Posts Tagged 'human rights tribunals'

Recent focus on child soldiers and what the research says

The International Criminal Court (ICC) has made its first ruling, convicting Congolese rebel leader Thomas Lubanga of using children younger than 15 as soldiers. For basic media coverage, see here, here, and here. The conviction if Lubanga is the ICC’s first in its decade of existence, and for those of you interested, the BBC has a decent discussion of the costs, estimated at $900 million, here.

Lubanga could have been accused of any number of war crimes, but the ICC chose to focus on child soldiering (due to the quality of evidence, say prosecutors). The recent Invisible Children anti-Joseph Kony video recently trending on Twitter (no need for a link, I’m sure) chooses to also focus on child soldiering. Clearly this is compelling stuff for the media as well as legal teams, nightmare material for those who love kids and those who fear teenagers. From the sympathetic side we often hear simplistic pronouncements like this one from today’s New York Times:

Social workers say that even if children have enlisted willingly, looking for food, status or protection, they are often still permanently damaged by war-time violence and drugs.

There is, however, a research literature on child soldiers that presents a more nuanced picture. Although certainly former child soldiers suffer higher rates of physical and mental health problems than similar kids, the research suggests that there is more hope for them than is commonly portrayed. The work of Jeannie Annan and Chris Blattman show that there is wide variability in what child soldiering actually entails, and, that former child soldiers – far from being permanently damaged – are more active in peaceful post-conflict political processes than their peers. Theresa Betancourt‘s work shows that symptoms of emotional distress decrease over time among many, and I believe she has plans underway for treatment trials for those with continuing problems. Brandon Kohrt’s work presents (among other things) complex stories of reintegration through film, as well as research articles.

All this is not to say that child soldiering is in some way really not so bad. Making this a cause is indeed appropriate. But there is more to the issue than just crazed violent teenagers and their adult bad guy overlords. Child soldiers become former child soldiers, adults who live lives and can contribute to their societies.

The (non)essentialism of dehumanization

It is a given that those who persecute others get to the point of committing barbarous acts by first dehumanizing them. In Today’s New York Times Book Review, David Berreby offers an intelligent critique of the essentialism of this tendency to dehumanize “the other” via a review of David Livingstone Smith’s Less than Human: Why We Demean, Enslave, and Exterminate Others. Berreby explains that Smith, as a philosopher, makes the argument that humans’ “cognitive architecture,” which places ideas and concepts into immutable categories, leads to categorizing other humans, which then leads to rejecting those who do not fall into the ethnic or cultural category into which they belong. Berreby tells us that Smith says this then leads to Nazis calling Jews “rats,” Hutus calling Tutsis “cockroaches,” and Arab Darfuris referring to Black Darfuris as “monkeys.”

Berreby, who writes Mind Matters, a blog on psychology on Big Think, correctly identifies this somewhat warmed over Social Psych 101 argument as “only half right:”

people do categorize themselves and others using essences, but there’s nothing immutable about them. If, like trained philosophers, we could settle for good who is essentially human and who is a zombie vampire squid, we wouldn’t have, or need, this drama of dehumanization, rehumanization, then more dehumanization, and so on. Instead, the who-is-and-isn’t-human question is never truly settled. In fact, it is the dynamic, even mercurial nature of “real human” status that makes this mystery of our psychology so fascinating.

It is certainly true that genocidaires and those who place themselves above others in general do so by demeaning their victims. But what is equally true is that they don’t always do this, and, if human history and diversity is any record, they usually don’t do this in ways that leads them to exterminating others. In other words, certainly it is the case that dehumanization is critical in getting humans to commit atrocities against other humans, but the reason this is so is that “we readily see others as human” and “we need reminding that our enemies are supposedly different.” It is the shift between “human” and “dehuman” categories that is really interesting, and probably more important if we are going to find some way to avoid the effects of the latter more often.

