Accra — Rape seems to be on the increase in Ghana. This may be because more victims are coming forward to talk about the crime.

But just because more rapes are being reported does not mean that more rapists are being punished. Our reporter Lois Beckett found that more than half of rape cases never make it to trial-simply because victims cannot afford the cost. It's a simple medical form that requires a doctor's signature. Without it, a rape victim has no chance of winning a case against her attacker. But getting the form signed costs 150,000 to 300,000 cedis. As a result, officials estimate, more than half of rape victims simply give up their hope of justice.

Ghana's new Domestic Violence Act, passed this May, specifies that victims of domestic violence are "entitled to free medical treatment from the State."

But the law is yet to be implemented. Until specific funding is allocated for their treatment, victims themselves still have to pay for the form that records the medical evidence of rape.

This form is essential if victims want to press charges against their attackers.

"It's the most important, number one evidence we have," said Jessie A. Borquaye, the commander of Accra's Domestic Violence and Victim Support Unit (DOVVSU), a special branch of the police force.

But the cost of the medical form puts a heavy financial burden on women already weighed down by physical and psychological trauma.

Ruth (not her real name) was raped by a neighbor who sneaked into her home while her husband was away. When she tried to scream, the man covered her mouth. A dignified, neatly dressed woman, Ruth told her story in a quiet voice. She moved only to adjust her puffed sleeves, which kept slipping down her shoulders.

But Ruth had to turn away her face away as she described the aftermath of her experience. Tears welled in her eyes, and she blotted them away furiously with a handkerchief.

After telling her husband what happened, she said through a translator, her marriage is on the verge of collapse. Tradition mandates that she cannot cook for her husband until she undergoes a ritual purification. But Ruth is not sure when-or if-this ritual will take place. She is still suffering medical complications as a result of the rape.

As if this were not enough, Ruth also has to worry about the 300,000 cedis it cost for her medical form. She and her husband did not have enough money to pay the fee themselves, but she was able to borrow money from her sister. The loan, of course, needs to be repaid.

Still, Ruth is one of the lucky ones. She was able to obtain a medical form, and that means her case against her attacker can stand up in court.

Women's advocates and officials from the Domestic Violence and Victim Support Unit of the police agree: without a signed medical form, there is no way to bring a rapist to justice.

"I don't know of any case where it was won without a medical form," said Deputy Superintendent of Police Angela K.Obeng, who works at DOVVSU's National Secretariat. For many women, the 150,000 to 300,000 cedi fee for a signed medical form is a staggering sum of money. DOVVSU Commander Borquaye estimated that as many as half of victims simply can't afford it.

Ama Agbodaze, a social worker, puts the number even higher. On average, she said, for every ten victims she gives a medical form to fill out, at most two or three return. According to this estimate, 70 to 80 percent of victims choose not to pursue justice past an initial visit to the police station.

"They can't afford the medical bill," Ms. Agbodaze said, adding, "that's why they don't come back."

It's not the medical examination that costs money, but the form itself, according to Commander Borquaye.

"They will examine you all right, give you the medication, but when it comes to writing the report, endorsing the medical form-that is where you have to pay before the doctor signs," Commander Borquaye said.

The reason many doctors charge so much for a signature, said Dr. James Clayman, a gynecologist, is that doctors may be called to testify in court if the rape victim presses charges. When this happens, doctors themselves have to pay the costs associated with testifying, as well as accept any missing salary from time spent out of the office.

This trial process can be so arduous and protracted that some doctors may be reluctant to sign victims' medical forms at all, said Dr. Clayman, who works at the Amasaman Health Center.

He said he knows a colleague who swore off signing forms after being called to court 17 separate times for a single case.

"All that expense-transportation and everything-was for him," Dr. Clayman said.

Another part of the problem, Dr. Clayman said, is that the medical form itself has not been updated since the 1960s. The two cedi, ten pesewa fee noted on the form (in old cedis, of course) is so obviously incorrect that it gives doctors the leeway to charge whatever they want, he said.

Whatever the doctors' rationale for the high price of the medical form, the burden of the expense ultimately falls on the victims.

DOVVSU has no official funding to help victims pay the medical fee, Commander Borquaye said. Local NGOs try to fill the gap, but their resources are limited.

A $3,000 fund set up jointly by DOVVSU and several NGOs has been in limbo for three years because of administrative confusion, according to Adwoa Bame, the acting executive director of WISE foundation, a women's and children's advocacy group.

From its own money, WISE can only afford to assist a few victims each year, Ms. Bame said. In the first quarter of 2007, she said, they could only fund three. "We are not able to support everyone who needs support," she said.

So WISE and Ark Foundation, another NGO that works with DOVVSU in supporting victims of domestic violence, try to refer victims to a network of sympathetic doctors who will examine them and sign the medical forms for free.

Dr. Clayman is one of these. He has been working with WISE foundation and other women's groups for five years, ever since a female patient praised his sensitivity to women's issues and urged him to get more involved.

Dr. Clayman credits his mother for inspiring him to provide free assistance to female survivors of rape ad domestic violence.

"My mom has been very good to me," he said. "I think I want to do something for women."

Dr. Clayman is part of the Gender Violence Survivor Support Network, set up several years ago to help make it easier for victims to get access to the services they need. But of all the doctors who pledged to help women, Dr. Clayman and Ms. Bame estimated, only four regularly provide free medical examinations to victims.

The help they can give is small compared with the hundreds of rape and defilement cases reported every year in Accra alone.

As a result, victims who can't afford medical forms must deal with the aftermath of their attack without help from the courts.

Some of these cases may be ultimately settled at home, Ms. Agbodaze, the social worker, said. Families will use a trip to DOVVSU as a way to scare the rapist into paying monetary compensation for the crime he committed. This happens most often in cases of defilement, the rape of a young child, Ms. Agbodaze said.

"The survivor doesn't really have a say," she added.

Other cases, however, may never be settled at all.

Ms. Bame said that she hopes the implementation of the Domestic Violence Act will ensure that rape victims no longer have to pay for justice.

"The law says don't charge," she said, "so if you do charge, it's illegal."

But rape victims' ability to secure the medical forms they need without paying huge sums will depend on how the law is put into practice-and whether the necessary funding is provided.

Ms. Bame thinks that civil society and the government can collaborate to make this happen.

"If you ask me, I'm not always an optimistic person, but on this one I think I am," she said.

But the timetable for the implementation of the Domestic Violence Act remains unclear. Until it's completed, the majority of rape victims will still be helpless to pursue justice.

At the end of the interview in which she shared her story, Ruth said that she only wanted two things. She will be happy, she said, if man who raped her is punished and if the government pays for her medical bills.

Under law, of course, she is entitled to both of these things. And Ruth may have the satisfaction of seeing her attacker sent to jail. But that's only because she could afford to pay.