Practice blog

Reflections on the role of the Hospital Idva

Kathy Bonney is Head of Safeguarding at East Lancashire Hospitals NHS Trust. In this blog post, she discusses the impact of having an Idva embedded within the hospital Safeguarding team.

Domestic Abuse and Safeguarding 

The Care Act 2014 came into force in April 2015 and defined adult safeguarding as 'working with adults with care and support needs to keep them safe from abuse or neglect'. It sets out a clear legal framework for how local authorities and other health and social care agencies should protect adults at risk of abuse or neglect.

Within the Act the list of recognised categories of abuse was expanded to include three additional types of abuse, one of which is domestic abuse. Domestic abuse is now recognised as the jurisdiction of Safeguarding Adult Boards across the country.

Health and Domestic Abuse

In addition to direct injuries sustained as a result of domestic abuse, there is good evidence to support the fact that women who are abused by their partners can suffer significant physical and mental health problems.

If we examine the reasons for attendance at hospital for those women who have experienced domestic abuse (who are known to us) we can see a picture of poor health including chest pain, recurrent infections, bowel complaints, anxiety and depression.

Within East Lancashire Hospitals NHS Trust, and other Trusts like ours, we have the opportunity to reach thousands of women who have experienced domestic abuse; they use our services every single day. With over 500 people coming through our emergency department and urgent care centres each day, over 1000 in-patient beds across our 5 hospitals, plus maternity services, hundreds of out-patient appointments, day case procedures and community appointments, we are likely to meet women who have experienced domestic abuse. We also employ over 7500 staff, many of whom could also be experiencing domestic abuse.

The Hospital Idva

East Lancashire Hospitals NHS Trust was in a fortunate position to be supported by the local provider of domestic abuse services. This started a few years ago as part of the IRIS project; bringing Idvas in to health, predominantly placed within the emergency department.

Integrating the Hospital Idva into our Safeguarding team enabled us to raise awareness of domestic abuse across our clinical services, which led to staff recognising the signs of Domestic abuse in their patients. The opportunity for patients to disclose domestic abuse was available, and the Hospital Idva became involved with the daily ward routines, including attending board rounds to assist staff in identifying patients at risk, and improving their knowledge and understanding of domestic abuse.

Most importantly, patients were afforded the opportunity for risk assessment, advice and initial safety planning before they left their hospital bed. We have also had patients who have been discharged from our hospital straight into a refuge, and we have had a few patients who were discharged to another life, simply taking the clothes and belongings they had with them in hospital to start a new life free from abuse elsewhere.

The Hospital Idva position lends itself perfectly to the 'One Chance Rule'. Many of the patients who we have supported have not been known to the police or other services; they have simply taken an opportunity to seek help and support whilst in our care. We have also had patients who may have denied they were experiencing domestic abuse, and those who have disclosed but do not wish to accept the help and support available. These patients may return to our Trust through another pathway, such as though our maternity services, and it may be at a later stage that these patients are ready to accept the specialist help they need.

Only recently a patient attending a gynaecology clinic appointment asked for help; she had been informed what was available during previous contact with our services, and she had made her mind up to ask for the support when she came to the hospital again; 'enough is enough' she said to the clinic nurse. 

Staff and Domestic Abuse

As a consequence of promoting the Hospital Idva role across our clinical services we found our staff began to refer themselves to us for specific advice and support in relation to domestic abuse. This simply grew – the more staff became aware of the Idva and her role, the more referrals we received. Staff were supported either by the Hospital Idva directly, or their local domestic abuse services.

Our own safeguarding team members, including myself, also engaged with individual staff members who chose to have ongoing support following initial assessment, safety planning and specialist support from the domestic abuse services. We learned so much;  staff had lots of episodes of short-term sickness, listed as 'back pain', 'stomach ache', diarrhoea and vomiting', and other minor conditions that simply disguised the truth that they were experiencing domestic abuse.

Patterns of sickness emerged, such as frequent days off on a Monday and Tuesday. Managers had been critical of these staff, never thinking for a moment that they may have bruises to hide following a weekend of drunken abuse. We have been privileged to support individual staff who have trusted us to ensure their story is sensitively told, and this has led to a greater understanding of domestic abuse amongst managers and HR Business Partners.