Cambodia 2009: Khmer Rouge and expelling asylum seekers… for a price

2009 will be remembered in Cambodia as the year of the first Khmer Rouge Tribunal. Duch (born Kang Kek Lew), head of the torture center S-21 during the Khmer Rouge was put on trial, causing considerable consternation for some, and some small measure of consolation for many who lived through that era (1975-79). This soul-searching, however, seems to have had little effect on the Cambodian government, as was recently shown by Cambodia’s expulsion of Uighur asylum seekers in exchange for foreign investment from China. (More background here.) Twenty Uighurs had sought asylum in Cambodia following China’s crackdown following the unrest in western China this past July. For those of you who don’t know, the Uighurs are a Turkic Muslim minority in China, and have in the past few years resisted aspects of Beijing’s development strategy of the Xinjiang Uighur Autnomous Region (which, of course, is not really autonomous), involving encouraging Han Chinese from the East to “go west.” Incidently, Xiinjiang’s Governor, the architect of the repression of protests this summer, had a similar job before this one: head of the Tibetan Autonomous Region.

Why did the Uighurs go to Cambodia? If you look on a map of Asia, it’d be hard from them to go farther and remain on the mainland. Well, Cambodia is one of only a very few countries in the region to have signed UN Convention Relating to the Status of Refugees. The others in East Asia are Japan, South Korea, the Philippines, and… China. (Central Asia has a few signatories, though I might think twice before applying for asylum in Kazakhstan; South Asia, surprisingly to me, has none.) During the Khmer Rouge millions fled Cambodia to neighboring states as refugees (neighboring states that were not particularly welcoming), and many sought asylum around the world. So it makes sense that if any country in the Asia were going to be sensitive to the needs of refugees and asylum seekers it would be Cambodia. And there are, therefore, asylum seekers from around the world who have successfully sought asylum in Cambodia.

But China is the biggest investor in Cambodia, and therefore has a voice in Cambodian affairs. The Chinese are calling the twenty Uighurs criminals (of course, in a country that doesn’t allow protest, protestors are criminals), so Cambodia calls them “illegal aliens,” and expels them. Two days after the expulsion, Cambodia signed a deal with China for $850 million.

Punjab at Kwantlen Polytechnic; or, “What I’m doing in Vancouver”

A few years ago I published an article on injuries and PTSD among Punjabi Sikh torture survivors in Abnormal Psychology with my colleagues Barry Rosenfeld (Fordham University), Kim Reeves (Simon Fraser University), and my boss, Allen Keller. The manuscript grew out of a forensic assessment done at the request of a couple Indian human rights NGO’s (who I will refrain from naming without their permission) invovled in a large, class action lawsuit alleging torture and abuse inflicted by the Indian government in the 1980s and early 1990s. My colleagues and I were connected to the lawsuit via Physicians for Human Rights. Jas Sandhu, an addiction counselor in Surrey, British Columbia found my article in Abnormal Psychology and invited me out to speak at an annual conference he organizes surrounding Sikh culture, at Kwantlen Polytechnic University. Surrey, just outside of Vancouver, is home to Canada’s oldest Sikh communities, and one of its largest.

What? You’ve never heard of any campaign of abuse targeting Sikhs in India? A brief history: Following the partition of British India into India for Hindus and Pakistan for Muslims, some among the nation’s third largest religious group, the Sikhs, felt that their interests were left out. A move for more autonomy (“Khalistan”) developed for the only Sikh majority state in India, Punjab, and a small minority started to openly carry guns. In 1984, this militant faction housed itself in the Golden Temple in Amritsar, the “Vatican of Sikhdom,” and the Indian Army attacked the temple. Reprisals came a few months later, when Indian Prime Minister Indira Ghandi’s Sikh bodyguards assassinated her. This was followed by what is known as the Delhi Massacre, in which mobs of Hindus sought out Sikhs in the capital and slaughtered them. Dark days followed. The Federal Government shut down the Punjab state government, the militancy grew, and a scorched earth counter-insurgency campaign was put into full effect, carried out mostly by Punjab state police. Young Sikh men, particularly those who were religious or even looked religious (turbans, uncut beards, steel bracelets, among other distinctions), were swept up indiscriminately. The estimates of those “disappeared” during this time ranges between 25,000 and 75,000 (the broad estimate gives you a sense of just how little is known about exactly what was going on). The militancy was harsh as well, accusing many of collaboration with the authorities, and, as in many such conflicts, many people who had never been political were caught in the crossfire. Punjabi police routinely used torture and threats to get information about the militants, and the militants regularly used torture and threats to intimidate the population. Eventually the militancy was effectively stamped out. Few participants in violence on either side were charged and prosecuted through the courts.

