At first, the responses to the questionnaire about the trauma of the war in Libya were predictable, if tragic: 10,000 people suffering post-traumatic stress, 4,000 children with psychological problems.
Then came the unexpected: 259 women said they had been raped by militiamen loyal to Muammar Qaddafi.
Dr. Seham Sergewa had been working with children traumatized by the fighting in Libya but soon found herself being approached by troubled mothers who felt they could trust her with their dark secret.
The first victim came forward two months ago, followed by two more. All were mothers of children the London-trained child psychologist was treating, and all described how they were raped by militiamen fighting to keep Qaddafi in power.
Dr. Sergewa decided to add a question about rape to the survey she was distributing to Libyans living in refugee camps after being driven from their homes. The main purpose was to try to determine how children were faring in the war; she suspected many were suffering from PTSD.
To her surprise, 259 women came forward with accounts of rape. They all said the same thing.
"I was really surprised when I started visiting these areas, first by the number of people suffering from PTSD, including the large number of children among them, and then by the number of women who had been raped from both the east and west of the country," Dr. Sergewa said in an interview with The Associated Press.
Rape has been a common weapon of war throughout the ages, most recently in conflicts from the Balkans in Europe to Sri Lanka in Asia and in sub-Saharan Africa, where Congo has been described as the epicenter of sexual crimes.
Across the world, rape carries a stigma. But it can be a deadly one in conservative Muslim societies like Libya, where rape is considered a stain on the honor of the entire family. Victims can be abandoned by their families and, in some cases, left in the desert to die. Speaking to a journalist is out of the question.
Dr. Sergewa’s questionnaire was distributed to 70,000 families and drew 59,000 responses.
"We found 10,000 people with PTSD, 4,000 children suffering psychological problems and 259 raped women," she said, adding that she believes the number of rape victims is many times higher but that woman are afraid to report the attacks.
The women said they had been raped by Qaddafi’s militias in numerous cities and towns: Benghazi, Tobruk, Brega, Bayda and Ajdabiya (where the initial three mothers hail from) and Saloum in the east; and Misrata in the west.
Some just said they had been raped. Some did not sign their names; some just used their initials. But some felt compelled to share the horrific details of their ordeals on the back of the questionnaire.
Reading from the scribbled Arabic on the back of one survey, Dr. Sergewa described one woman’s attack in Misrata in March, while it was still occupied by Qaddafi’s forces.
"First they tied my husband up," the woman wrote. "Then they raped me in front of my husband and my husband’s brother. Then they killed my husband."
Another woman in Misrata said she was raped in front of her four children after Qaddafi fighters burned down her home.
"She ran away with her children and tried to escape to the port, but then they started shelling the port. In the chaos, she was separated from the children," Dr. Sergewa said.
"She was distraught when I interviewed her, not knowing if her children were dead or alive. I wish I knew the end of her story, but I don’t know what happened to her."
Doctors at hospitals in Benghazi, the rebel bastion, said they had heard of women being raped but had not treated any. The first international airstrikes on March 19 saved the city from falling into the hands of Qaddafi forces who were advancing in columns of tanks.
However, a doctor in Ajdabiya, 100 miles (150 kilometers) south of Benghazi, said he treated three women who said they were raped by Qaddafi fighters in March when the town was invaded.
"These women were terrified their families would find out – two were married, one was single," Dr. Suleiman Refadi said. "They only came to me because they also were terrified that they may have been infected with the AIDS virus." He said they had tested negative but doubted they would return for follow-up tests.
Qaddafi’s fighters were forced out of Ajdabiya weeks ago and the town now is largely deserted but for the rebels.
In a highly publicized case in Libya, Iman al-Obeidi burst into the hotel housing foreign journalists in Tripoli in March and accused pro-Qaddafi militiamen of gang-raping her because she is from rebel-held eastern Libya. Her anguished disclosure was captured by Western cameras and shown around the world.
Earlier this month, the prosecutor of the International Criminal Court in The Hague, Luis Moreno-Campo, said he has "strong evidence" of crimes against humanity committed by Qaddafi’s regime, including serious allegations of "women arrested and gang raped."
One of Libya’s leading psychiatrists, Dr. Ali M. Elroey, told the AP that he has set up three mobile teams to treat trauma victims of the war in their homes or in temporary shelters: one for PTSD, one for other psychological problems and one for rape survivors.
Dr. Elroey said they need to reach out to people in their homes because the stigma associated with psychiatric care is leaving large numbers of patients untreated.
His outpatient clinic at Benghazi’s psychiatric hospital has treated more than 600 patients in two months, many responding to radio and newspaper advertisements offering psychiatric help for war trauma. He said most were women, though none had acknowledged being raped.
Dr. Sergewa said she has interviewed 140 of the rape survivors in various states of mental anguish, and has been unable to persuade a single victim to prosecute. None would speak to the AP about her ordeal, even with a promise to hide her identity.
"Some I diagnosed with acute psychosis; they are hallucinating," Dr. Sergewa said. "Some are very depressed; some want to commit suicide. Some want their parents to kill them because they don’t want their families to bear the shame."
Some already have been abandoned by their husbands and fear seeking treatment could get them ostracized or cast out of their communities. Others have kept the rapes a secret for fear of retribution from spouses. "They fear their husbands will take them out to the desert and leave them there to die," Dr. Sergewa said.
It is likely more rapes could occur as the conflict drags on, Dr. Sergewa said.
"They are using rape not just to hurt women but to terrorize entire families and communities," Dr. Sergewa said. "The women I spoke to say they believed they were raped because their husbands and brothers were fighting Qaddafi.
"I think it is also to put shame on the tribes or the villages, to scare people into fleeing, and to say: ‘We have raped your women,’" she said.
Dr. Sergewa says women will continue to be targets of the militiamen, and this makes it all the more urgent to finish her study and get it published.
"We must throw light on what is really happening in Libya and fight to bring justice for these women, to help heal them psychologically," she said.
(Associated Press writer Mike Corder contributed to this report from The Hague.)