Continuum Of Violence Research Articles

Contributions and limitations of diverse qualitative methods to feminist participatory and action research with women in the wake of gross violations of human rights

This article explores several qualitative research methods deployed in three case studies in which activist feminist scholars trained in the global north engaged in participatory research processes with Indigenous women in Guatemala and Peru and with Latina migrants in the United States. We authors accompanied these women as they resisted oppressive conditions, engaged in healing processes, and persisted in transforming their lives towards realizing a better future for themselves and their families in the context of continuous violence and impoverishment. The article explores sometimes overlooked aspects of participatory methods, including (1) the contribution of individual interviews within participatory and action research processes, which are generally based on group processes; (2) diverse creative, participatory strategies for data collection, analysis, and sharing of co-constructed knowledge(s) to study participants and co-researchers who have endured gross human rights violations; and, (3) the dialectics of voice and silence evident in FPAR and FPR processes of accompanying these women through dialogic research relationships. We conclude with implications for participatory activist scholarship that draws on qualitative methods to document the diverse meanings of experiences of violence, resistance, and healing.

The place and markers of intra-family violence in violent extremism

International research literature documented two red threads of extreme violence, identified misogyny and dehumanisation as the roots of extreme and violent ideologies, and revealed that support for violence against women predicts support for violent extremism more than any other factor. Research evidence documented the lasting impact ofviolence against women and children. Considering the place and markers of domestic violence inviolent extremist trajectories means to address their driving processes and thecontinuum of violence characterized by constant, cumulative, non-episodic strategies used by aggressors to control and dominate thevictims.

War by other means at the extractive frontier: the violence of reconstruction in ‘post‐war’ Peru

AbstractThis article examines the meeting of local and national reconstruction priorities in the wake of Peru's internal war (officially, 1980‐2000). I focus on the impact of the state's extractivism‐led agenda on indigenous Asháninka people's projects of remaking themselves into Asháninka sanori (‘real Asháninka people’). Taking an Asháninka sanori‐centred analysis of their experience of war and post‐war violence, I propose an approach to understanding the impact of mainstream reconstruction efforts on survivors that centres on the latter's articulations of personhood. This approach, possible through ethnographic engagement, sets anthropology at the forefront of the necessary rethinking of mainstream reconstruction interventions to foster approaches that are supportive of survivors’ priorities. The article explores a continuum of violence through war and extractivism that is undoing the networks of relations through which a group of survivors constitute themselves as people and communities and set their aspirations for the future.

Violence that builds sovereignty: the transnational violence continuum in deportation from the United States

ABSTRACT Building upon an abundance of theoretical literature describing the role of deportation in the assertion of nation-state sovereignty, this article asks how deportees experience state sovereignty. Its conclusions are informed by an ‘ethnography of removal’ drawing on 62 interviews with 25 Mexican deportees interviewed in their communities of origin in Oaxaca after ‘3D’ (detection, detention and deportation) removal. Acknowledging deportation as an example of legal violence, the paper describes various other types of violence (physical, structural and symbolic; executed by state agents, private contractors, other deportees, criminal organisations, and communities of origin) that produce US sovereignty at the level of individual experience. ‘3D’ deportation causes suffering, embarrassment and fear. The paper shows how US borders are externalised on the micro and meso level without the involvement of state actors as deportees, invested with a new governmentality after being violently deported, exercise border controls over themselves and refrain from returning to the US.

Lost and Forgotten: Missing and Murdered Sex Workers on Vancouver's Downtown Eastside

From 1978 to 2002, more than 60 women went missing from Vancouver’s Downtown Eastside, an area that has often been described as “Canada’s poorest postal code”. For decades, families of the area’s missing women filed police reports and engaged with the media about their vanished loved ones, however little headway was made in the case until ten years later, when the Vancouver Sun began publishing a series of stories on the women that drew provincial and national attention. Motivated by citizen dissent and accusations of negligence, The Vancouver Police Department and the RCMP finally launched a joint task force, resulting in the arrest and conviction of Robert “Willie” Pickton, a pig farmer from Port Coquitlam, for the serial murders of street-involved women. The subsequent excavation of the Pickton property became the largest criminal investigation in Canadian history, spanning several years and costing tens of millions of dollars. However, the danger and violence that plagued women on the Downtown Eastside remained largely the same for many years after Pickton’s arrest. While media coverage narrated Pickton as a single deranged male, this narrative effectively eliminated the context of the broader social background that thrust these women into harm’s way. In this paper, I will discuss the racialization, spatialization, and class distinctions that heavily influence women's participation in the sex trade, as well the media narratives that enable an understanding of Pickton as a violent outlier. The research shows that despite these narratives, violence against marginalized women is a part of the normative social order, which is precisely what allows violent men to function without apprehension in these communities for so long. As you will read, violence against women cannot be described as simply the action of a few bad apples, but is instead a larger part of a “continuum of violence” enacted against already marginalized women. Keywords: MMIWG, Robert Pickton, sexual violence, street-level sex work

