Warning: This article contains references to suicide, sexual assault and other details that readers may find disturbing

Joel Le Scouarnec is not the name on everyone's lips in the western French seaside town of Vannes, where this week the former surgeon was sentenced to 20 years in prison for raping and sexually abusing nearly 300 of his patients — most of them children — over more than three decades.

His face was not on the front page of the local newspaper the morning after his conviction, and, as the weather oscillated between grey rainy skies and bright May sunshine, people mulling around the boat festival at Vannes harbor — a 10-minute walk from the courtroom — preferred not to talk about one of France's most prolific abusers.

"It's the shame of the Brittany region," 83-year-old pensioner Joelle Leboru said. "He started everything here."

"How could he get away with it for so long?"

That's the question that's been keeping people in Vannes up at night: Under the authorities' noses, dressed in a white medical coat of respectability, and in the heart of middle-class society, Le Scouarnec sexually abused hundreds of children. The crimes in the latest case against him spanned from 1989 to 2014 and were committed in a dozen hospitals in western France.

Le Scouarnec often violated victims while they were under anesthesia or waking up from surgery. He wrote graphic descriptions of hundreds of these instances of rape or sexual assault against children — and animals — in his journals, which police discovered when they raided his apartment in 2017 after he was accused of sexual abuse against a child who lived next door.

"I'm a major pervert. I'm at once an exhibitionist, voyeur, sadist, masochist. I'm scatological, a fetishist, a pedophile. And I'm very happy about it," he wrote in one 2004 entry quoted in Le Monde. Police also found a collection of dolls, some the size of a baby, some the size of toddlers, around the apartment — according to the French newspaper.

The 2017 knock on Le Scouarnec's door came over a decade after his first brush with the law. The surgeon was charged and convicted in 2005 of possessing child sexual abuse material. He received a four-month suspended sentence, but was able to continue practicing medicine — including working with children — until he retired years later.

During the recent trial, hospital administrators who kept him on staff and later hired him elsewhere after his 2005 conviction denied direct responsibility. Since the court had not issued a professional ban or a prohibition on working with minors, they argued they were not obligated to impose additional restrictions.

Le Scouarnec worked primarily in rural, relatively resource-strapped hospitals, where the loss of a surgeon could have spelled closure for a whole department.

Questions were also raised during the trial about whether anyone else — in particular his ex-wife — knew about the abuse and failed to act. She denied any knowledge. Further legal proceedings are expected, as survivors push for accountability beyond Le Scouarnec himself.

Unlike in most criminal cases, in which police identify suspects based on victims' reports, this case unfolded in reverse: Investigators uncovered reams of evidence and then sought out victims — many of whom had no memory of the abuse and learned only from a call or visit from the police.

Among them was 35-year-old Louis-Marie, who stood outside the Vannes courthouse on sentencing day with other survivors. Together, they unfurled a banner adorned with hundreds of sheets of paper, each printed with a silhouette representing one of Le Scouarnec's victims. Some of the figures were accompanied by names and ages — some of them under five. Many were labeled "anonymous."

"We've realized there were major institutional failures, which to this day haven't been recognized," Louis-Marie told DW as he rallied with other survivors.

Le Scouarnec admitted guilt on all counts and asked for "no leniency" in his sentencing. He apologized to most of his victims, asking for forgiveness, in a way some of them described as merely mechanical. Le Scouarnec does not plan to appeal.

In a statement after Wednesday's verdict, the French National Medical Council (CNOM) vowed to "conduct all reforms needed to ensure that such a tragedy never arises again." France's health minister also promised to work with the Justice Ministry to better protect children and other patients from being exposed to predators.

The guilty verdict was not a surprise. Regine, the mother of one abuse survivor, told DW before the reading that she was simply "exhausted."

"As parents, we're considered secondary victims. But it's hard, knowing we left our children in the hands of this monster," she said. "That's something I'll regret forever. It won't disappear. For us, it's for life."

But not for Le Scouarnec. Under French law, the maximum sentence for aggravated rape — whether it involves one victim or hundreds — is 20 years. And that's exactly what judges handed down to the 74-year-old former doctor in Vannes on Wednesday — with presiding judge Aude Buresi taking time to point out she was bound by her country's legal limits. Now, advocacy groups are calling for legislative reform, pushing for tougher sentences for serial rapists.

The court also imposed additional restrictions on Le Scouarnec, including measures to keep him away from children and animals and a ban on medical pracitce, should he ever be released. 

And that's a real possibility. Le Scouarnec has already spent several years in jail on pre-trial detention for separate convictions — including raping four children, two of whom were his nieces. 

Unlike in the United States, French jail sentences are not cumulative — meaning that some of his 20-year term is already considered served and he could be eligible for early release in the 2030s, subject to judicial approval.

Judges on Wednesday decided against taking the exceptional step of confining Le Scouarnec to a secure psychiatric facility after his release, citing his age and stated willingness "to make amends."

And that has left some survivors and family members shocked and bitterly disappointed. Xavier Vinet, whose son was abused by Le Scouarnec as a child, shook with anger as he spoke to DW outside the court.

"We should have lifelong jail time, given that we don't have the death penalty here. We should bring it back — that's what's needed for men like him," he said.

Vinet's son Mathis will never see justice served. He died in 2021 of an overdose which his family says was suicide.

"He was a joyful kid before all of this," Vinet said. "He got on so well with his grandfather and with me."

In 2018, like so many others, Mathis and his family heard from police that Le Scouarnec had written about abusing him during a hospital stay when he was 10.

"Then everything changed. Then he destroyed himself. That's what I can say about him," Vinet added.

Le Scouarnec admitted in court that he bore "responsibility" for the deaths of Mathis and another of his young victims who died in 2020.

There's no doubt that the case shocked France. So did the countless disturbing details that emerged during the trial — including a moment when the 74-year-old unexpectedly admitted to abusing his own granddaughter, a crime previously unbeknownst to both prosecutors and his son, according to French media's courtroom reporting.

But survivors said there's been much less of a reckoning than they had hoped for.

It's hard not to draw comparisons with the case of Gisele Pelicot, a French woman who waived her right to anonymity in the trial against her husband and about 50 other men who raped her over a 10-year period. Like Le Scouarnec's survivors, Pelicot only learned the details of these crimes through police, as her husband had been routinely drugging her and recruiting men online to rape her while she was sedated.

Yet, unlike the Pelicot trial, which sparked international media attention, the Le Scouarnec case was comparatively low-profile. Back at the Vannes marina, local student Emma Le Floch explained why she thinks the ex-surgeon's crimes garnered less attention.

"Everything to do with children is even more taboo," the 21-year-old said. "It's shocking to think that the people impacted live right nearby — that I could easily have had that doctor or been taken in for an operation with him or something like that," she added.

"We don't talk enough about sexual violence against children," she said. "I think it's that we don't want to talk about it."