October 8, 2004
Even as there is a growing body of evidence suggesting staggering numbers of violent deaths in Darfur over the past 20 months, and even as grimly authoritative predictions of accelerating mortality suggest that there will be many tens of thousands of additional deaths in the coming months, there is no analytic or synthetic news reporting on these terrible realities and their implications for an understanding of what is occurring in Darfur. Individual reports from extremely authoritative sources are ignored or misrepresented, and no efforts to survey the reports and data as a whole have figured in any news accounts of Darfur. The effect is a massive understatement of the nature and destructiveness of the catastrophe.
The most commonly cited number of deaths, in both wire reports and newspaper accounts, is “50,000.” This is a transparently untenable figure, and severely misrepresents the import of a recent UN World Health Organization (WHO) mortality update. In mid-September 2004 the WHO announced that 50,000 people had died of disease since April 2004 in camps for the displaced. But this has been perversely reported as a total morality figure for all 20 months of the Darfur conflict, instead of a five-month segment. Nor does the WHO figure make any attempt to include the much greater number of violent deaths defining total mortality in Darfur. As Dr. David Nabarro, head of WHO emergency response efforts, insisted in a clarifying email to this writer:
“I fear that remarks I made at a Press Briefing on September 13th 2004 were misquoted. I said that we estimate that at least 50,000 Internally Displaced Persons have died from disease (in some cases exacerbated by malnutrition) since April 2004.” (email to this writer, September 16, 2004)
To be sure, UN and humanitarian organizations have been slow to respond to the challenges of mortality assessment, and public presentation of the data and evidence at hand has often been ineffective. But it is unconscionable that the lives of more than 200,000 people from the African tribal populations of Darfur are, because of journalistic slovenliness, being elided from present international awareness of this already well-advanced genocide.
This present analysis of total mortality related to the Darfur conflict concludes that the most appropriate figure for deaths from violence, disease, and malnutrition—from February 2003 to the present—approaches 300,000. Of these, over 200,000 have died from the effects of violence; over 80,000 have died from disease and malnutrition. The statistical extrapolations from the various reports guiding this analysis are not complex; assumptions are made here with conservative intent; there is necessarily a wide margin of error, though the more distinct possibility is of significant understatement.
There is an inevitably heuristic quality to such an analysis: assumptions are made that can be only partially justified, comparisons that are subject to debate, and conclusions that should be challenged. This writer welcomes all reasonable criticisms and suggestions, and especially data and statistical perspectives relevant to this analysis. A number of suggestions and criticisms that have come in the wake of six previous analyses of mortality are incorporated here. Necessarily, any assessment of mortality in Darfur is a work-in-progress.
Following an overview of the current situation in Darfur, especially as it bears on prospective mortality, this assessment analyzes (i) current mortality from violence, and (ii) current mortality from disease and malnutrition, (iii) prospective mortality indicators.
THE CURRENT SITUATION IN DARFUR
The humanitarian situation in Darfur continues to deteriorate rapidly, with a highly distressed and weakened displaced population that is not receiving half the necessary food aid, or critical non-food items (clean water sources, shelter, sanitary facilities). Moreover, as the deadly mismatch between humanitarian need and humanitarian capacity continues to grow in the coming months, the global Crude Mortality Rate (CMR) will begin to surge. From Geneva, Deputy Assistant Administrator of the UN Agency for International Development William Garvelink declared:
“‘The crisis in Darfur has not yet peaked. We have not yet seen the worst.’ Earlier this year, US AID predicted that between 80,000 and 300,000 people could die if the situation failed to improve in Darfur. ‘We’re now coming to the high side of that range,’ Garvelink told reporters. After months of relying on scarce food handouts—when aid agencies have been able to reach refugee settlements—more than a million people in Darfur face severe malnutrition, Garvelink [said]. ‘We’re going to see a tipping point in December, January or February.'” (Associated Press, October 4, 2004)
“People were already weak from struggling through the early part of the summer with little international help, and women and children would be particularly vulnerable to food shortages. ‘Woman and children will die at a much higher rate than they are now,’ Garvelink said.” (Reuters, October 4, 2004)