Global South Perspectives on Stonewall after 50 Years, Part II—Brazilian Stonewalls: Radical Politics and Lesbian Activism

Abstract The riots against a New York City police raid at the Stonewall Inn bar in June, 1969, are often identified as having sparked the movement for LGBT rights, and the commemoration of the riots one year later in June, 1970, inaugurated a series of annual LGBT Pride events that continues to this day worldwide. In this two-part Forum, we reflect on the contradictory effects of Stonewall’s international legacy. In this second part of the Forum, Ferreira and Belmont investigate the ways in which ‘Stonewall’ has been appropriated specifically in Brazil, both during the civil-military dictatorship and in the current fraught political moment. Belmont locates current mismatches between LGBT and queer struggles in Brazil by juxtaposing more mainstream visions of LGBT politics with the margins they create, especially the marginalization of travestis. Belmont exposes the way that dominant LGBT discourse and practices reinforce the continuous violence over dissident bodies and proposes that we look at travestis’ experiences and arguments as necessary contributions to a more radical (queer) politics. In the final contribution, Ferreira recapitulates the political demands of NYC’s Stonewall events and contrast them to the revolutionary claims of what was called a ‘Brazilian Stonewall.’ Considering the protagonism of lesbian movements in such events in Brazil, her contribution analyzes, from a queer perspective, the embrace of a multiplicity of identifications in contemporary lesbian activism. She argues that this move creates potentialities for responding to structural violences, while also speaking to questions such as the judicialization and commercialization of LGBTTI causes and homonormativity.

Digital intrusions: technology, spatiality and violence against women

Technologies have transformed self-expression, interactions and relationships. Temporal and geographic boundaries have been tested and overcome by instantaneous and borderless contact, communication and monitoring. Unfortunately, this has provided new channels and opportunities to extend and exacerbate gendered violence and other forms of hate. We contend that the unique features of digital harms warrant attention, but ultimately online harms cannot be divorced from those which occur offline. Drawing on what Kelly (1987; 1988; 2012) conceptualised as a ‘continuum of violence’ (and what Stanko, 1985, refers to as climates of ‘unsafety’), digital violence is, we suggest, part of the spectrum of harm to which women are exposed throughout their life-worlds. The industries that create technologies do not exist in a vacuum, and we explore how the workforce, design and management of platforms not only reflects but reinforces ‘offline’ inequalities and facilitates violence. There are challenges in harnessing technology but, in closing, we explore ways that women can claim and create digital spaces to resist violence and seek ‘justice’.

Corporal punishment, discipline and social norms: A systematic review in low- and middle-income countries

Abstract There is increased recognition that incorporating a social norms approach provides insights for understanding corporal punishment and/or discipline (CPD). This review seeks to explore how the literature analyses social norms and CPD in low- and middle-income countries (LMICs). We searched eight electronic databases, Google Scholar, Google and institutional websites, including articles in LMICs which examined social norms and CPD perpetrated by family members or teachers. Data was extracted, assessed for quality and analyzed according to key themes. Of 21,708 articles from academic databases and 92 from other sources, 37 studies were included. We observed heterogeneity in study design, and in the definition and measurement of social norms. In the majority of studies, social norms supporting CPD were either harmful or, at times, protective. The review also finds that gender, age, power hierarchies and changes such as conflict, migration and modernization may influence norms on CPD. CPD interventions should be evaluated over longer periods and with consideration to the continuum of violence between homes and schools. Future research on CPD should (1) theorize and define social norms more clearly; (2) examine both harmful and protective norms linked to CPD; (3) explicitly examine perpetration of violence across the home-school continuum.