This morning I spoke about how my colleagues and I went about using research methods to document events and assess damages due the litigants. The audience was a group of about 100 or so, some Kwantlen students, some professional counselors, some members of the local Sikh community. The question and answer session (my favorite part of any talk) was a mixed bag about the experience of being an evaluator, psychiatric diagnoses, and evidence-based treatment recommendations for these diagnoses. The last question, from Jas Sandhu, concerned collective identity. Last year a few 15-year old teenage Sikh boys in Surrey had found a website with t-shirts promoting Khalistan with crossed AK-47s on them. They wore them to school, and were quickly suspended for promoting antisocial behavior. Jas has seen my CV, so he knows I worked as a disciplinary dean in New York Public Schools, and he asked me how I would have dealt with these kids. I asked him what the problem was. He explained the situation again, and my response was the same, and then I went on to explain that I don’t think we do anyone any favors by silencing youthful exploration of identity even when we think the tone of that exploration is misguided. Young people need to discuss these things, they need to know their families’ histories, their communities’ histories, in order to make decisions about how to live their lives. It’s only when we don’t discuss these things that they choose simplistic, sometime violent interpretations: Black and Latino gangs, White Supremacist organizations, etc. So assign homework on history of the Khalistan movement, on the consequences of using an AK-47, on the insurgency and counterinsurgency — don’t just call them dangerous or stupid.

What really shook me about Jas’ example was not, however, how these teenagers used their collective identity or the liberal school system’s response, but how the horrific era of the 1980s and early 1990s, so far removed in time and space from present-day western Canada, would resonate so strongly there even today. It was a perfect example of how even far-off, localized conflicts from a previous generation effect our lives in the present day. The complex stories of conflicts that seem long ago and far away are hardly irrelevant; they are real, alive, even vibrant in the present day.

Psychoanalysts in Lima working with survivors of the Shining Path and government response

Last week I was visiting the Centro de Atencion Psicosocial (CAPS) in Lima, Peru, as part of an evaluation for USAID. CAPS has been working in psychotherapy and human rights since 1994, in the latter half of the conflict between Shining Path guerillas and the Peruvian government. Those days are done, but putting the pieces back together for victims of the violence is a long-term project.

CAPS started with a group of psychoanalysts, trained in the classic Freudian tradition of long-term, insight-oriented therapy. But as Director Carlo Jibaja says, when you’re dealing with people who witnessed the terror of the Shining Path, insight into the inner workings of their psyche is not exactly what’s needed to uncover their psychological problems. In addition, most of the victims of those days were rural poor, most of whom had never considered therapy and most of whom had to scrabble to make ends meet, and therefore couldn’t go to long-term therapy. CAPS has modified its treatment to a 12 session brief therapy, after which therapists and patients evaluate the effects and discuss continuing treatment from there.

But CAPS’ work is not limited to therapy in the traditional sense. They’ve done short-term work throughout Peru, from the Andean communities where most of the violence took place to the jungles where the remnants of the guerillas remain. These communities often include a many people displaced by the violence who have not returned, and so CAPS has focused on building ties between people to build social capital. They working first with groups of children, then mothers, and then the men finally come along. The groups they run have not been therapy in the traditional sense, but more along the lines of psychosocial support and community organizing.

CAPS has also been important in the process of truth and reconciliation in Peru. During Peru’s Truth Commission, CAPS provided necessary support to victims testifying to both Shining Path atrocities and those committed by the military (I’m told it was about a 60-40 split between the Shining Path and the government in terms of who was responsible for the 70,000 deaths during that period). Currently, CAPS is involved in designing the protocol for how damages will be awarded to those who have been designated as victims of these atrocities — a tricky venture indeed.

In addition to all this, CAPS has integrated an innovative research and evaluation program into their service program (with support provided via the Center for Victims of Torture in Minneapolis, in a project funded by USAID… that’s where my trip come in). Using quantitative and qualitative methods, they have charted improvement in symptoms for their therapeutic clients, and provided some fascinating information on therapists’ and clients’ perceptions of the therapeutic process. You might think that self-evaluation would be common in this field… well, I can tell you it’s not, and the CAPS staff is to be lauded for its dedication to self-evaluate and use what they find to improve their services.

