Rape is being used as a weapon of war in the Syrian conflict to such an extent that many refugee families are citing it a as a primary reason to flee, according to a new report.
The study of the nearly 600,000 people who have fled the country since the start of the civil war stated it was a "staggering humanitarian disaster".
On top of those in neighboring countries, mainly Jordan, Lebanon, Turkey and Iraq, 2.5 million had fled their homes but remained in Syria, while 4 million people were in need of help.
"The extent of the bloodshed, devastation, displacement and suffering inside Syria cannot be easily or precisely measured, but it is certainly extraordinary in its magnitude, and it is steadily worsening," the report for the US-based International Rescue Committee said.
"Millions of Syrians are in desperate need and have little if any access to humanitarian relief."
Their overall comments reflect widespread feelings that despite promises from across the world not enough assistance is reaching the often bleak and frozen refugee camps on the country's borders.
However, while there had been allegations of rape and sexual abuse before, the scale suggested by the refugees was shocking.
Women were in particular danger of being dragged away and raped, sometimes gang-raped, at checkpoints set up by armed groups. The report did not single out either side as responsible, but the biggest network of checkpoints is in regime areas and the most serious allegations of human rights abuses have been made against regime troops and in particular its "Shabiha" militia.
"Many women and girls relayed accounts of being attacked in public or in their homes, primarily by armed men," the report said. "These rapes, sometimes by multiple perpetrators, often occur in front of family members.
"The IRC was told of attacks in which women and young girls were kidnapped, raped, tortured and killed.
"The IRC's women's protection team in Lebanon was told of a young girl who was gang-raped and forced to stagger home naked."
With no side currently making major advances, and efforts of the UN envoy Lakhdar Brahimi to find a peace deal petering out, there is no end in immediate sight to the refugees' suffering.
A major regime push on southern and eastern suburbs of Damascus, which have been fought over for months, has killed scores of people in the last few days alone, including eight children and five women in an air strike on Monday morning.
The regime has taken to using an ever more extreme array of weaponry. In recent weeks it has begun employing Scud missiles – unguided land-to-land missiles – and, most recently, land-fired cluster bombs, on top of the aerial cluster bombs it has been dropping for several months, according to Human Rights Watch.
Rebels who seized an airbase at Taftanaz near Aleppo at the weekend, after months of fighting, also found a hanger containing a row of prepared "barrel bombs", home-made devices that can be dropped from planes and helicopters.
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