VATICAN CITY — With his moral authority in question and his papal legacy in the balance, Pope Francis opened a historic summit meeting at the Vatican on Thursday devoted to clerical child sexual abuse, an issue that has for decades devastated some corners of his vast church while being utterly ignored and denied in others.

“We hear the cry of the little ones asking for justice,” Francis told the 190 leaders of the Roman Catholic Church who had assembled from around the world at the start of a four-day conference intended to instruct them on the depth and universality of the problem and how to deal with it.

“The holy people of God look to us and expect from us not simple and obvious condemnations, but concrete and effective measures,” Francis said.

Survivors of clerical abuse, their advocates and faithful disheartened and disgusted by the failure to address the abuses are demanding that the church enshrine in Canon Law a policy of zero tolerance for abusive priests and bishops who cover for them.

The Vatican made clear on Thursday that that was not in the cards. Instead, Francis — who intends the meeting to be a “catechesis,” educating bishops and religious leaders so they could undergo a conversion of spirit on the severity of the crisis — provided them with 21 “reflection points.”

“They are a road map for our discussion,” Archbishop Charles Scicluna, the Vatican’s leading sex crimes investigator, said in a news conference. “They are very, very concrete.”

The points included codifying the participation of lay experts in sexual abuse investigations; ensuring priests and bishops found guilty of abuse are dismissed from ministry; preventing the names of accused clerics being published before convictions; and requiring reporting to civil authorities and church superiors.

Other points set out specific protocols for handling accusations against bishops, screening seminarians, increasing pastoral focus on abuse victims, and greater collaboration with the media to determine the credibility of accusations. Another raised the minimum age for marriage in the church to 16 from 14 for women.

There was no mention of a zero-tolerance policy, or of automatic dismissal from the clerical state, for abusive priests and or for bishops who concealed abuse.

“You have to take it on a case-by-case basis,” Archbishop Scicluna said.

[Read more about the Vatican’s hopes for the meeting.]

At Thursday’s session, bishops heard searing prerecorded video testimonials from abuse survivors, including one who was impregnated three times by a priest and forced to have abortions and another who spoke of being abused hundreds of times. None, however, addressed the congress in person.

“Victims need to be believed,” one pleaded by video, urging bishops to collaborate with civil authorities.

In the decades since the crisis first erupted in the United States, where a systemic problem of moving predatory priests from parish to parish spread abuse like a virus, the scourge has devastated the church around the world.

Francis’ own missteps and inaction since his election in 2013 have made it an existential threat to his papacy. After he accused victims of slandering bishops during a trip to Chile early last year, the outcry from victims was fast and furious.

Criticism reached a feverish pitch last summer, when the Pennsylvania attorney general released a scathing grand jury report charging that more than 300 priests had abused at least a thousand victims over 70 years. Prelates in Francis’ own hierarchy also accused him of covering up for abusers.

Since last year, Francis has himself undergone something of a conversion on the issue, admitting errors, asking forgiveness and growing tough on those who covered up the crimes. He has fired bishops in Chile and last week defrocked the American former cardinal Theodore McCarrick.

[Gay priests, secret rules and the abuse of nuns: Read about some of the Vatican controversies as bishops meet.]

Francis called the landmark meeting last September with the apparent aim of relieving some pressure, but it has also dramatically increased expectations that after years of talk that the Vatican would finally institute new rules to hold bishops accountable.

On Thursday, as he brought together clerical leaders from around the world, Francis said that the church was obliged to discuss the extent to which abuse was afflicting the church and humanity in a “sincere and in-depth manner.”

Many bishops have long denied that clerical sex abuse of minors was a problem, or suggested that it exists only in the Western or Anglo-Saxon world, or is a result of homosexuality in the church, a contention discredited by most scientific studies.

When bishops have acknowledged abuse, they often treated it as a sin to forgive rather than a crime to prosecute, reflexively protected their own and believed bishops over victims.

Those gathered on Thursday included the presidents of many of the world’s bishops’ conferences, men’s and women’s religious orders and powerful cardinals from his committee of top advisers.

All of them rose to sing off the same prayer sheet and listened to the Rev. Hans Zollner — an organizer of the meeting and a member of the Vatican’s child-protection commission — give voice to victims who lamented being ignored by the church leaders.

“They didn’t listen to me and my cry,” Father Zollner said, followed by a long and haunting silence.