Cambodian Psychiatrist testifies at Khmer Rouge trial

The following was sent to me by my friend and transcultural psychology colleague Ambreen Mirza. Ambreen is a counselor and supervisor working at TPO Cambodia, in Phnom Penh (see posts from 6/13 and 6/17 of this blog for more on TPO Cambodia), and she’s been going regularly to the ongoing trial of Duch. The following description of Cambodian Psychiatrist Chimm Soetheara’s testimony is lengthy for the blogosphere (even for this blog), but worth every word. Thanks much to her for the donation of her time and her report.

A Great Day for Mental Health

Yesterday I spent the morning at the Extraordinary Chambers of the Courts of Cambodia for the Khmer Rouge Tribunal. Psychiatrist Dr. Chimm Sotheara, the Director of TPO, the organization I work with, testified as an expert witness at the trial against the accused, Kaing Guek Eav or “Duch”. I have been to the tribunal many times before, but this testimony was different from all the others. Dr. Sotheara is the first Cambodian expert witness to testify at the tribunal, though he himself was only seven years old when the regime came into power.

Tears, deep sighs, long pauses, raised voices, and lowered eyes of various witnesses thus far have all hinted at the psychological impact Pol Pot’s Khmer Rouge regime had on Cambodians, yet Dr. Sotheara, one of Cambodia’s few qualified psychiatrists, is the first expert witness to provide a public testimony of the wide-spread and on-going effect of that trauma.

He talked about two strains of impact. First he focused on the psychological impact on the individual: how the trauma of imprisonment, torture, starvation, slave labor, witnessing deaths, and being forced to execute loved ones has left survivors with severe anxiety and post traumatic stress. Symptoms consist of recurring nightmares, avoidance of people and places that bring back painful memories, and hypersensitivity to everyday events which may trigger flashbacks.  He shared how many of his patients and other survivors are alcoholics, physically and verbally abusive, victims of domestic violence and/ or are suffering from depression.

He then outlined how the Khmer Rouge systematically broke down the very fabric of Cambodian society: children were separated from their parents, and instead “belonged” to Angkar (The Organization). Those lucky enough to live with their parents were forced to spy on them for the regime. Husbands and wives were separated, extended family members lost and killed. In essence, the regime severed relationships, destroyed the sense of community, safety, and spirituality. After the regime ended in 1979, Cambodians had lost the structures that would have allowed them to heal from trauma.  There was no family, no teachers, no doctors, no monks, no honoring of the dead, no comfort, no closure, and no justice.  The very institutions that would help Cambodia recover from the immense trauma no longer existed.

Thirty years later, survivors are still suffering.  According to a research conducted by Jeffrey Sonis, over 14% of Cambodians over the age of 18 show symptoms of post-traumatic stress. Dr. Sotheara is one of 32 psychiatrists in the country, and one of the first 10 trained by psychiatrists from Oslo University in 1994. He had no intention of becoming one, but as a medical doctor working with UNTAC in 1992, trauma and suffering were so prevalent that it became an obvious choice

During the course of the testimony one of the co-prosecutors commented that many of the civil parties dropped out due to fear of facing Duch. Another civil party lawyer shared that his clients felt that the deaths at S-21 lacked motive, they were senseless killings, deaths for nothing. He wondered if this in turn could create more confusion for their clients, and increase their trauma.  Another asked Dr. Sotheara’s opinion about guilt and the widely used defense that members of the Khmer Rouge were strictly following orders; kill or be killed.  He first stated that if the perpetrator was an adult at the time, and not a child, they should be responsible for their actions. However the concept of guilt was far more complex in this scenario. Often times there weren’t clear cut perpetrators and victims. He was referring to members of the Khmer Rouge who were themselves later detained, tortured and killed (such as in prison S-24) by the very regime they served. Perpetrators became victims and victims became perpetrators. Many of the civil parties that recently testified against Duch are ex-Khmer Rouge, mainly prison guards, interrogators, and medics.  This trial is different from others, such as that in Rwanda, where there was a clear ethnic divide between perpetrators and victims.