The support has been unbelievable within our Trust, from the Board members to our car park managers who willingly reserve safe car parking spaces for staff at risk. A special mention has to be given to our Occupational Health and Well Being service who have introduced Routine Enquiry of domestic abuse for all staff who access their service. Finally, we now have a cohort of people who have experienced domestic abuse and received support. In turn they are able to offer peer support to other staff, and this has been of great value to all involved. 

The Hospital Idva going forward

There have been many changes in relation to investment in services for domestic abuse. We now find ourselves, an Acute Hospital Trust, with limited access to an Idva. It would be wonderful to introduce Routine Enquiry across all in-patient services, but it is essential that we are able to meet the needs of those patients who disclose domestic abuse. As part of our safeguarding role, and high on the safeguarding agenda, we would like to strengthen the support in hospital for those who are experiencing domestic abuse.

We welcome the opportunity to prove that having Hospital Idvas working closely with Hospital Safeguarding Teams will not only increase the numbers of people disclosing abuse – and receiving support – but will ultimately improve the long term health outcomes of many hundreds of people.

We're calling for every hospital to have an Idva. Read about our Cry for Health research.


Thinking intersectionality: forced marriage and 'honour'-based violence as forms of violence against women and girls in a context of structural inequality

Lia Latchford is a Development Co-ordinator at Imkaan. Imkaan is the only UK based, national second tier women’s organisation dedicated to addressing violence against Black and ‘minority ethnic’ (BME) women and girls.  The organisation works at local, national and international levels, and in partnership with a range of organisations, to improve policy and practice responses to BME women and girls. Imkaan works with its members to represent the expertise and perspectives of frontline, specialist and dedicated BME women’s organisations that work to prevent and respond to violence against women and girls.

The UN defines violence against women and girls as “any act of gender-based violence that is directed against a woman because she is a woman or that affects women disproportionately” (UN General Assembly, 2006, pp.12).  While forced marriage and ‘honour-based’ violence can and do affect men and boys, it is well evidenced that women and girls are disproportionately targeted, impacted and encountered by agencies following these forms of violence (Home Office & Foreign and Commonwealth Office 2017; Swegman 2016).  As such, Imkaan views these issues as gendered, and as forms of violence against women and girls that exist as a cause and consequence of their unequal status in the UK and globally.

In the UK, women and girls of all ethnicities experience routine abuse, control and victimisation based on their gender.  However, when forms of violence disproportionately impact Black and ‘minority ethnic’ (BME) women and girls, there is a tendency in policy, practice and media discourse to ‘otherise’ these issues and frame them as cultural phenomena rather than as occurring in the context of gender inequality (Imkaan & Rights of Women 2016a). Such discourse is based on simplistic and essentialist notions of culture and religion which can result in inadequate, discriminatory and racist practice (Imkaan & Rights of Women 2016b). 

Women and girls are also likely to experience multiple forms of violence and abuse that overlap, or intersect, within a broader pattern of control.  This could include physical and sexual violence, stalking, female genital mutilation, trafficking or child abuse, alongside forced marriage for example (Swegman 2016).  In the context of forced marriage, Swegman states:

“For service providers and survivors alike, it is critical to recognise and understand these links and to connect the dots between the mechanisms of power, control, and coercion that may precede a forced marriage, and the forms of abuse that can follow it.  With this increased understanding of historic and related trauma, it is more possible to effectively identify opportunities for safety and healing” (Swegman 2016, p. 2).

Acknowledging that women and girls affected by forced marriage and ‘honour-based’ violence are subjected to multiple forms of VAWG helps to ensure that professionals are more alert to their vulnerabilities and support needs and are better able to respond appropriately. 

For these reasons, an intersectional analysis of forced marriage and ‘honour-based’ violence is useful - to acknowledge and respond to the intersections between different forms of violence and abuse, the intersections between gender inequality and other inequalities across the protected characteristics, and the impact on women and girls’ journeys and experiences.  As an example of how this plays out in reality, last year, the team at Imkaan committed to archiving and amplifying young Black women’s voices created a film focused on racialised sexual harassment, which demonstrates some of the ways in which the intersections between racism, sexism and age impact everyday experiences of harassment.  Young women highlighted that racism could not be separated from their experiences of harassment and spoke about the ways in which racialised gendered stereotypes and racist violence formed part of the harassment against them, as one felt experience.  They also highlighted that, as young BME women, they felt less entitled to space and support following harassment.