This grim forecast, perhaps statistically overstating what US AID data presently demonstrate, is a function of a collapsing agricultural economy, inadequate humanitarian transport and logistical capacity, a lack of resources, and continuing insecurity. On this latter issue, undeniable realities obliged Secretary-General Kofi Annan in his report to the UN Security Council to speak with some refreshing honesty, noting not only the increasingly desperate humanitarian situation but an increasingly perilous security situation:
“Today, still increasing numbers of the population of Darfur are exposed, without any protection from their Government [the Khartoum regime], to hunger, fear, and violence. The numbers affected by the conflict are growing and their suffering is being prolonged by inaction. In a significant proportion of the territory security conditions have worsened. In the month of September the Government has not been able to fulfill its responsibilities and commitments to protect the people of Darfur.” (Report of the Secretary-General to the UN Security Council, pursuant to Resolutions 1556 and 1564; October 4, 2004)
To be sure, even this damning commentary is not without some degree of disingenuousness. Trapped by his own previous dishonest refusal to state the most basic truth about the conflict in Darfur—that it continues to be conducted in genocidal fashion by the Khartoum regime itself, in concert with its Janjaweed allies—Annan speaks of the regime “not being able to fulfill its responsibilities to protect” the people of Sudan. Of course the regime is “able”: it has simply chosen to flout the demands of UN Security Council Resolutions 1556 and 1564, as well as promises made to Annan himself on July 3, 2004 in Khartoum. Certainly until the regime is held clearly accountable for its fundamental responsibility in orchestrating genocide, it will presume that no meaningful international action is impending.
And despite Annan’s suggestion that violence in Darfur has recently diminished somewhat, reports from the ground—from UN and relief officials, as well as journalists—suggest quite the opposite:
“Attacks by armed gangs on internally displaced persons and clashes between armed groups have continued in the troubled Sudanese state of North Darfur, creating ‘a fragile security situation’ and widespread fear among civilians living in camps within the region, humanitarian sources said on Thursday [September 30, 2004].”
“According to another source, another group of 3,000 IDPs who had fled their villages in early September and camped in El Bisharia, 2.5 km south of El Fasher, had reportedly been forced to return to their villages about 10 days ago. But after they arrived at their homes, many of them were attacked forcing some to flee into the bushes or to El Fasher.”
“[Humanitarian organizations] operating in South Darfur reported that on Tuesday that renewed fighting had driven at least 5,000 people from their homes within three days.” (UN Integrated Regional Information Networks [Nairobi] October 1, 2004)
Though over 2,000 villages have now been destroyed, Janjaweed attacks continue remorselessly:
“Thousands of terrified Sudanese are again straggling into refugee camps in the Darfur region, driven from their villages by fresh violence that illustrates the challenges of ending the conflict here. UN and relief officials said Thursday that there’d been an upsurge in violence this week in southern Darfur. Hege Ospeth, a spokesperson for Norwegian Church Aid, which runs a refugee camp in Bashom, said 5,000 new refugees had arrived from 10 villages that had been attacked by government-backed militias in the past week.” (Knight Ridder news [Ishma, Darfur], October 1, 2004)
The effects of such continued violence and displacement have led one UN official to declare recently that “Darfur could continue to mushroom out of control because of ongoing insecurities”:
“Arab militiamen attacked villages in Sudan’s North Darfur state as recently as last month, according to residents who fled the attacks to camps for displaced people. [ ] Residents of Abu Delig, about 50 km south of El-Fasher, capital of North Darfur state, said their village was attacked by 150 military personnel and aerial bombardment in late August to early September, said the official who declined to be named. [ ] The residents described the attackers as heavily-armed men wearing camouflage-style uniforms, a common description for the Janjaweed militia.”
“The [UN] official said she heard first-hand reports from residents of tens of thousands of new displaced persons in government and rebel territory in North and South Darfur state. The new figures have yet to be included in UN estimates that 1.5 million people have been displaced by the conflict that erupted in 2003, she said. ‘Darfur could continue to mushroom out of control because of ongoing insecurities.'” (Reuters, October 7, 2004)
Massive, violent human displacement informs both retrospective and prospective morality assessments.