Sexual violence, identity and gender: ISIS and the Yezidis

ABSTRACT This paper explores the gender dimension of the relationship between the political marketplace and identity formation. Gender is a central, not tangential, component of violence and gender norms are an essential part of singular and exclusive identity formation. The article focuses on ISIS’s sexual and gender-based violence against the Yezidis and contextualises this case within wider long-term gender- and identity-based structural inequalities that facilitate sexual violence in conflict. Structural inequalities are understood here within a continuum of violence and through an intersectional study of sexual violence in conflict. In the case of ISIS and the Yezidis, specific ethnic or religious constructions of identity intersected with gender, leading to targeting of a minority community. This identity formation is part of becoming a militarised masculine warrior within a group – ISIS used sexual violence in forming its group identity against a subordinated outgroup. In doing this, ISIS objectified and commodified the bodies of the Yezidi women and created an economic market around this. Objectification and commodification of Yezidi women reinforced ISIS’s hegemonic and militant masculinity. The construction of identity through sexual violence took place in a socio-economic and political context situated within a long-term history of the intersection of gender and identity-based hierarchies. This was possible because of the existing repertoires of values, perceptions and practices of hegemonic and militant masculinity. The organisation and institutionalisation of sexual violence and objectification and commodification of Yezidi women and girls was based on this repertoire which was based on intersectional hierarchies of gender and religious-ethnic-sectarian identities.

Third-Party Mediation in Sri Lanka’s Peace Attempts: A Study on the Role of Norwegian Mediation

Regional and international mediation by third parties in Sri Lanka’s ethnic conflict have had diverse impacts on the country’s political scene at various times. India spearheaded a significant regional mediation following the July 1983 pogrom against minority Tamils. An international mediation effort by a third party was initiated in 2000, with Norway playing the role of facilitator. Both of these attempts to resolve Sri Lanka’s ethnic conflict, which were taken to bring an end to the intense and continued violence, have had mixed outcomes. In particular, Norway’s initiative to bring an end to the conflict with international facilitation was taken in the backdrop of the changed world order that prevailed after the September 11 attacks on the World Trade Center in New York. It is against this backdrop; this article attempts to examine the contributions made by Norway towards the resolution of Sri Lanka’s ethnic conflict. The major finding shows that Norwegian initiative fell into fail after a period and the armed insurgency did not come to an end until 2009. In May 2009, the government forces defeated the LTTE militarily and declared the war victory.

Domestic violence as initiated by Batak culture in East Medan, Indonesia

ABSTRACT It is natural for human beings to hope that their married life will run smoothly and be full of happiness even though at times the reality they face could be far from what is expected, with some marriages witnessing lies, deceit and continuous violence. This research is a descriptive normative research with data sources that are both secondary and primary in nature. The results show that despite the existence of Law No. 23 of 2004 which regulates the elimination of domestic violence, domestic violence still thrives. It was observed that the regulation was greatly overlooked because of the strong influence of the Batak culture which was able to create the character of the Batak Toba tribe woman who always maintained the integrity of her household for family honor and natolu from both parties.

Violence and space: A comparative ethnography of two Italian “badlands”

This paper compares two marginal neighbourhoods and Italian “badlands”: the Zona Espansione Nord (ZEN) of Palermo and San Siro in Milan. It concerns multiple types of violence that affect them and their connections with different multi-scale processes. The two neighbourhoods emerge as the result of two urban histories that can be partly schematised in two dichotomous images: on the one side, the “non-Fordist” marginality of the ZEN, a social enclave of unemployment without a working-class past; on the other side, the “post-Fordist” marginality of San Siro, a multicultural socio-spatial configuration with a working-class past. Following the idea of the continuum of violence, we suggest that space is heuristically connected with violence and to this continuum. In order to illustrate this hypothesis, this paper introduces two case studies, drawing out their main common characteristics as urban badlands, and singling out the different traits that mark their specificity. It then links the continuum of violence to urban space, firstly in a synchronic perspective, mapping the different forms of violence that affect the two neighbourhoods today, and secondly on a diachronic perspective pointing to their different on-going dynamics, through the life stories of some of our interlocutors. Through this comparison, we illustrate how these two case studies combine and account for what we call the urban space-violence continuum.

