Pope Francis has promised concrete action over the Catholic Church's child sexual abuse scandal, although victims in Australia and worldwide remain sceptical a landmark summit will lead to real change.
Brisbane Archbishop Mark Coleridge is among those hoping a four-day meeting in Rome of Catholic leaders from around the world will result in real action, calling the crisis a global emergency that required a global response.
Pope Francis told the 190 church leaders to "hear the cry of the little ones who plead for justice" over the evil scourge of child sexual abuse committed by clergy.
"The holy people of God looks to us, and expects from us not simple and predictable condemnations, but concrete and effective measures to be undertaken," he said.
Malta Archbishop Charles Scicluna, the Vatican's top sex abuse crimes investigator, said the Pope had provided 21 concrete proposals setting out a roadmap for developing policies and canon laws to combat abuse and protect children.
The list fell short of survivor demands that offending clergy be expelled, instead talking about proportionality of punishment to the crime and that priests and bishops guilty of abusing children leave public ministry.
Australian victims' advocate Dr Cathy Kezelman said anyone convicted of abuse or involved in a cover-up should be removed altogether.
"We'd strongly believe that any alleged perpetrator should be stood down instantly when under investigation and removed altogether if convicted, not just from the public ministry," the Blue Knot Foundation president told AAP on Friday.
Dr Kezelman said the list contained some fairly entrenched approaches that appeared like "business as usual".
"It should no longer be up to the clergy to make decisions about cases," she said.
"This is a crime and it needs to go through the appropriate civil authorities."
Dr Kezelman said the summit was significant but it was a beginning.
"The fear is that this may feel like a tick - we've done the four-day summit," she said.
"It is going to take, sadly, generational change maybe from the top, and with a very powerful entrenched hierarchical system one wonders how that will happen."
The summit was shown video messages from five victims, including a Chilean man who said he and others were treated as liars and "enemies of the church" when they reported their abuse.
Archbishop Coleridge, the Australian Catholic Bishops Conference president, said he was deeply moved by the victims' messages.
"It's not that I hadn't heard these voices before, I have, but I had never heard them in the extraordinary context of this gathering and frankly in the presence of the Pope," he said.
Archbishop Coleridge said vast cultural differences presented challenges.
"Bishops from Africa and Asia (are) saying: 'Why are we just talking about sexual abuse because abuse in my country takes many forms, child labour, child soldiers. Why this obsession with sexual abuse?'"
Australian Associated Press