Joel Le Squarneck, 74, a former surgeon in France, is expected to be sentenced to just 20 years in prison in the coming hours, accused of the most extensive paedophile case in the country’s history, as his long-running trial in Van, Brittany, concludes.

During the shocking three-month trial, Le Squarneck was charged with 111 rapes and 189 sexual assaults committed between 1989 and 2014, mostly on children under the age of 15. The attacks occurred in at least a dozen hospitals, and many of the victims were under sedation or recovering from surgery.

He admitted the crimes in court, saying: “I was a surgeon who used his authority to attack children – I don’t deny it” and said he was not seeking leniency from the court. Psychiatric assessments even described him as “extremely dangerous”.

The case has brought to light huge gaps and failings in the French health system. Despite his 2005 conviction for possession of child abuse material – after an FBI warning – he was only given probation and was never banned from working with children. He continued to be employed in public and private hospitals until his retirement in 2017.

Hospital administrators and doctors who either ignored or failed to adequately investigate the allegations against him testified in court. The director of the hospital in Zonzaq, Michelle Kals, said she was aware of his conviction but hired him as “we needed surgeons” and there was no formal directive to disqualify him from the position.

Psychiatrist Thierry Bonvalot described the case as a “medical fiasco”, while the head of the medical association in Charad-Maritime said that “with his experience today” different decisions would have been taken.

Le Squarneck is already serving a 15-year sentence from 2020 for four cases of statutory rape, and new prosecutions are expected as prosecutors have opened a file on hundreds of new allegations.

Outside the court, about 20 victims and their relatives protested against the “silence of the political world”, calling for a commission of inquiry. “It is unthinkable that this trial of the century is not a turning point for the government and society,” they said.

Manon Lemoine, a victim of rape by the surgeon when she was 11, said: “They are trying to portray him as a monster, but the real monster is the society that created him and let him continue.”