Antidemocratic and Exclusionary Practices: COVID-19 and the Continuum of Violence

AbstractThe global coronavirus pandemic has reified divisions, inequity, and injustices rooted in systems of domination such as racism, sexism, neoliberal capitalism, and ableism. Feminist scholars have theorized these interlocking systems of domination as the “continuum of violence.” Building on this scholarship, we conceptualize the U.S. response to and the consequences of the COVID-19 pandemic as reflective of the continuum of violence. We argue that crises like pandemics expose the antidemocratic and exclusionary practices inherent in this continuum, which is especially racialized and gendered. To support our argument, we provide empirical evidence of the continuum of violence in relation to COVID-19 vis-à-vis the interrelated issues of militarization and what feminists call “everyday security,” such as public health and gender-based violence. The continuum of violence contributes theoretically and practically to our understanding of how violence that the pandemic illuminates is embedded in broader systems of domination and exclusion.

Of One Mind and of One Government: The Rise and Fall of the Creek Nation in the Early Republic

The decades following the American Revolution were a critical period for Native peoples in the southeastern United States. With the loss of British support, Native Americans had to establish relations with the Spanish, who had regained Florida, while grappling with expansionist Americans. The Creeks, as Kevin Kokomoor describes in Of One Mind and of One Government: The Rise and Fall of the Creek Nation in the Early Republic, eventually chose an accommodationist policy toward Americans. The result, Kokomoor argues, was an unprecedented unification of the Creeks under the National Council, which for several years managed to maintain Creek sovereignty against American encroachment.Before the revolution, the Creeks, apart from their geographical grouping into upper and lower communities, generally identified with their towns and clans rather than any larger polity. Yet all Creeks shared a commitment to retaining their land, as Kokomoor demonstrates with a discussion of the Ceded Lands Crisis of 1773. This conflict nearly precipitated a Creek war with Georgia. During the revolution, Creek divisions were reinforced by connections to pro-American or pro-British traders who lived among them. With the defeat of the British, the pro-American faction gained influence and sought to curry favor with Georgians by means of a land sale.The treaty angered many Creeks, and with Spanish support Alexander McGillivray emerged as the leader of the faction opposing the cession. Georgia’s aggressive policies strengthened McGillivray, and Creek successes in the resulting Oconee War forced Georgia to moderate its demands. McGillivray undermined Creek achievements, however, when he accepted the earlier cession in the 1790 Treaty of New York. McGillivray’s influence subsequently collapsed as numerous Creeks repudiated the agreement. This, along with Spain’s more conciliatory policy toward the United States and the continued violence along the Georgia frontier, created the conditions for an incipient Creek nationalism. Pro-American Creeks managed to harness this nationalism to create a unified Creek nation in the mid-1790s.Kokomoor argues that while the new Creek National Council adapted some Native traditions, it was primarily a response to American expansionism, and was heavily influenced by federally appointed Indian agents James Seagrove and Benjamin Hawkins. Under pressure from these agents, the council sought to avoid conflict by complying with American demands, including the punishment of Creeks who raided settlements or stole horses. However, Creek efforts to accommodate Americans were never reciprocated, as new land cessions were demanded, crimes committed by Georgians against Creeks went unpunished, and roads and forts were built in Creek territory. When the council opposed American demands, it was ignored, and by the early 1810s, Kokomoor shows, the United States had reduced the body to little more than a “puppet government” (324).The growing ineffectiveness of the National Council encouraged militant Red Stick Creeks to fight against both the council and the United States, and in a display of its dependence on the Americans, the council welcomed military forces sent to crush the Red Sticks. Although the council reasserted its leadership after the conflict, and complied with every American demand, its concerns were ignored as the United States ultimately imposed its removal policy on the Creeks. The story of the National Council is a tragedy in which the Creeks, compliant to the point of executing their own people to appease the Americans, failed to avoid destruction. Kokomoor convincingly shows that the council could govern effectively, but that no level of accommodation could satisfy its expansionist neighbors.This volume is comprehensive in scope, thoroughly researched, and well written. It is a valuable resource for scholars of Native American history and of the Early National period and should also interest general readers interested in those subjects.

