Wafa Sultan is manoeuvred into the hotel lift like a precious parcel in the grip of an expert handler. Sultan's female bodyguard is taking no chances even in the hushed and sparsely populated corridors of this elegant Sydney hotel. When the lift doors open again, we move briskly towards the room set aside for our talk, the agile young minder sweeping the diminutive Sultan to safety.

From what? What threat could there be to this homely looking mother of three children? In fact, hanging over Sultan's head like a sabre are two fatwas - legal rulings by Muslim clerics - that declare Sultan to be an apostate, a renouncer of Islam. The formal penalty for such renunciation is death.

Sultan's rejection of Islam became known to millions worldwide when the Syrian-born psychiatrist, now a citizen of the US, made an extraordinary appearance on the Qatar-based Arabic-language TV network, Al Jazeera, in February 2006. Filmed speaking from her home in California, where she has lived since 1989, Sultan, with breathtaking audacity, confronted a Muslim cleric in a Middle East studio with an explanation of why she had rejected the faith into which she was born. Her eloquent critique of Islam was provocative and deeply damaging.

She described the difference between the Muslim world and the Western world this way: "It is a clash between a mentality that belongs to the Middle Ages and another mentality that belongs to the 21st century. It is a clash between civilisation and backwardness, between the civilised and the primitive, between barbarity and rationality. It is a clash between freedom and oppression, between democracy and dictatorship.

"It is a clash between human rights on the one hand, and the violation of these rights on the other hand. It is a clash between those who treat women as beasts and those who treat them as human beings."

The 49-year-old Californian housewife arrived at this juncture in her life after years in which she was torn between love and hate - love for her Syrian Muslim family and hate for the abuse she felt the family's faith inflicted on her as a woman.

Nestled into a sofa in the Sydney hotel room, halfway around the world from the coastal town of Baniyas where she was born, Sultan tells about the early stirrings of her doubts about Islam: "I started to hate it, but to be afraid at the same time to face it or to acknowledge it. It's very hard...torn between the two forces. Most women, I believe, in the Islamic culture, suffer from this conflict."

It is Sultan's connection with women - particularly as a doctor - that has fired her passion. She says, "I practised medicine for nine years. I went very deeply into women's lives. I got to know what was going on behind closed doors. They were very open; they were very damaged ... Actually, my attitude to Islam is not because of my [own] personal life. I did much better than many women in Syria ... They touched [me] with their stories, they touched my life and I felt like I am responsible to do something."

Three episodes (of the many we discuss) from Sultan's experience go some way to go some way to explaining why Sultan now dedicates her life to this cause. The first is from the very beginning of Sultan's life, a story - recounted to her by her mother - that she now passes on to me with fiery indignation: "When I was a newborn baby and my uncle was passing by our balcony, he said to my mum, 'So, did you choose a name?' She said, 'No.' He said, 'Name her 'Shit.'" Such disrespect for a female child and the routine humiliation of all women and girls, contends Sultan, is typical of male Muslim attitudes. "If I was a boy, do you think he would say that? Of course not! ... As a little girl, feeling you're nothing but shit, how [would] you feel about it?"

The second instance concerns one of Sultan's nieces who, she tells me, was 11 years old when forced into a marriage with a 41-year-old wealthy businessman who also happened to be the girl's cousin. Sultan remembers how at various points during the marriage, her niece would plead with her father to not be sent back to the man with whom she bore four children. "My niece committed suicide. She was 28, a mother of four ... I was in America when I heard the news. I still remember her beautiful face. She poured [petrol] on herself and set herself on fire." Sultan says again, as if in a trance, "She was the mother of four children."

A third episode is from Sultan's time as a doctor. She vividly remembers a patient who, when told she was three months pregnant, fell to her knees, begging Sultan to protect her from her own teenage son. When asked why the boy should be a threat, Sultan recalls the woman replying: "My 15-year-old son is going to kill me once he knows about my pregnancy because I am a widow. My husband died four years ago, and my husband's brother forces me to sleep with him every day in order to feed my four children. Once he knows about my pregnancy, he will tell my son, and my son, he [will] for sure, kill me."

Sultan explains in a voice rising with rage, "I still remember her statement: 'I don't want my son to get his hands dirty with my filthy blood.' Do you believe it? She blamed herself...This poor woman was programmed to believe she was the source of the shame...Do you believe it?" Then Sultan adds softly that there are "many, many stories" like this one.