The church leaders arrived against a backdrop of feverishly high expectations from abuse survivors. Many former victims descended on Rome to meet with the church’s leading officials on the issue.

But they were also there to march, protest and make their anger known to the news media, reflecting the frustration with the Vatican’s inability to confront a problem that has devoured the church from within for decades now.

Advocates for other victims of abuse and secrecy in the church, including for the children of priests and for nuns raped by clerics, were also there.

After the pope spoke on Thursday, the Holy See said the assembled bishops privately watched video presentations of testimony from victims, who were not identified to the news media.

“The first thing they did was to treat me as a liar, turn their backs and tell me that I, and others, were enemies of the Church,’’ one victim, apparently from Chile, said of the church leaders.

‘‘This pattern exists not only in Chile,’’ the victim added. ‘‘It exists all over the world, and this must end.”

Another victim talked about becoming pregnant three times by a priest who started abusing her at age 15, and being forced by him each time to have an abortion.

“Every time I refused to have sex with him, he would beat me,” she said. “And since I was completely dependent on him economically, I suffered all the humiliations he inflicted on me.”

A 53-year-old priest also addressed the conference on a prerecorded video and recounted his own abuse by a priest and not being attacked for it by his bishop.

Another, apparently from Asia, spoke of being sexually molested more than a hundred times, and of being the victim of cover-ups by religious superiors.

“I’ll request the bishops to get their act clear because this is one of the time bombs happening in the church of Asia,” the victim said.

Cardinal Luis Antonio Tagle of the Philippines, widely considered a contender to be the next pope, also addressed the gathering.

“Wounds have been inflicted by us bishops” on the faithful, said Cardinal Tagle, who has himself come under criticism from victims’ groups for his apparent lack of commitment to zero-tolerance policies.

He said that the lack of response from church leaders, and the efforts to cover up scandals to protect abusers and the church, had injured its people.

Cardinal Tagle, who is known to grow emotional, choked up as he spoke about how “each of us and our brothers at sisters at home must take responsibility” for bringing healing to victims.

Seeming to touch on the denial of the problem in many parts of the world, he recalled that Jesus’ apostles “fled at the first moment of danger,” with even Peter, considered the rock upon which the church is built, “denying that he even knew the Lord.”

The bishops, he said, needed to face the wounds caused by the church, but he also sought to balance the faith’s belief in mercy and “unconditional love for those who have done wrong” with the need for justice for victims.

That emphasis on mercy for abusive priests was in keeping with the concerns of many of the bishops in the hall, who fear that clergy are being unfairly targeted.

It was also in keeping with Pope Francis’ own past remarks. But such suggestions were likely to enrage victims’ groups, who have grown tired of abstract responses, filled with biblical allegory, and demand concrete solutions.

Archbishop Scicluna, the Vatican’s sex crimes investigator, gave more practical advice to the bishops, many of whom are still not exactly sure what to do when confronted with accusations of abuse by priests.

He insisted that easy-to-use reporting mechanisms needed to be put in place and all protocols closely followed so that people “should know that we mean business.”

He gave the bishops a detailed account of what exactly they were supposed to do and recalled that Pope Benedict XVI was clear on eradicating the root causes of the problem nearly a decade ago.

He talked about how candidates for the priesthood needed to undergo more rigorous screening and that existing rules of canon law needed to be better applied.

With the pope sitting beside him, the archbishop told his audience that the faithful “have the duty and the right” to report abuse and that “civil or domestic laws should be obeyed.”

He instructed them to rely on experts and said that they must apply their judgment, and act in the best interests of children, when the “dilemma” arises of a church trial finding that a priest is not entirely innocent, even if the allegations against him are unproven. Guilty verdicts, he said, should be promptly communicated, publicly, to the faithful.

But some of the bishops in the hall said this was not a new lesson.

“These things are known,” Bishop Ricardo Ernesto Centellas Guzmán, president of the Bolivian Bishops’ Conference, said as he walked out of the Vatican on his lunch break. “There is nothing new.”

During the discussion period, some African bishops asked why the conference was focusing on clerical sexual abuse and not other vital concerns facing young people in war-torn countries, Archbishop Mark Coleridge of Brisbane, Australia, said at a news conference.

In his own opening remarks, Pope Francis, sitting front and center, again made clear that this was a priority for his church, but also for the legacy of his pontificate. “We need concreteness,” he said.

Elisabetta Poveledo contributed reporting.

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