He did stress, however, the importance of tribunals such as this one, where their past and experiences are no longer abstract,  crimes are being acknowledged, their pain and suffering validated, where they are given a voice, and they can seek and obtain justice (albeit three decades later).  The majority of survivors have been living side by side with perpetrators for decades; they have had no choice but to learn how to co-exist.  But despite this, a survey conducted by the UC Berkeley Human Rights Center shows that four out of five respondents said they harbored feelings of animosity towards those Khmer Rouge members who were responsible for violent acts. Seventy-one percent said they wanted to see them suffer in some way. A third said they wished they could take revenge (37%) against former Khmer Rouge and that they would do so if they had the opportunity (40%). (So We Will Never Forget: A Population-based Survey on Attitudes about Social Reconstruction and the Extraordinary Chambers in the Courts of Cambodia, January 2009.)

One of the co-defense lawyers commented that Duch was not responsible for all of the suffering of the survivors of the Khmer Rouge regime, and was being tried for his role in the S-21 prison. He highlighted the resilience of the Cambodian people, that the country is slowly rising up, making its mark, and is flourishing in many ways.  He added that after this tribunal, he imagines Cambodians will be able to “turn the page”.   Dr. Sotheara agreed that the tribunal is extremely important, and that for some  it would provide answers, healing and closure. For others, however, it could be a trigger for them to re-experience the atrocities committed, and revive the memories of what they suffered.

The co-defense lawyer also mentioned that Duch had sought forgiveness from the Cambodian people, and asked what it would take for them to forgive.  Dr. Sotheara answered that telling the truth was very important, as was accepting ones actions and admitting guilt.  However forgiveness is a process, one that will not happen overnight. There is forgiveness at the individual level, some will never let go of the anger, and some may feel relieved by the truth that emerges from this tribunal.  Buddhists may forgive but know that the perpetrator will get their due karma in their next life. In the humanistic sense, people will forgive when justice is served.

He also stressed that forgiveness needs to happen at the community level, and stressed the need for the creation of local reconciliation commissions alongside the Khmer Rouge Tribunal. This, he said, should be a joint effort of the NGOs, local authorities, and the government, to establish reconciliation forums as an avenue to heal the pain of the victims.

Duch listened intently as Dr. Sotheara testified.  As per usual at the end of a testimony, he was given a chance to comment or respond to the witness (via the President).  He said he was fascinated with what Dr. Sotheara had testified, as he himself has no psychological knowledge (umm, forced confessions, torture…??). He said crimes against humanity were committed and the consequences still continue, and that he accepts responsibility for all crimes at S-21, “legally and psychologically”. He expressed his “gratitude” and congratulated Dr. Sotheara for his “outstanding achievements” and bowed before he was led out.

Dr. Sotheara’s testimony lasted three and a half hours, extending beyond the usual time, during which the mood at the court was distinctly different from other days. There was a sense of calm and relief amongst the witnesses, other survivors, the prosecutors, and even the defense; almost as if the elephant in the room had finally been acknowledged. The President of the Chamber (who has been previously criticized for asking witnesses to “compose themselves” and to “remember they were doing this for Cambodia”) was quiet for the most part, but nodded in agreement many times while leaning back in his chair and processing.  Civil parties shared with TPO counselors later that they felt Dr. Sotheara’s testimony was what they had been waiting for and they felt truly understood.  Most of all, the feelings of thousands of people who were not present were validated and their past experiences and present pain were given a voice.

Duch’s trial will be over by the end of September, but hopefully this testimony will pave the way for more sensitivity in the cases to follow, and greater recognition and action regarding current mental health issues and needs in Cambodia.

The Khmer Rouge Tribunals and PTSD: Human rights law as mental health intervention?

Jeff Sonis (University of North Carolina at Chapel Hill) has published an important paper in the August 5 edition of the Journal of the American Medical Association that has interesting implications for the intersection of human rights and psychology, and for the effects of the Khmer Rouge Tribunals in particular. Using an impressive multistage sampling method, Sonis and a group of Cambodian, Dutch, and South African colleagues recruited a probability-based sample of 1017 Cambodians (the most impressive such sample in Cambodia to date), and asked them about their knowledge and expectations about the Khmer Rouge Tribunals, their desire for revenge on the perpetrators, and administered a measure of posttraumatic stress disorder (PTSD) and mental and physical disability. In order to account for the fact that the majority of Cambodians were not alive during the “Pol Pot time” (1975-1979), they oversampled those older than 35 years old (meaning they increased the proportion of this group in relation to the general population) in order to make sure they could examine how those people who were the direct victims of the Khmer Rouge felt about the tribunals.

