment is the most indescribably gripping pain Shachar has ever felt. Her heart is shattered. Her nights are haunted by the absence.
Contributing: Michael Collins and Maureen Groppe. Illustrations by Veronica Bravo/USA TODAY.
If you are a survivor of sexual assault, RAINN offers support through the National Sexual Assault Hotline (800.656.HOPE & online.rainn.org).
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