RETROSPECTIVE MORTALITY ASSESSMENT: VIOLENT DEATHS
The previous mortality analysis by this writer (September 15, 2004; available upon request) highlighted several important new sources of mortality data. The most important of these was a very extensive study conducted by the distinguished Coalition for International Justice (“Documenting Atrocities in Darfur,” available at: http://www.state.gov/g/drl/rls/36028.htm). On the basis of 1,136 carefully randomized interviews, conducted among the Darfuri refugee population in Chad at a number of camp locations along the border, the Coalition for International Justice (CIJ) found that “sixty-one percent [of those interviewed] reported witnessing the killing of a family member.”
The total number of refugees in Chad is now greater than 200,000. If we assume that this population of persons displaced from Darfur is representative of many hundreds of thousands of violently displaced persons within Darfur, then the total number people represented by the CIJ study is over 1.5 million, and may reach to 2 million.
How do we establish the approximate figure for those people violently displaced, either into camps, into towns, within inaccessible rural areas in Darfur—or into Chad?
In its most recent “Darfur Humanitarian Profile,” the UN Office for the Coordination of Humanitarian Affairs (OCHA) estimated that 1.45 million people have been displaced into accessible camps within Darfur; this figure is based on food assistance registrations by UN and nongovernmental humanitarian organizations (“Darfur Humanitarian Profile,” No. 6, September 16, 2004, page 5; http://www.who.int/disasters/repo/14756.pdf). The OCHA report also estimates that an “additional 500,000 conflict-affected persons are in need of assistance” (page 9), and it is reasonable to assume that most of these are displaced persons in inaccessible rural areas. (Even a figure of 500,000 almost certainly understates the number of displaced persons in rural areas.) Moreover, the OCHA report does not attempt to assess either the host communities or the size of displaced populations in the three state capitals (Nyala, el-Fasher, and el-Geneina) because there are still no systematic food registrations in these large urban areas.
Thus out of a total displaced population in Darfur of over 2 million, we require an estimate of the number of persons who experienced violent displacement of the sort that created refugees in Chad. Given the extremely high level of village destruction throughout Darfur, and the tenacity with which these people have sought to cling to their land and livelihoods, displacement per se is a very likely indicator of violent displacement.
Moreover, a recent epidemiological study published in The Lancet (Britain’s premier medical journal) offers clear evidence that displacement is overwhelmingly related to violent attacks. In two camps, Zalingei and Murnei, statistically rigorous assessments found that “direct attack on the village” accounted for displacement of 92.8% of the Zalingei population and 97.4% of the Murnei population (the combined camp populations is approximately 110,000) (The Lancet, October 1, 2004, “Violence and mortality in West Darfur, Sudan (2003-04): epidemiological evidence from four surveys” (available online at: http://www.thelancet.com/journal [requires (free) registration]).
If we conservatively assume that 80% of the total displaced populations that have remained in Darfur were driven to flee by “direct attack on villages,” the number of violently displaced persons is 1.6 million.
This yields a total figure of violent displacement, for Chad and Darfur, of very approximately 1.8 million. The average family size in Darfur is slightly more than five, suggesting that a population of 1.8 million represents almost 360,000 families. If randomized interviews by the Coalition for International Justice (CIJ) find that “sixty-one percent [of those interviewed] reported witnessing the killing of a family member,” then this yields a mortality figure for violent deaths of over 200,000 human beings.
Caveats and other considerations:
There is some chance that despite randomizing of interviews in Chad, and multiple camp locations at which interviews were conducted, overlaps exist in the “family members” identified as having been seen killed. This is a negligible number if “family” refers to nuclear family. Indeed, the chances of overlap even for members of extended families are quite small, given the diversity of interview locations.
More significant is the fact that those conducting interviews for the CIJ found that interviewees often reported more than one family member had been killed, often several more than one. Yet the statistical derivation offered here presumes that only one family member has been killed among the 61% who reported seeing (at least) one family member killed.
Secondly, the study cannot take account of the number of families in which all members were killed, and who thus had no reporting presence in the camps where interviews took place. The CIJ study does report that 28% of those interviewed “directly witnessed” persons dying from the consequences of displacement before reaching Chad. These deaths must be considered the direct consequence of violence, if not violent deaths per se, and would significantly increase violent mortality totals.
