They say the next decades of the Catholic Church's efforts against clerical abuse depend on whether those countries can be pushed to take safeguarding measures preemptively, rather than responding only after a crisis explodes into the open. "No bishop may say to himself, this problem of abuse in the church does not concern me because things are different in my part of the world," Cardinal Oswald Gracias, the archbishop of Mumbai, who has been criticised for his own handling of cases, told the Vatican gathering of 190 bishops and other Catholic leaders. "I dare say there are cases all over the world, also in Asia, also in Africa." Pope Francis attends a penitential liturgy at the Vatican on Saturday. The pontiff is hosting a four-day summit on preventing clergy sexual abuse. Credit:AP This week, Francis and his lieutenants organising the summit have made a point to emphasise the global nature of the problem. On the first day, victims from five continents - North and South America, Europe, Asia and Africa - told the bishops in videotaped testimony about the trauma of their experiences. And the Vatican has drawn up a geographically balanced lineup of featured speakers, including a nun from Nigeria who on Saturday told the bishops about several cases she knew of in that country.

But there remains some resistance to the idea that sexual abuse is a pressing global church crisis. Though that notion no longer has much traction among top Vatican officials, church watchers say, some bishops still claim abuse is primarily a problem of the West, the result of secularisation or corrupted sexual and family values. Other bishops acknowledge that abuse might be a problem in their own backyards, but say they are facing other grave crises, including warfare, famine, and climate change. Archbishop Mark Coleridge, of Brisbane, Australia, said this week that some bishops, during discussion sessions that are not open to the media, have asked why there is a church "obsession" with sexual abuse. Sex abuse survivors and members of the ECA (Ending Clergy Abuse) march in downtown Rome holding a banner reading "stop excuses", on Saturday. Credit:AP "Bishops from Africa and Asia are saying, 'Well, why are we just talking about sexual abuse? Because abuse in my country takes many forms: child labor, child soldiers,'" Coleridge said. "To come to an agreed approach that embraces all of those cultural differences will be one of the big challenges of the meeting."

National-level Catholic leaders have typically enacted reforms only after damaging revelations - and only under intense pressure. The countries that now have the most rigid anti-abuse rules - including the United States, Ireland, Australia and Canada - have governments and media outlets willing to investigate the church. Abuse remains little-discussed not just in Africa and Asia, but also in parts of Europe, including Italy, where the dioceses do not automatically cooperate on cases with criminal investigators, and where the many media outlets are reluctant to cover stories that might hurt the church. But activists say that it is in other major Catholic countries - Brazil, the Philippines, and Democratic Republic of Congo - where the scale remains the least explored and the most potentially explosive. In the Philippines, no priests have been convicted on child sex crimes, according to Anne Barrett Doyle, the co-founder of a website, Bishop-Accountability.org, that tracks abuse cases. Sex abuse survivor Alessandro Battaglia is hugged by survivor and founding member of the ECA (Ending Clergy Abuse), Denise Buchanan, right, during a march in Rome on Saturday. Credit:AP And in the Congo, there are only a few known cases, including that of Kitobo, who says he was sexually abused for four years by a priest who had been sent to the country from Belgium.

In large swaths of the world, victims are reluctant to come forward because of societal pressures or legal dangers. Kitobo said that in the Congo, the church is deeply-engrained in schooling and in medical care. "The church owns everything," he said. The Reverend Lambert Riyazimana, a priest in Burundi, said taboos prevent reporting. "Priests are respected," Riyazimana said. "So it's first of all hard to report if anything happens, because it wouldn't be believable in the eyes of the public." Before the summit began, one archbishop from Ghana told the Catholic outlet Crux that, although he had enacted anti-abuse initiatives, he felt the problem was "very, very, very minimal". Archbishop Philip Naameh of Ghana said abuse did not happen on the same scale as in the West "because children are generally looked at as a great gift from God".

Naameh, speaking Saturday evening to fellow bishops, struck a different tone, telling the gathering, "We have not afforded people the protection they are entitled to." More than a half-dozen African and Asian bishops this week declined requests for interviews. Another bishop, Rochus Tatamai, the president of the episcopal conference representing Papua New Guinea and the Solomon Islands, said the church in his territory was consumed in dealing with malnutrition, low mortality rates, dangerous sanitation standards, and living conditions that are "far from the basic standards." He said he had never heard about a case of clerical abuse, among 22 dioceses. Loading "For us - some of the African and Asian countries - it is not really a priority," Tatamai said of abuse. But, he said, "This has been like a wake-up call."

In 2011, the Holy See had asked countries to draw up their own child protection guidelines, but not every country has followed the request. On the website it created for this event, the Vatican posted such procedures for 31 different countries. Only two countries in Africa are listed, South Africa and the Central African Republic. Only Sri Lanka and South Korea represent Asia. The Vatican also included guidelines from Kerala, a southern Indian state. Cardinals and bishops selected to speak this week have emphasized that national-level Catholic leaders need to take new steps to handle accusations of abuse, including creating clear outlets for people to come forward with claims. Kitobo said that, in his former country, people will come forward - eventually. "It is just a matter of time until this explodes," he said. "You need a trigger." Kitobo said the trigger could be anything that makes people feel less shame about their experiences, or anything that gives people more confidence that the church will listen to them.

"Maybe," he said, "the trigger will be this summit." Washington Post