Forced marriage and ‘honour-based’ violence require specific skills and awareness from professionals and much of this expertise is held within ‘by and for’ BME women’s specialist organisations that work to provide safety, support, space and social justice to BME women and girls (Larasi & Jones 2017).  In recognition of this specialism, Imkaan has developed a quality assurance framework that is designed to identify and quality-mark the critical support that such organisations provide.

However, it is also important that all agencies working on VAWG are able to respond to forced marriage and ‘honour-based’ violence.  Practically, organisations should ensure that staff members are aware of their safeguarding responsibilities, the multi-agency guidance on forced marriage, and the current civil and criminal legal frameworks in place to respond to these forms of VAWG (Imkaan & Rights of Women 2016a). 

Professionals should also routinely consider how issues of forced marriage and ‘honour-based’ violence are discussed and thought about within their organisations, for example, are these forms of violence integrated into broader VAWG issues or is there anything that needs to change attitudinally within the organisation?  In terms of practice, do needs and risk assessments cover all forms of violence against women and girls, including forced marriage and ‘honour-based’ violence and are there clear referral pathways to specialist organisations to support women’s safety and healing processes (Imkaan & Rights of Women 2016a)?

Responding to forced marriage and ‘honour-based’ violence is an important part of ensuring women and girls freedom, safety and healing and a critical part of addressing violence against women and girls, towards creating an equal society.  In order to do this effectively, understanding these issues as forms of violence against women and girls, that occur in a wider context of inequality, is crucial.  


Home Office & Foreign and Commonwealth Office (2017) Forced Marriage Unit Statistics 2016. London: Home Office & Foreign & Commonwealth Office

Imkaan & Rights of Women (2016a) Strengthening responses to forced marriage and female genital mutilation– Good Practice Briefing. London: Ascent

Imkaan & Rights of Women (2016b) Creating a clear pathway for practice: working towards more effective responses to survivors of forced marriage. London: Imkaan & Rights of Women

Larasi, M. & Jones, D. (2017) Tallawah: a briefing paper on black and ‘minority ethnic’ women and girls organising to end violence against us. London: Imkaan

Swegman, C. (2016) The Intersectionality of Forced Marriage with Other Forms of Abuse in the United States. National Resource Center on Domestic Violence

UN General Assembly (2006) In-depth study on all forms of violence against women: report of the Secretary-General, 6 July 2006, A/61/122/Add.1


For more research, expert insight and survivor stories, visit our Spotlight homepage.

State Accountability for All: Why Should BME Organisations Do Strategic Litigation?

Dr Hannana Siddiqui is a freelance policy and research consultant with over 30 years of experience on tackling violence against BME women and girls. She works for a number of organisations, including the leading BME women’s organisation, Southall Black Sisters  (where she has worked for 30 years in various capacities, including as a casework advocate) and the Angelou Centre in Newcastle (where she helps to co-ordinate the Fatima Network, which involves 15 BME women’s organisations across the UK). For an audio version of this blog, scroll to the bottom of the page or visit our Soundcloud profile.

The blog is based on a speech made by Dr Hannana Siddiqui at a seminar organised by the Centre for Women’s Justice in Bristol on 20 April 2017.

Many black and minority ethnic (BME) women’s violence against women and girls (VAWG) organisations are stretched for time and resources. Not only do the day-to-day services have to be provided, but yet another grant application needs to be submitted so that these services can survive. In this midst of this whirl of activity, it is often difficult to step back, consider and act upon what more can be done to help BME women and girls whose cases may seem hopeless. What, for instance, can be done to find safe accommodation for those without legal rights to access social security benefits and Council housing if their non-spousal visa states that they have no recourse to public funds, even if they have fled forced marriage or ‘honour-based’ violence (HBV)?

While many organisations would be angry and frustrated by a law that fails BME women and girls, few consider legal remedies to the problem, particularly if there is no obvious legal argument to be made or legal aid to support the action. Strategic litigation or casework which aims to push the boundaries of the existing law, or the way it is applied by the state, is something few BME women’s organisations have time and resources to pursue. Yet it is precisely this type of action which can trigger a quantum leap in improving the rights of BME women and girls by setting new legal precedent which assists both the individual, and a highly vulnerable and disadvantaged social group. Indeed, strategic litigation can be successful when campaigning alone has been met with refusal by the state to create wider reform in the face of injustice. Strategic litigation is therefore a vital tool in holding the state accountable for all women.