Moreover, the CIJ study indicates that 67% of those interviewed “directly witnessed” the killing of a non-family member.” As the raw data from the CIJ study is soon scheduled for release, it may be possible to put this extraordinary figure in a statistical context that is yet more revealing of violent mortality. Given the number camp locations (19), and the randomizing techniques used within the camps—
“refugees were selected using a systematic, random sampling approach designed to meet the condition in Chad. Interviewers randomly selected a sector within a refugee camp and then, from a fixed point within the sector, chose every 10th dwelling unit for interviewing. [ ] One adult [from the dwelling unit] was randomly selected [for interviewing]” (CIJ study, page 5)—
—the figure of 67% of refugees “directly witnessing” the death of a non-family member strongly suggests that assumptions made in this analysis may lead to significant underestimation.
In light of these various CIJ findings, and data reported in The Lancet, a figure of 200,00 violent deaths over the past 20 months of conflict seems a conservative estimate. The Lancet article, which concludes that West Darfur is the site of a “demographic catastrophe,” has other important implications, some of which are noted below.
RETROSPECTIVE MORATLITY ASSESSMENT: DEATHS FROM
DISEASE AND MALNUTRITION
Journalists of all stripe have failed to understand the implications of the recent UN World Health Organization (WHO) study of health-related mortality in Darfur. Indeed, the study was extremely badly misreported by both wire services as well as print and broadcast journalists. This has had the extremely unfortunate effect of giving apparent UN authority to a putative total morality figure of “50,000” deaths. What the WHO study and accompanying public commentary represented—as explicitly confirmed to this writer by David Nabarro, chief of emergency operations for WHO—was a figure of more than 50,000 deaths from disease and malnutrition since April 2004 in camps to which there is humanitarian access.
Thus the now frequently cited UN figure of “50,000” does not include violent deaths over the course of 20 months of extremely violent conflict. It does not represent morality in Chad. It does not represent mortality in areas inaccessible to humanitarian operations. And it does not include deaths from disease and malnutrition prior to April 2004 (again, the conflict began in February 2003). In short, “50,000” is a number of highly limited relevance. Further, as Dr. Nabarro confirmed to this writer by telephone communication, the WHO figure for monthly mortality should be closer to 10,000 in the “6,000 to 10,000 deaths per month” range reported as coming from WHO. Only such a higher number begins to take some account of populations more difficult to access.
In the three weeks since WHO report was published, assuming a mid-range figure for mortality in accessible areas, another 6,000 people have died, suggesting that more 56,000 people have died in accessible areas since April 2004.
Mortality in rural areas to which there is no access is best assessed on the basis of the US Agency for International Development projections (“Projected Mortality Rates in Darfur, 2004-2005” (http://www.usaid.gov/locations/sub-saharan_africa/sudan/cmr_darfur.pdf). We may use as a conservative denominator for these projections the current figure of 500,000 inaccessible persons in need of humanitarian assistance promulgated by OCHA. For the past four months, US AID projections indicate an average Crude Mortality Rate of almost 9 per day per 10,000 (for a population without humanitarian relief and experiencing severe food shortages). In these 120 days, assuming a constant denominator of 500,000, this suggests a total mortality of approximately 50,000. These deaths would be primarily among very young children, the elderly, and those made vulnerable from violent trauma.
Still, a figure of 50,000 may be too high for several reasons, primarily the highly skilled foraging abilities of these people and the use (and likely exhaustion) of food reserves. On the other hand, insecurity produced by continuing Janjaweed predations would compromise both of these food sources. If we assume (very conservatively) that a figure of 50,000 overstates by 100%, this still leave a figure of 25,000 deaths from malnutrition and related disease over the past four months in inaccessible areas of Darfur. Together with the figure deriving from the WHO report and data, this suggests a total figure of 80,000 deaths from malnutrition and disease since April 2004.
Still excluded is the number of deaths from disease and malnutrition during the period February 2003 to April 2004. During this period several humanitarian organizations reported high Crude Mortality Rates at various junctures. Many thousands died in the camps, especially children, though there is no systematic data that permits extrapolation of a total figure. If we couple this knowledge with a figure of more than 200,000 violent deaths, and more than 80,000 deaths from disease and malnutrition (according to WHO and US AID), then a total mortality figure for all of Darfur over the past 20 months is approximately 300,000.
PROPSECTIVE MORTALITY INDICATORS
Though the UN World Food Program heroically strove to increase the total number of food recipients in September, reaching 1.3 million people under extremely difficult circumstances, the UN target figure for October is 2 million. This does not include more than 200,000 refugees in Chad, where many camps actually report higher average Global Acute Malnutrition rates for children under five than in Darfur itself. Moreover, this new figure includes only a few of those who are beyond humanitarian reach (again, OCHA’s figure is 500,000).
