VATICAN CITY — 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 clergy sexual abuse and cover-up, 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.”

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 cover-up case in Chile last year and the scandal reignited in the U.S.

Pope Francis speaks with Rev. Federico Lombardi, the former Vatican spokesman who is moderating the summit, at the opening of a sex abuse prevention summit at the Vatican on Thursday. Vincenzo Pinto/Pool Photo via Associated Press

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.

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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.”

After he offered the bishops a vision of what a bishop should be, the Vatican’s onetime sex crimes prosecutor told them what a bishop should do. Archbishop Charles Scicluna delivered a step-by-step lesson Thursday on how to conduct an abuse investigation under the church’s canon law, repeatedly citing the example of Pope Benedict XVI, who turned the Vatican around on the issue two decades ago.

Sex abuse survivors gather during a twilight prayer vigil near Castle Sant’ Angelo in Rome on Thursday. Associated Press/Gregorio Borgia

Calling for a conversion from a culture of silence to a “culture of disclosure,” Scicluna told bishops they should cooperate with civil law enforcement investigations and announce decisions about predators to their communities once cases have been decided.

He said victims had the right to seek damages from the church and that bishops should consider using lay experts to help guide them during abuse investigations.

The people of God “should come to know us as friends of their safety and that of their children and youth,” he said. “We will protect them at all cost. We will lay down our lives for the flocks entrusted to us.”

Finally, Scicluna warned them that it was a “grave sin” to withhold information from the Vatican about candidates for bishops — a reference to the recent scandal of the now-defrocked former American cardinal, Theodore McCarrick. It was apparently an open secret in some church circles that McCarrick slept with young seminarians. He was defrocked last week by Francis after a Vatican trial found credible reports that he abused minors as well as adults.

Francis, for his part, offered a path of reform going forward, handing out the 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.

One idea called for bolstering child protection laws in some countries by raising the minimum age for marriage to 16; another suggested a basic handbook showing bishops how to investigate cases.

In the final speech of the day, Colombian Cardinal Rubén Salazar Gómez warned his brother bishops that they could face not only canonical sanctions but also imprisonment for a cover-up if they failed to properly deal with allegations.

Abuse and cover-up, he said, “is the distortion of the meaning of ministry, which converts it into a means to impose force, to violate the conscience and the bodies of the weakest.

Abuse survivors have turned out in droves in Rome to demand accountability and transparency from church leaders and assert that the time of sex abuse cover-ups is over.

“The question is this: Why should the church be allowed to handle the pedophile question? The question of pedophilia is not a question of religion, it is (a question of) crime,” Francesco Zanardi, head of the main victims advocacy group in Italy Rete L’Abuso, or Abuse Network, told a news conference in the Italian parliament.

Hours before the Vatican summit opened, activists in Poland pulled down a statue of a priest accused of sexually abusing minors. They said the stunt was to protest the failure of the Polish Catholic Church in resolving the problem of clergy sex abuse.

Video showed three men attaching a rope around the statue of the late Monsignor Henryk Jankowski in the northern city of Gdansk and pulling it to the ground in the dark. They then placed children’s underwear in one of the statue’s hands and a white lace church vestment worn by altar boys on the statue’s body. Jankowski is accused of molesting boys.

The private broadcaster TVN24 reported the three men were arrested.

Jankowski, who died in 2010, rose to prominence in the 1980s through his support for the pro-democracy Solidarity movement against Poland’s communist regime. World leaders including President George H.W. Bush and British Prime Minister Margaret Thatcher visited his church to recognize his anti-communist activity.