She and her husband, who now goes by the Americanized name of David, laid plans to leave for the United States. Their visas finally came in 1989, and the Sultans and their two children (they have since had a third) settled in with friends in Cerritos, Calif., a prosperous bedroom community on the edge of Los Angeles County.
After a succession of jobs and struggles with language, Dr. Sultan has completed her American medical licensing, with the exception of a hospital residency program, which she hopes to do within a year. David operates an automotive-smog-check station. They bought a home in the Los Angeles area and put their children through local public schools. All are now American citizens.
BUT even as she settled into a comfortable middle-class American life, Dr. Sultan's anger burned within. She took to writing, first for herself, then for an Islamic reform Web site called Annaqed (The Critic), run by a Syrian expatriate in Phoenix.
An angry essay on that site by Dr. Sultan about the Muslim Brotherhood caught the attention of Al Jazeera, which invited her to debate an Algerian cleric on the air last July.
In the debate, she questioned the religious teachings that prompt young people to commit suicide in the name of God. "Why does a young Muslim man, in the prime of life, with a full life ahead, go and blow himself up?" she asked. "In our countries, religion is the sole source of education and is the only spring from which that terrorist drank until his thirst was quenched."
Her remarks set off debates around the globe and her name began appearing in Arabic newspapers and Web sites. But her fame grew exponentially when she appeared on Al Jazeera again on Feb. 21, an appearance that was translated and widely distributed by the Middle East Media Research Institute, known as Memri.
Memri said the clip of her February appearance had been viewed more than a million times.
"The clash we are witnessing around the world is not a clash of religions or a clash of civilizations," Dr. Sultan said. "It is a clash between two opposites, between two eras. 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 civilization and backwardness, between the civilized and the primitive, between barbarity and rationality."
She said she no longer practiced Islam. "I am a secular human being," she said.
The other guest on the program, identified as an Egyptian professor of religious studies, Dr. Ibrahim al-Khouli, asked, "Are you a heretic?" He then said there was no point in rebuking or debating her, because she had blasphemed against Islam, the Prophet Muhammad and the Koran.
Dr. Sultan said she took those words as a formal fatwa, a religious condemnation. Since then, she said, she has received numerous death threats on her answering machine and by e-mail.
One message said: "Oh, you are still alive? Wait and see." She received an e-mail message the other day, in Arabic, that said, "If someone were to kill you, it would be me."
Dr. Sultan said her mother, who still lives in Syria, is afraid to contact her directly, speaking only through a sister who lives in Qatar. She said she worried more about the safety of family members here and in Syria than she did for her own.
"I have no fear," she said. "I believe in my message. It is like a million-mile journey, and I believe I have walked the first and hardest 10 miles."