The figure of 2 million also does not include large numbers of displaced persons who have fled to urban areas rather than the camps, or newly displaced persons. The larger urban areas (the three state capitals of West, South, and North Darfur) present severe problems in effectively registering displaced persons for food distributions. As food prices begin to skyrocket in these towns, and foodstocks dwindle, people will be forced to move to camps, further increasing the assessable number of food-dependent people who must receive humanitarian assistance.
Though there are of course different degrees of food-dependency, the overall malnutrition rates for the total population presently in need—approximately 2.5 million in Darfur alone—are climbing. This is obscured by the fact that assessments of malnutrition take place only in accessible camps, to which food can be transported: those in urban areas or inaccessible rural areas do not figure in malnutrition studies.
This is the real significance of the comments by US AID’s Garvelink:
“‘The crisis in Darfur has not yet peaked. We have not yet seen the worst. [ ] After months of relying on scarce food handouts—when aid agencies have been able to reach refugee settlements—more than a million people in Darfur face severe malnutrition,’ Garvelink told reporters. ‘We’re going to see a tipping point in December, January or February.'” (Associated Press, October 4, 2004)
For even in reaching 1.3 million people in September, the World Food Program is providing food for only half those in need. To be sure, with the impending end of the rainy season transport will become easier, as roads dry out and a large dedicated truck fleet can move food to more remote locations. But under-funding threatens the longer-term viability of even present levels of inadequate capacity. UN spokeswoman Radhia Achouri recently announced that, “the UN has said it has received just a little over half the required funds to meet the needs of the 1.5 million displaced in Darfur” (Reuters, October 6, 2004). But as indicated above, the real figure is closer to 2.5 million in need of food and humanitarian assistance; in this context, the UN has received less than a third of what is needed need for the distressed populations of Darfur
Moreover, there is a much larger food crisis in Africa, with many countries facing huge drought-related food deficits. Without much greater donor response to the overall food needs of Darfur and the rest of Africa, we may be sure that many hundreds of thousands of additional deaths from starvation and disease will be recorded in the coming year.
For Darfur, the food requirements for 2.5 million people are over 42,000 metric tons per month (according to humanitarian logisticians, the food requirements for 1 million people—cereal, pulses, oil—are 17,000 thousand metric tons per month). Critical non-food items (medical supplies, shelter, water-purification) add substantially to transport and logistical requirements. The 200,000 refugees in Chad are not included in this figure, and add approximately 3.5 thousand metric tons per month. There is nothing approaching 45,000 metric tons of monthly capacity in the humanitarian theater at present, and it is impossible to see how transport and logistical capacity can be increased sufficiently without robust humanitarian intervention, far in excess of what can be provided by even an augmented African Union force (which has virtually no logistical or transport capacity even for its military forces).
As a consequence, even those in camps with humanitarian access will continue to die at very high rates, well above the threshold for a humanitarian emergency. Shortfalls in food, in the context of a collapsed agricultural economy (and a distinctly possible locust plague), will take an ever greater toll as Darfur’s overall population weakens in coming months. We may not see the greatest mortality rates until February 2005.
The threat of donor fatigue, or a loss of the present acute interest in Darfur, is also of great concern, and has immense implications for long-term mortality rates, as camps for the displaced become more permanent—warehouses for survivors of genocide. A UN World Food Spokesman offers a grim prospective view:
“UN World Food Programme spokesman Greg Barrow said the crisis [in Darfur] would drag on because so many Darfur residents were still in refugee camps, unable to harvest this year or plant crops for 2005. ‘The aid crisis is going to continue at least until the end of next year,’ Barrow said. ‘This is a very, very precarious situation. The levels of humanitarian aid will need to be sustained at or above the same level as this year.”’ (Reuters October 6, 2004)
Associated Press also reported on Barrow’s comments:
“‘We are looking at a long-term situation there,’ [Barrow] said. ‘Possibly towards the end of next year and maybe even beyond, there is going to have to be large-scale international humanitarian assistance to help these people feed themselves.'” (Associated Press, October 6, 2004)
The chances of such long-term, very high levels of humanitarian commitment are unlikely; perversely, such commitment would likely diminish the ability of the UN and humanitarian organizations to respond to crises elsewhere in the world.