Drawing on the continuum: a war and post-war political economy of gender-based violence in Bosnia and Herzegovina

ABSTRACT Current understandings of why and how gender-based violence continues beyond the end of conflict remain siloed along theoretical and disciplinary lines. Recent scholarship has addressed the neglected structural dimension when examining the incidence and variation of post-conflict gender-based violence. In particular, continuum of violence and feminist political economy perspectives have offered accounts of gender-based violence during and after conflict. However, these approaches overlook how war and post-war economic processes interact over time and co-constitute the material basis for the continuation of gender-based violence. The war and post-war political economy perspective that we leverage examines critically the distinction, both in theory and practice, between global and local dynamics, and between formal and informal actors in post-conflict societies. Exposing these neglected structural and historical interconnections with evidence from post-conflict Bosnia and Herzegovina, we demonstrate that the material basis of gender-based violence is a cumulative result of political and socio-economic dynamics along the war-to-peace trajectory. Our findings point to the need to be attentive to the enduring material consequences of interests and incentives formed through war, and to the impact of post-war global governance ideologies that transform local conditions conducive to gender-based violence.

Migration of Violence, Violence in migration. The Vulnerabilities of Central American Populations Going North

Central American migratory journeys take place in risky geographical and socio-political spaces, where situations involving danger and vulnerability take many forms. Based on observation of experiences and contexts of mobility, the author examines expressions of violence as one of the motives for migration, as a constraint affecting the implementation of migration projects and finally, as an effect of migration policies of containment. He postulates that forms of violence are intertwined, often cumulative, and that their persistence constitutes a component of migration phenomena in the region today. The article aims to examine the ways in which a ‘continuum of violence’ creates marginal status and generates situations that, in turn, fuel forms of vulnerability where risks are trivialised, while the migratory presence is socially, legally and politically undervalued and rendered invisible.

Angifi Dladla and the Bleakness of Freedom

Angifi Dladla is a Poet of No Sure Place. His poetry speaks for the marginalized and explores the otherwise unmentioned dynamics of South Africa's political and social landscape. In this article I explore how this label is demonstrated within his two collections of poetry, The Girl Who Then Feared to Sleep and Lament for KofifiMachu. More specifically, my argument engages with the evolving meanings of freedom evoked by Dladla, first in his apartheid-era poetry and, second, in that of today's post-apartheid situation. I demonstrate how the black-on-black violence of the 1980s townships caused a sense of confinement that forced Dladla within himself. Only then was he able to understand freedom and chart a way forward. Following this, the article turns toward those poems that depict contemporary South Africa. My analysis suggests that when freedom, not oppression, is the official political environment of the day, the reality for many is only continued violence and despair. To chart a way out of this bleak malaise, Dladla exhorts others to write in the style of his own poetry.

National Resilience to Protracted Violence in Ukraine

This paper concentrates on the production of power of the Ukrainian nation, that not only deals with continuous violence within the nation, but also develops national strength to address this violence. This paper aims to explore how the Ukrainian nation develops resilience to protracted violence as a form of transformative power and what factors contribute or impede this process. The paper defines resilience as a form of power that enhances the capacity of a national community to heal from trauma, effectively resists perpetrators of violence, and positively transform intergroup relations to remove communities from contexts of chronic violence and war. Based on semi-structured interviews with twenty-six respondents and a phenomenological analysis of data, this paper shows that effective practices of resilience developed by the national community of Ukraine, including volunteerism, a critical approach to history, and dialogue, not only aid Ukrainians in the adaptation to the chronic violence but also in the transformation of the nature and the impact of the violence on the national community. At the same time, these practices not only utilize external and internal resources but shape the societal capacities and the international interventions. Finally, these practices also alter visions of the society and dynamics of relations between power agents.

Hostile Heartland: Racism, Repression, and Resistance in the Midwest by Brent M. S. Campney

