Released under a freedom of information request in 2010, it found a "shame and blame" culture in the NHS in England, which got in the way of improving quality of care.

BBC: Turn Stafford anger into action, says Obama adviser

Brok said the United States tends to have a culture more oriented toward shame and individualism, and an ethic of finding solutions to particular problems.

CNN: In therapy? In Argentina, it's the norm

But perhaps the most significant factor is the extremely conservative culture in Libya - and in Misrata in particular - which regards rape as a matter of profound shame for an entire family, and not something to be mentioned in public.

BBC: Libya: 'Forced to rape in Misrata'