The specific benefits for BME women and girls of such action are highlighted in several cases brought by a few BME women’s organisations which undertake strategic litigation in addition to providing routine casework and campaigning or policy advocacy. For example, in the 2000s, I helped to change family law in a case of forced marriage while conducting casework advocacy for Southall Black Sisters (SBS). The case involved a young Asian woman who had been forced into marriage while visiting Pakistan. With our help, she obtained an annulment rather than a divorce from her husband, which had been normal practice in England and Wales in such situations. The woman said that this meant she was not regarded as a divorcee (which can be a cultural taboo), but as someone who had never given valid consent to the marriage. This outcome also meant that more BME women are encouraged to challenge the validity of forced marriage; and helped to deter abusive families from holding them hostage for fear of bringing shame and dishonour by obtaining a divorce. 

Also remember, in some cases, organisations can act as interveners or interested third parties, which can help to support individual litigants, as witnessed by the current case of ‘Worboys’ where a number of women’s organisations, including SBS, are intervening to hold the police accountable for failing to protect women from rape and gendered violence.

However, as organisations cannot obtain legal aid, legal costs can prove to be a barrier, particularly if the organisations lose the case and are required to pay the costs of the opposing party. This is where campaigning is important as it can help raise donations, although the courts can grant a waiver. For instance, in 2002, I intervened with SBS as an interested third party involving the tragic deaths of an Asian woman, Nazia Bi, and her young daughter to demand that the Coroner hold an inquest to establish if they had died as a result of suicide or murder in a context of domestic violence and HBV. Although the case denied SBS permission for a judicial review, the courts nevertheless accepted that SBS had a standing with a right to bring such action as an interested third party. While SBS had raised some money through a public campaign, the courts ordered that no legal costs should be paid by SBS as it had acted in the public interest.    

So, how can BME women’s organisations pursue effective strategic litigation?   

1. Find the right case: not all cases are suitable for strategic litigation as some can establish ‘bad’ law if unsuccessful. Be guided by your passion and sense of injustice, but sound legal advice is needed before you launch into legal action.

2.Find the right lawyer:  not all lawyers understand the needs of BME women and girls facing VAWG. Find a high quality lawyer with an understanding of intersectional or multiple discrimination, and who is willing to work with you to push the boundaries of the law in directions which seek to end race and gender discrimination. This often means lawyers have to be very imaginative and committed as they may have to work pro bono, at least at the beginning while they establish the basis for obtaining legal aid.

3.Find the money: not all cases would qualify for legal aid. Check if the service user would be entitled to legal aid. If you are pursuing a legal case as an organisation (as an interested third party), you would need to raise money for legal costs through donations, including crowd funding. Legal costs, however, can be high, particularly if you lose a case and you need to pay the legal costs of the opposing party (unless the court orders otherwise), even if your own lawyer/s are pro bono. So be very careful – check the strength of your case with lawyers and try to raise sufficient sums to cover all legal costs.

4.Find support for the case:  not all cases are successful without a campaign behind them.  While some cases should not be publicised, ensure, where possible, that there is public support. This not only helps to raise donations for legal and campaign costs, but also raises the profile of the issues and adds pressure for legal and policy reform.         


Contact Dr Siddiqui on Twitter: @hannanasiddiqui 

Website: (under construction)  

For more survivor stories, practice tips and research, visit our Spotlight homepage

Dr Roxanne Khan: Three myths about 'honour'-based violence

Dr. Roxanne Khan is a Chartered Psychologist and Senior Lecturer in Forensic Psychology at the University of Central Lancashire. An expert in family violence, she publishes and presents her research on ‘honour’-based violence to national and international audiences.

Dr Khan is also Director of HARM (Honour Abuse Research Matrix), a network that connects professionals working to combat this form of abuse. 

For an audio version of this blog, scroll to the bottom of the page or visit our Soundcloud profile.

There are many myths about ‘honour’ based violence (HBV) that distort our understanding these crimes. Before we explore 3 of these myths, it is important to understand how they formed.