Reviewed by: Hostile Heartland: Racism, Repression, and Resistance in the Midwest by Brent M. S. Campney Amy Louise Wood Hostile Heartland: Racism, Repression, and Resistance in the Midwest. By Brent M. S. Campney. (Urbana and other cities: University of Illinois Press, 2019. Pp. x, 240. Paper, $27.95, ISBN 978-0-252-08430-0; cloth, $99.00, ISBN 978-0-252-04249-2.) Hostile Heartland: Racism, Repression, and Resistance in the Midwest is a welcome follow-up to Brent M. S. Campney's earlier book, This Is Not Dixie: Racist Violence in Kansas, 1861–1927 (Urbana, 2015), which challenges the popular illusion that Kansas was a bastion of pastoral virtue, free of the racial conflict that consumed the South or urban locales in the North. Instead, Campney argues that racist violence was as important to maintaining racial hierarchy in this midwestern state as it was in the South. Hostile Heartland expands this same argument to the larger region, with chapters that cover histories of racist violence in Illinois, Indiana, Ohio, and Missouri, as well as Kansas. He also extends his time frame, reaching back to the antebellum era and spanning through the 1930s. Campney makes a number of important contributions. First, he is one of just a handful of scholars who have examined lynching as part of a continuum of violence that includes threatened lynchings, homicides, rapes, whippings, and expulsions. Hostile Heartland makes clear that all these various forms of racist violence terrorized African Americans and supported white efforts to institute segregation, by law or custom, in public life. Second, Campney's chapter on [End Page 733] antebellum violence in the Old Northwest upsets the common presumption that Jim Crow–era lynchings represented a new phenomenon. Third, Campney shows how African Americans resisted white attacks, often through armed selfdefense. Black resistance happened organically and locally, rather than through official civil rights activism, and that resistance could engender further attacks and retribution. Fourth, his chapter on the role of law enforcement in aiding and—over time, as the police became more professionalized—stopping lynchings is a careful analysis of the topic that should plant the seed for more scholarship on the relationship between policing and mob violence. Finally, Hostile Heartland contributes to a historiographical trend that seeks to challenge the notion that racism and racist violence were distinctive features of the South. In Campney's reading, what distinguished the South was not white supremacy but demographics; if there were fewer lynchings and other forms of attacks in the Midwest, it was only because there were fewer African Americans in the region. On the whole, white midwesterners targeted African Americans as fiercely as their southern counterparts did. Neither was racist violence merely a product of white southern migrants to the Midwest, as other scholars have assumed. Rather, Campney shows that white migrants from the Northeast were just as protective of white supremacy as those from southern states. The modes of violence that northern and southern migrants used, however, often differed, a point Campney could have elaborated upon. Campney also does not spend much time discussing what motivated this violence beyond white supremacy. He provides thorough context on the racial climate in each state he covers. Readers do not learn much, however, about the political, social, or economic contexts that might have precipitated acts of racist violence. He does note that African Americans were at times targeted because they posed an economic threat to local whites. Were there local circumstances that made those attacks more likely? What other factors might have prompted white attacks? If white supremacy was a persistent fact, why did violence break out only at certain times in certain places—and take the forms that it did? Still, despite these questions, Hostile Heartland is a thickly researched survey that draws a striking picture of just how precarious life was for African American migrants to the Midwest. Amy Louise Wood Illinois State University Copyright © 2020 The Southern Historical Association

Accidents in Iraq during the period of conflict (2003-2016).

Background: Injuries are increasingly recognized as a major component of the global burden of disease, as they tend to affect mainly youth and are usually followed by premature death or severe disability. The longstanding conflict in Iraq has resulted in a situation of continuous violence and ongoing instability, which has in turn led to an increasing incidence of injuries and a crippled health system. Objective: To sketch a trend of non-military accidents in Iraq (road traffic accidents [RTA], falls, burns, firearm injuries, assaults by sharp objects and sexual assaults) among civilians during the last 14 years associated with the period of conflict (2003–2016). Methods: This descriptive study was conducted during the period from January 1st through to December 31st, 2017 using already available surveillance data from the Ministry of Health in Iraq. The methodology was based on measuring the incidence of each accident for the period from 2003 through 2016 and plotting it against time. Linear regression was computed to estimate the trends of the disease. Results: The rate of RTAs significantly increased between 2003 and 2016, from 1.85 to 2.9 per 1000 (p ≤ 0.01), as did accidental falls especially after 2008 (males more than females) (p ≤ 0.01). By contrast, after a peak in 2011, burns dropped significantly from 4.19 to 3.42/1000, along with firearm accidents, which fell from 2.2/1000 in 2007 to 0.39 in 2016 (p ≤ 0.01), mostly among males. Assaults with sharp objects also decreased with time to a rate of 0.47/1000 (p = 0.0001). Sexual assaults showed a significant downward sloping trend over time to p = 0.037. Conclusion: Accidents still add a burden on the already deteriorated Iraqi health system. Understanding the impact of this burden is essential to better prepare for future plans and interventions that may help improve the quality of health services.