© 2012 Samer Muscati/Human Rights Watch

Since September 2011, Sudanese government forces have bombed indiscriminately across Blue Nile State, spreading palpable fear among civilians who live there. Government bombardments and ground attacks have killed, maimed and injured scores of civilians, destroyed property including markets, homes and schools, and displaced tens of thousands of women, men and children.

Sudan's abusive tactics against civilians in an area it considers allied with rebels are reminiscent of those used in Darfur and during the long civil war, including blockading humanitarian assistance. These actions have had a particularly negative impact on women and girls. Women have been forced from their villages into the bush, where they no longer have access to hospitals or health care providers -- even for childbirth. Women and girls who are able to flee the country have had to walk for days and weeks carrying their children and property, while under threat of attack from government forces and militias. Sometimes the women are separated from their husbands, who fled earlier or joined the rebels.

Once the women and girls reach the refugee camps in South Sudan, their struggle continues. With limited means to support themselves, women and girls are at risk of sexual violence from soldiers and other men in host communities and when collecting firewood outside the camps to cook food.

Since September, 2012, witnesses have reported seeing more frequent use of planes flying at high altitude and dropping bombs in rapid and multiple succession. The intensification of Sudanese government forces attacks across various Blue Nile localities perhaps indicates an effort to displace the civilian population from rebel-controlled areas. Despite the attacks, the international response to this crisis remains muted.

As of November, 110,000 refugees from Blue Nile had registered in four refugee camps in South Sudan and 30,000 had sought shelter in Ethiopia. Female-headed households make up a significant proportion of many of the communities in the camps -- as many as 50 percent in some communities. Their need to rely on others, particularly male community members, and the lack of livelihood options for women who head households also makes women more vulnerable to sexual exploitation and abuse.

Human Rights Watch has conducted research in Blue Nile state during the bombing campaign, despite Sudan's blockade on the civilian population, which has severely restricted access to the area for news organizations and humanitarian agencies. Human Rights Watch interviewed women and girls in refugee camps in both Blue Nile state and South Sudan and in displaced communities and villages.