Why do this? This is the baseline study of research in which Sonis and colleagues will examine the effects of having the tribunal on Cambodians mental health. Building on therapeutic approaches like Testimony Therapy (developed by Chilean psychologists in the Pinochet era) and really catching fire around the time of South Africa’s Truth and Reconciliation Commission, the idea that human rights tribunals could have direct salutory mental health effects has been very attractive to trauma psychologists. This is in line with the now very popular idea of therapeutic jurisprudence, in which the court’s actions are designed to “treat” the victim of a crime (unfortunately used in the US primarily to justify harsher punishments on perpetrators). Of course, there is the possibility that testimony may bring up painful memories which will cause further distress. Sonis explains it this way in the introduction:

Since anger and desire for revenge have been shown to be associated with PTSD symptoms and functional disability, tribunals might reduce the prevalence and severity of PTSD and impairment in postconflict societies by facilitating feelings of justice and reducing the desire for revenge. However, others have suggested that trials may actually increase PTSD prevalence and severity by “retraumatizing” survivors. (p. 528)

With the type of information they collected and the fact that it was all collected before the tribunals began, Sonis and colleagues can’t really answer the question of whether or not the tribunals were therapeutic (nor would they say they could). So what did they find? Well, the first notable finding was the prevalence rate among the over 35 group (the people present during the time of the Khmer Rouge). Within this group the rate of “probable PTSD” (“probable” because the self report measure is not technically diagnostic) was 14.2%. I usually don’t get excited about epidemiology, but let’s put this finding in context: Of the great killers of the 20th century — Hitler, Stalin, Mao — none were responsible for killing 20% of a population. That award goes to Pol Pot. This is in addition to the slave labor camps and torture chambers that were a part of everyday life under the Khmer Rouge. The fact that among those who survived this era, 14.2% suffer from PTSD is, to me anyway, a pretty optimistic finding. Granted, it’s 35 years later (a lot of PTSD may have been present for a long time and then remitted), but still, the common perception that Cambodians of that age are a traumatized population is simply not true, if you take the definition of “traumatized” as “most have PTSD.” That’s not to say that a higher proportion of Cambodians are affected by PTSD than members of other societies, only that a sizeable majority are not. People, even those who have gone through unspeakable terror, turn out to be pretty resilient. The population rate for PTSD was 11.2% (that’s for both groups combined).

What else? The expectation that the tribunals would deliver justice was inversely associated with probable PTSD. Sonis and colleagues conclude that this means that this “raises the possibility that the trials may be an effective societal-level intervention for reducing PTSD symptoms” (p. 535). However, the authors also found that almost 93% of those who knew about the trials reported that the prosecutions would probably bring up painful memories, and that raises “the possibility that the trials could increase the prevalence and severity of symptoms of PTSD” (p. 536). Hm. This confirms that both arguments made at the beginning of the study might hold water, but doesn’t really say anything more. Sonis ends with a rare instance of foreshadowing in academic writing: “That question can only be answered through a longitudinal study over the course of the trials” (p. 536).

I’m not convinced the two “competing” arguments — justice v. retraumatization — are really in competition. The most effective treatment for PTSD is exposure with response prevention, a process by which the therapist guides the PTSD patient through a retelling of their trauma. this has been shown to be effective in numerous situations, and does not seem to be dependent on the type of trauma causing the problems. If we abstract the individual case to a societal level, we have the tribunals which help the society face their traumatic memories — which may be painful — but come through them to some resolution. Justice and retraumatization, but then resolution.

However, I’m also not convinced that this is what will happen. I actually don’t think that we should expect that either justice or retraumatization will have a significant effect. A tribunal is not exposure with response prevention, particularly since the perpetrator is involved in the tribunal. Justice is good, but it’s not treatment. This is not to say that the tribunal will not make some Cambodians feel better, just that we shouldn’t expect it to cure their PTSD. That Sonis found an inverse proportion between the expectation of justice and PTSD seems evidence to me that people who have PTSD are generally more pessimistic, and that’s not likely to change just because something goes right in their world. This is not blaming the victim, only acknowledging that people with mental health problems see the world with much darker lenses.

Justice is a value in its own right. We don’t need to justify the pursuit of justice with mental health outcomes. It may be that there is some relationship, but they are not the same. Still, I look forward to the next installment from Jeff Sonis to let us know more about the relationship between the two.


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