The killings, which appear to stem from a power struggle within the Northern Family, Brazil’s third-most powerful gang, began Sunday at the Anísio Jobim penitentiary complex in Brazil’s northwestern Amazonas state.

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Inmates stabbed rivals with sharpened toothbrushes and choked them to death in front of visiting family members, authorities said.

Forty more inmates were killed in three other Amazonas state prisons on Monday. The death count was so high that bodies were transported by refrigerated meat trucks to other states for autopsies.

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State officials, worried that the clashes could spread, asked authorities to transfer gang leaders to federal penitentiaries.

Many of Brazil’s prisons are effectively run by inmates, and fights between and within gangs often yield deadly results.

One hundred and twenty inmates were killed in prisons across several states in January 2017 in a massacre that drew international attention. That violence was blamed on a clash between the Sao Paulo-based First Capital Command, Brazil’s largest and most powerful gang, and the Rio de Janeiro-based Red Command. Some of the dead were decapitated and disemboweled.

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After the most recent carnage, the Amazonas state prosecutor urged the government to retake control of the prisons, using military force if necessary.

Amazonas Gov. Wilson Lima told the newspaper Estado de Sao Paulo that “the system is under control,” but “it is nearly impossible to prevent these types of situations.”

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Brazil has the world’s third largest prison population. Nearly 800,000 inmates are crammed into facilities equipped to hold half that number.

For decades, Brazil’s government has transferred gang leaders to prisons far from their homes in the hope of weakening the groups. But the policy has backfired by helping neighborhood gangs develop a national reach.

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Prisons have become centers of initiation, where new inmates are sorted into gangs as soon as they enter.

As established gangs clash with new arrivals, leaders use violence to keep members in line.

“It’s intended to send a message,” said Robert Muggah, director of the think tank Igarapé Institute in Rio de Janeiro. “The control of organized crime groups depends on them exerting control outside prison gates, in neighborhoods from where a lot of the prisoners come.”

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President Jair Bolsonaro, who campaigned last year on promises to crack down on Brazil’s violence, vowed to “stuff prison cells with criminals.”

“I’d rather a prison cell full of criminals than a cemetery full of innocent people,” he said. “We will build more if necessary.”

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Yet successive governments that promised to build more prisons weren’t able to keep up with the ballooning inmate population. Space for more than 8,650 inmates has been built since the beginning of 2018 — but the number of new inmates jumped by more than 17,800 during the same period, according to the Igarapé Institute.

Prisons are so crowded that some inmates sleep standing up, their hands tied to the bars to keep from falling.

Muggah said the latest round of killings is “a reminder to this government of the severity and complexity of the challenge they face.”

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