The hostages held by Hamas in Gaza are at an “immediate risk of death” due to starvation, according to a report released Monday by the Hostages and Missing Families Forum.

The report, described in a press release by the group representing relatives of most of the 50 hostages still held by Hamas in Gaza, said the policy of starving the hostages is intentional.

The report was published days after videos were released showing hostages Rom Braslavski and Evyatar David both looking emaciated. The videos prompted shock in Israel and beyond, and lent greater urgency to calls to free the hostages, at least 20 of whom are thought to be alive. The report was also published as global outrage has mounted over reports of widespread starvation and deaths from malnutrition among Palestinians in Gaza.

The report was compiled by three medical and public health experts. It was based on the videos of David and Braslavski, as well as testimonies from released hostages and examinations of those who were killed.

“[T]he hostages still held alive in Gaza are suffering from deliberate, prolonged, and systematic starvation — an advanced medical state of severe hunger, causing multisystem damage and posing an immediate risk of death,” the report said.

“According to testimonies, the food provided to the hostages was minimal, nutritionally poor, and lacking essential nutrients — at times, no more than half a pita per day,” the report said. “Hostages reported constant hunger, entire days without food, persistent exhaustion, and the use of food as a means of punishment.

Some hostages who were released earlier this year also looked emaciated. Iair Horn, a dual Israeli-Argentinian citizen who was taken hostage in the Hamas-led October 7, 2023, attack, said in July that the paucity of aid in Gaza meant hostages would also get less food.

“When there’s less food, then there’s also less for the hostages. When there’s aid, there’s a possibility you might get a cucumber,” said Horn, 46.

The researchers assessed that David and Rom Braslavski are severely underweight, based on the videos.

David has lost more than 40 percent of his body weight, while Braslavski has dropped 31%, the report said. Their gaunt appearance, as well as that of hostages who were released during a ceasefire earlier this year, led to comparisons to Holocaust survivors.

In the video of David, he appeared skeletal and was shown digging what he said he feared was his own grave.

The report said the hostages are at risk of suffering from what is known as “starved brain,” a condition with effects, it said, that include “memory impairment, cognitive decline, depression, confusion, apathy, and in some cases, hallucinations.”

The report added that the hostages are at added risk because they are kept out of daylight, deep underground, without access to clean water or medical care.

“The medical evidence is unequivocal. The hostages in Gaza are in a state of extreme hunger and face an immediate risk of death due to deliberate starvation,” Hagai Levine, head of the forum’s health team, said in a statement. “The outcome of this cruel experiment is foreseeable — body and mind will gradually deteriorate until they collapse.”

He added, “Any further delay in rescuing the hostages may cost human lives. We must not stand idly by while our brothers vanish. We must act now to bring them all home.”

Negotiations over a ceasefire and hostage release deal hit an impasse in July. On Monday, Prime Minister Benjamin Netanyahu reportedly conveyed that Israel will now seek to fully occupy Gaza, including fighting in areas where hostages are held.

David’s first cousin, Matan Eshet, told The Times of Israel that the family did not pay close attention to the medical team’s report.

“They can tell me his medical condition and the statistics, but he’s in such bad shape that I can see it with my own eyes,” said Eshet. “I don’t need a degree to tell me that he’s on the brink of death.”

David’s family first caught a glimpse of the video on Telegram on Friday night, but did not watch it, said Eshet, knowing it would break their spirits.

“I was broken when I saw it,” says Eshet. “My cousin doesn’t look or sound like himself. He looks like a copy of a copy of a copy of Evyatar.”

Eshet said he had hoped for a glimpse of the cousin he knows. What angered him the most was seeing the meaty hand of the Hamas terrorist shown in the uncut video, next to David’s emaciated body.

He said he is taking a break from social media because he keeps seeing his cousin’s face.

“I see him every time I close my eyes,” said Eshet.

AP contributed to this report.