The day began with an African woman telling an extraordinary gathering of Catholic leaders that her priestly rapist forced her to have three abortions over a dozen years after he started violating her at age 15. It ended with a Colombian cardinal warning them they could all face prison if they let such crimes go unpunished.

In between, Pope Francis began charting a new course for the Catholic Church to confront the “evil” of clergy sexual abuse and coverup, a scandal that has consumed his papacy and threatens the credibility of the Catholic hierarchy at large.

Opening a first-ever Vatican summit on preventing abuse, Francis warned 190 bishops and religious superiors on Thursday that their flocks were demanding concrete action, not just words, to punish predator priests and keep children safe. He offered them 21 proposals to consider going forward, some of them obvious and easy to adopt, others requiring new laws.

But his main point in summoning the Catholic hierarchy to the Vatican for a four-day tutorial was to impress upon them that clergy sex abuse is not confined to the United States or Ireland, but is a global scourge that requires a concerted, global response.

“Listen to the cry of the young, who want justice,” Francis told the gathering. “The holy people of God are watching and expect not just simple and obvious condemnations, but efficient and concrete measures to be established.”

READ MORE: Sex abuse crisis threatens Pope’s legacy

More than 30 years after the scandal first erupted in Ireland and Australia, and 20 years after it hit the U.S., bishops and Catholic officials in many parts of Europe, Latin America, Africa and Asia still either deny that clergy sex abuse exists in their regions or play down the problem.

Francis, the first Latin American pope, called the summit after he himself botched a well-known sex abuse coverup case in Chile last year and the scandal reignited in the U.S.

The tone for the high stakes summit was set at the start, with victims from five continents — Europe, Africa, Asia, South America and North America — telling the bishops of the trauma of their abuse and the additional pain the church’s indifference caused them.

“You are the physicians of the soul and yet, with rare exceptions, you have been transformed — in some cases — into murderers of the soul, into murderers of the faith,” Chilean survivor Juan Carlos Cruz told the bishops in his videotaped testimony.

Other survivors were not identified, including the woman from Africa who said she was so young and trusting when her priest started raping her that she didn’t even know she was being abused.

“He gave me everything I wanted when I accepted to have sex; otherwise he would beat me,” she told the bishops. “I got pregnant three times and he made me have an abortion three times, quite simply because he did not want to use condoms or contraceptives.”

Manila Cardinal Luis Tagle choked up as he responded to their testimony.

In a moving meditation that followed the video testimony, Tagle told his brother bishops that the wounds they had inflicted on the faithful through their negligence and indifference to the sufferings of their flock recalled the wounds of Christ on the cross.

He demanded bishops and superiors no longer turn a blind eye to the harm caused by clergy who rape and molest the young.

“Our lack of response to the suffering of victims, yes even to the point of rejecting them and covering up the scandal to protect perpetrators and the institution, has injured our people,” Tagle said. The result, he said, had left a “deep wound in our relationship with those we are sent to serve.”

Francis, for his part, offered a path of reform going forward, handing out 21 proposals for the church to consider.

He called for specific protocols to handle accusations against bishops, in yet another reference to the McCarrick scandal. He suggested protocols to govern the transfers of seminarians or priests to prevent predators from moving freely to unsuspecting communities.

Nicole Winfield, The Associated Press

Like us on Facebook and follow us on Twitter

Juan Carlos Cruz, second from right, waves to journalists as walks to meet with organizers of the summit on preventing sexual abuse at the Vatican, Wednesday, Feb. 20, 2019. (AP Photo/Gregorio Borgia)