‘Honour’-based abuse ranges from daily pressures to maintain a “respectable” image to extreme violence for tarnishing this reputation. As HBV is often premeditated and inflicted by males against female relatives, ‘honour’ crimes seem irrational, ruthless, and indefensible.

The media’s interest in torturous ‘honour’ killings keeps HBV newsworthy, fueling public outrage and professional concern. Yet, these extreme cases often overshadow less sensationalist research findings. Graphic news stories pack an emotional punch. They steer our attention away from subtle but important details, shaping our opinions and playing a part in creating myths.

These following 3 myths, in particular, are important to dispel because they may influence the way practitioners perceive and approach victims or perpetrators of HBV and forced marriage.

Myth #1: “Males can’t be victims of HBV and forced marriage…

Unquestionably, the majority of victims are female, yet …

  • …often ignored is the abuse experienced by a notable proportion of males. Annually in the UK, for example, males represent one-fifth of cases reported to the Forced Marriage Unit [1] and one-third of ‘honour’ killings [2].
  • Male victims are abused for associating with a ‘dishonourable’ woman. Or if they are perceived not to be heterosexual. Gay males may be forced into marriages if their sexuality is thought to pose a threat to their family’s reputation [3], and so ‘coming out’ may lead to HBV.
  • This ill-treatment reflects the wider abuse both men (and women) experience if they openly identify as LGBT+ [4], [5], 6].

Myth #1 must be dispelled; studies show that professionals are not immune to stereotyped or prejudiced beliefs about male and LGBT+ victimisation in the name of so called ‘honour’, [7] [8] [9] and this may obstruct genuine efforts to help.


Myth #2: “Females don’t commit HBV...”

Overwhelmingly, HBV is committed by male relatives, yet…

  • …female relatives, particularly mothers, also inflict extreme ‘honour’ violence [4][ 5]. In two notorious British ‘honour’ killings, the mothers of Rukhsana Naz and Shafilea Ahmed were instrumental in each of their daughter’s abuse and violent murders [10]. While Shakeela Naz and Farzana Ahmed are currently serving life-sentences for these crimes, they still deny any wrongdoing.
  • More commonly, females (unwittingly or not) amplify this abuse when they ignore, minimise, excuse, or forgive the harm caused by male kin. Women continue the cycle of violence by ‘policing’ family and community members, or spreading harmful rumours about someone’s ‘dishonourable’ behaviour [11].  When this gossip triggers an ‘honour’ killing, it has been called “murder by language” [12].
  • So why do females, most at risk of HBV themselves, encourage or inflict it on others? Often, because they are caught between a rock and hard place. Globally, in male-controlled honour cultures, females can protect themselves with a ‘respectable’ image, and this, in part involves identifying ‘dishonour’ in others [13].

Despite this catch-22, Myth #2 must be dispelled as studies show that females can be just as abusive as their male counterparts. For practitioners, this means being alert to the methods of abuse used by women, as these are less easy to detect.


Myth #3: “Females ‘at risk’ of HBV condemn it…”

Females are typically HBV victims, so it is unsurprising that they strongly oppose it, yet…

  • …a proportion of females, including healthcare workers [14], from honour cultures endorse ‘honour’ abuse and killings of other females [15] [16].
  • In a survey of 500 young British Asians, 18% of both males and females agreed that there was at least one reasonable excuse for committing HBV against women, ranging from disobeying a father, marrying someone unacceptable, or wanting to end a marriage [17].
  • As with Myth #2, this seems contradictory, but victim-blame is a strategy commonly used by females to make sense of violence in an unjust world [18]. The strength of a woman’s religiosity might also play a part in their acceptance of HBV [19].

Myth #3 must be dispelled so educational and intervention programmes are not designed naively to assume that all females, simply based on their gender, fully disapprove of HBV [20].

These are only 3 of many myths that shape the way HBV and forced marriage is publically perceived in the UK. It is important that professionals are alert to such myths when working on HBV cases, as they may obstruct genuine efforts to combat this perplexing form of abuse.

For more research, expert insight and survivor stories, visit our Spotlight homepage.

'Honour'-based abuse: Amala's* story

In this blog Amala* talks about the abuse that she suffered from her parents-in-law soon after her arranged marriage to her husband. The abuse from her parents-in-law was replicated by other members of the family, her husband and subsequently their children.  To protect anonymity, this blog was written using the words from a recorded interview between Amala*, her Idva and a SafeLives Advisor. For an audio version of this blog, scroll down to the bottom of the page or visit our Soundcloud profile.

