VATICAN CITY — Pope Francis warned top Roman Catholic leaders Thursday that they would need to emerge with more than just “predictable" statements as he opened a highly anticipated summit aimed at defining a worldwide response to clergy sex abuse.

To back up his call for “concrete” solutions, the pontiff offered 21 proposals to punish predators and keep children safe, including expanding roles for lay experts in investigations and requiring prelates to report abuse to civil authorities in their countries.

“The holy people of God are looking at us, expecting not only simple and predictable condemnations but concrete and effective measures to put in place,” he said. “We need to be concrete.”

The assertive tone Francis set at the start of the unprecedented four-day gathering of bishops he summoned from more than 100 countries came as something of a surprise even to some of the meeting’s organizers. For weeks, the pope has been downplaying expectations that the global summit would end with the implementation of any specific reforms.

Still, there was skepticism among the victims and their advocates — including many from Pennsylvania — who have flocked to St. Peter’s Square as the conference plays out behind closed doors.

“First, they said this meeting was going to be serious. Then they said it was only going to be a teaching lesson. Now they say there will be concrete action,” said Mark Rozzi, an abuse victim and state legislator from Berks County who met Thursday with Italian lawmakers and victims. “When I heard that there was going to be a meeting to have a meeting, as a Harrisburg politician I laughed at that. It basically means we’re kicking the can down the road.”

The outcome of this week’s summit could shape the legacy of Francis’ papacy — one that has become overwhelmed by an issue that plagued the church for decades only to reemerge with new ferocity.

In less than a year, the United States alone has seen the defrocking of top Cardinal Theodore McCarrick for his alleged abuse of seminarians and minors and the scathing Pennsylvania grand jury report that has since spawned similar investigations in more than a dozen states, including New Jersey.

The pope’s critics have described him as sluggish to respond to the crisis and, at times, callous toward victims. On the eve of this historic meeting, some took offense at his remarks to a group of pilgrims from an Italian archdiocese.

“Those who spend their life accusing, accusing, accusing are … friends, cousins, relatives of the devil,” he said, according to an official readout of the Wednesday meeting released by the Vatican. “This is not good. Flaws must be indicated so they can be corrected, but at the moment that flaws are noted, flaws are denounced, one loves the Church. Without love, that is of the devil.”

Others questioned why Francis has no meetings with victims on his schedule during the conference. But the pope began to hear from them Thursday in other ways.

A handful of survivors from across the globe have been invited to share their accounts during the opening and closing prayers of each day’s session. One, a woman from Africa, told the gathered prelates Thursday that her abuser forced her to have three abortions as a teenager while he raped her again and again for more than 13 years.

The conference’s organizers also met with a dozen of the world’s most outspoken victims Wednesday, including Johnstown resident Shaun Dougherty, whose abuse by a priest who served as his basketball coach in the 1980s was detailed in a 2016 grand jury report on abuse and cover-ups in the Altoona-Johnstown Diocese.

“It was respectful, it was very informative, it was frank — at times hostile,” Dougherty, 49, said in an interview Thursday. “My supreme takeaway: It is up to our politicians back home in Pennsylvania to protect us because this organization is too large to protect itself.”

Dougherty said he was humbled by the chance to air his complaints with top officials, such as the Vatican’s chief sex-abuse investigator, Archbishop Charles Scicluna of Malta, and Cardinal Blase Cupich, the archbishop of Chicago and the lone American on the summit organizing committee.

Still, he was disappointed that the pope himself didn’t make time to meet with them.

“I was upset he didn’t come to Pennsylvania after the grand jury reports,” Dougherty said. “Then, to add insult to injury, we have to come to his country and to his office and he delegates to someone else?”

While their detractors raged outside the Vatican, the members of the hierarchy spent most of the day cloistered inside, listening to lectures on responsibility and breaking into working groups to discuss Francis’ proposals.

It quickly became evident, said Mark Coleridge, archbishop of Brisbane, Australia, that wide gulfs exist between church leaders in the West and their counterparts in developing nations, many of whom have not yet had to reckon with public backlash regarding clergy sex abuse.

At a news conference Thursday afternoon, Coleridge said bishops from Africa and Asia questioned why the church was devoting so much energy to sex abuse when, in their countries, children also face dangers ranging from enslavement to conscription into militia groups.

Even some of Francis’ own reform proposals might raise eyebrows in the United States. For instance, the pope suggested Thursday that the minimum age for marriage in the church be raised to 16 years — from the current 14 — a move that would still keep it two years below the standard in most U.S. states.

And nowhere on the list was the issue that victim advocates most often call for: the worldwide adoption of a “zero-tolerance” policy for abusive clerics — a measure bishops in the United States adopted nearly two decades ago.

In fact, the U.S. is the only one of the eight largest Catholic countries in the world to have committed to removing any priest with even a single substantiated claim of sexual abuse, according to a report released this week by the watchdog group

Bishops in many nations have no formal policy on how abuse claims should be handled. Just outside the Vatican’s walls, the president of the Italian bishops’ conference met with victims for the first time last week — at the request of summit organizers.

It’s unlikely that those shortcomings will be fully addressed before the summit concludes Sunday, despite Francis’ assertive tone at its start.

“We’re not going to solve all the problems in three days,” said Scicluna, the Vatican investigator. “That is not a reasonable expectation.”

It’s what will come afterward, as the prelates return home and continue to debate the issues, that will define whether the meeting was a success, he told reporters at a news conference.

Rozzi, the Pennsylvania lawmaker, wasn’t willing to accept such pleadings for patience from church leaders anymore.

Standing side-by-side with Riccardo Magi — an Italian lawmaker and member of the Chamber of Deputies, a rough equivalent of the U.S. House of Representatives — at the Parliament building in Rome, he said that Italy provides the perfect example of the church’s historic inability to reform itself without the intervention of law enforcement and civil legislation.

He cited the measure he has pushed in Pennsylvania to give victims more time to sue their accusers. The church, as it has done across the United States, has opposed the bill.

“Make no mistake about it,” Rozzi said. “What the Catholic Church, the bishops, the pope are doing is blocking justice for all victims of sexual abuse. That is the real crime.”