Continuing violence in Darfur also defines prospective mortality assessment. The Lancet article (“Violence and mortality in West Darfur”) gives us extraordinary insight into mortality rates for those displaced persons from the time they are violently attacked to the time they arrive at a camp (what is called the “village and flight period”). Crude Mortality Rates (CMR) for the populations assessed in the Zalingei, Murnei, and Niertiti camps were 5.9, 9.5, and 7.3 respectively (again, CMR is a measure of deaths per day per 10,000 of affected population). The average CMR for people who were violently forced to flee their villages is thus 7.6 for a population of 135,000 people (page 4). 3.0 is often considered a “catastrophic mortality rate.”
While the CMR declined by five-fold to eight-fold when displaced persons entered the “in camp period,” it remained above the levels defining of a humanitarian emergency.
The implications are chiefly for those populations that continue to be displaced by Khartoum and its Janjaweed militia forces: the people attacked, during the period of attack and flight, will continue to experience mortality at rates far above the “catastrophic level.”
THE POLITICAL AND DIPLOMATIC CONTEXT
Khartoum has peremptorily refused to enter into meaningful political discussions with the Darfur insurgency groups, even before negotiations resume in Abuja (Nigeria) on October 21:
“[The government of] Sudan on Monday ruled out any notion of self-rule for Darfur and said rebels in the western region would not secure the same concessions agreed with southern rebels after two decades of war. ‘There will be no question about power-sharing or wealth-sharing,’ [Agriculture Minister Majzoub al-Khalifa, head of the government’s Darfur peace talks delegation] said, referring to demands made by rebels.” (Reuters, October 4, 2004)
Nor is Khartoum willing to enter into meaningful discussions of the essential security issues. A political settlement, essential to any meaningful peace, seems a distant prospect—as does humanitarian intervention to increase transport and logistical capacity and to provide troops adequate to protect displaced civilians, humanitarian workers, and to create safe corridors for people trapped in presently inaccessible areas.
Indeed, so distant is the prospect of humanitarian intervention that Khartoum’s ambassador to the UN feels comfortable taunting the US for simultaneously finding that genocide is occurring in Darfur and yet refusing to intervene to halt this ultimate crime:
“Elfatih Mohamed Erwa was asked [about US declarations of genocide in Darfur]: ‘If it is really a genocide they should be committed to send troops,’ the Sudanese ambassador said. ‘This is why I don’t think they’re genuine about its being genocide.'” (Associated Press, October 6, 2004)
We must credit Erwa with raising an appropriate question. But the genocide is all too real, and it is not simply the US Congress and executive branch that have declared as much. In addition to numerous human rights organizations, in addition to the Committee on Conscience of the US Holocaust Memorial Museum and Yad Vashem in Jerusalem, in addition to numerous genocide scholars and organizations, the government of Germany and the Parliament of the European Union (by a vote of 566 to 6) have also declared that Khartoum’s actions in Darfur are genocide. No organization has credibly argued that genocide is not occurring in Darfur, though Doctors Without Borders/Medecins Sans Frontieres has sadly disgraced itself with ill-conceived and politically motivated comments about the issue.
Despite this rapidly growing consensus, the international failure to respond to Rwanda in the spring of 1994 tells us all too much about the fate of Darfur over the past year—and for the foreseeable future. Here no voice carries more authority than that of Romeo Dallaire, who wrote of Darfur recently:
“The UN, emasculated by the self-interested maneuverings of the five permanent members of the Security Council, [has failed] to intervene. [ ] When I read phrases [in UN Security Council Resolution 1556, July 30, 2004] like ‘reaffirming its commitment to the sovereignty, unity, territorial integrity and independence of Sudan’ and ‘expressing its determination to do everything possible to halt a humanitarian catastrophe, including by taking further action if required,’ I can’t help but think of the stifling directives that were imposed on the UN’s department of peacekeeping operations in 1994 and then passed down to me in the field.”
(International Herald Tribune, October 4, 2004)
Present threats and exhortations, even the deployment of an expanded African Union force, “are simply not going to be enough to stop the killing—not nearly enough,” Dallaire rightly argues.
There is still no evidence that this matters sufficiently.
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