I’m sharing my story to give a voice for other women who have experienced this, so they might seek help too. My mum and dad gave me a really good upbringing. They taught me right from wrong and to always side with what is right, and to think about what is supposed to be equal.

I’m a mother with 5 children, and my husband no longer lives in the country.  I met my husband through an arranged marriage in another country. At the time my parents met my husband’s family they put themselves across as a nice, loving family. When we got married I found out what the family was really like, what the expectation was. It all started from the day we got married. My husband and I lived with my mother and father-in-law and their other adult children. There were 8 people living in the house. I wasn’t allowed to go out anywhere. While my husband’s family went to work and school I was expected to make the lunch, the evening meal, to clean and dust the house, making sure that everything was prepared by the time that they got back. With 8 people living in the house, that’s all it was day in and day out, picking up and taking away. My husband’s family had all of the control, whatever I did was on their terms.

When my mother-in-law would wake up it was my duty to have the breakfast ready by the time she came out of the bathroom, to have her tea at a certain temperature. If the evening meal wasn’t ready for my father-in-law by 5pm when he came back from work, he’d go around picking up dishes, suggesting that if I hadn’t made new chapattis, I’ll just have the ones from yesterday. Just trying to have a dig at me “It’s fine, give me the ones from yesterday’’.

I could see that my husband loved and cared for me, but it wasn’t how it should be because he was scared of his parents. He never fully showed his love and care towards me. For my first birthday after we got married my husband got me a bouquet of flowers. My mother-in-law shouted at him ‘’why did you buy that? It’s a waste of money!’’ Things began to change with my husband too. After doing all of the work in the house, I’d go to bed late and this would upset him.  I was not only having to take care of my in laws, but also having to take on what he was saying as well and that really upset me. When I tried to tell him what was happening with his parents, he’d say his mum was right because he was frightened of them. He used to work all day and he didn’t want to get involved in all of this. He’d be tired, he wanted a peaceful life.  

As our family got bigger and we had more children my husband and I decided to get a house of our own. When we got our own house life seemed better, it seemed more peaceful. My husband realised…my husband felt guilty, he realised he hadn’t given time to his wife and children. We went out as a family. But even after we moved out of the house, his family’s expectation was that I’d drop the children off at school, come back to do the housework and my duties. They put pressure and control on my house, they got a spare key to come and check when we were home and what we were doing. I wasn’t allowed to go to parent’s evenings, children’s parties, they’d send my brothers-in-law instead.

When I stood up and said, I’m not going to go to your house and do all of the work, that’s when they turned against me. They manipulated my husband and my children. I began to see the change in my husband. There was soon no financial support and the first time there was physical abuse, it came from my husband. My father-in-law knew and didn’t do anything, he didn’t support me. My husband started the physical abuse, and the other family members soon followed. His family began to give the children expensive gifts and my children began to turn against me. My husband ignored it and it was not spoken about again. I got complaints from the school as well about the children getting involved in fights. My children now have no respect for me, they don’t listen to me, they swear at me. I’m not a statue, how I’ve been treated is wrong, that anyone can do what they want. I’m human too, I can’ t be treated like this. What is my life, what can I do, what am I allowed to do? From day one, my mother-in-law, father-in-law, sisters and brothers in law, and then my husband and now children too. What was I going to do?  I felt so upset and sad, like my life had ended. My in-laws threatened that if I told anyone they’d call the police, throw me out of the house and take my children from me.

The important thing to me is my children. I want to put them first. I could see what was happening to them, what was going on. I’ve got this hope, that now with the support from my Idva and the children’s social worker, the police, and I can see little changes and there are boundaries with my in laws and their influence on our lives.  All I want is for the children to go back to how they were before all of this, I want my husband to realise that he has a responsibility as well. For him to be supportive towards me.  I want to live independently with my children. I want them to have respect for women, to not hit women, to not swear at women. I don’t want my children to have that kind of attitude - looking down on everyone, thinking they are above everyone else. Most of all, I want my husband to take responsibility, to be supportive, to encourage their good behaviour. But for now, there is his ego, he can’t see right from wrong, only that I am wrong and to blame for everything.

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