A former surgeon who is accused of abusing hundreds of young patients, often while they were under anaesthetic, is set to go on trial this month in the largest child abuse trial in French history.

Joel Le Scouarnec, 73, is accused of assaulting or raping 299 children – the majority former patients of his – between 1989 and 2014, mostly in Brittany.

He has admitted to some charges, but not all.

The trial in Vannes, north- west France, follows a painstaking police investigation lasting several years.

It is likely to raise uncomfortable questions over whether Le Scouarnec was protected by his colleagues and the management of the hospitals that employed him, despite an FBI warning to the French authorities that he had been consulting child abuse websites, after which he was given only a suspended sentence.

A staggering number of opportunities to stop the former surgeon from having contact with children appear to have been missed or rejected.

Members of his own family also knew of Le Scouarnec’s paedophilia but failed to stop him, it is claimed.

“It was the family’s omertà which meant his abuse was allowed to continue for decades,” one lawyer involved in the case told the BBC.

Le Scouarnec, once a respected small-town surgeon, has been in jail since 2017, when he was arrested on suspicion of raping his nieces, now in their 30s, as well as a six-year-old girl and a young patient. In 2020 he was sentenced to 15 years’ imprisonment.

After his arrest, police searched his home and found child-sized sex dolls, more than 300,000 child abuse images, and thousands of pages of meticulously compiled diaries in which Le Scouarnec is alleged to have logged assaults he carried out on his young patients over 25 years.

He has denied assaulting or raping children, arguing that his diaries merely detailed his “fantasies”.

In several instances, however, he had also written: “I am a paedophile”.

Le Scouarnec is facing more than 100 rape charges and more than 150 charges of sexual assault.

Some of his former patients, who are all now adults, have said they remember the surgeon touching them under the guise of medical examinations, sometimes even when their parents or other doctors were in the room.

But because a huge number of his alleged victims were under the effect of anaesthetics when it is claimed the assaults took place, they had no recollection of the events and were shocked to be contacted by police and told their names – alongside graphic descriptions of abuse – allegedly appeared in Le Scouarnec’s diaries.

Le Scouarnec felt “all-powerful” and liked the feeling of “flirting with danger” through “calculated transgressions,” French daily Le Monde quoted the court order against the former surgeon as saying.

Some of the alleged victims have said the unsettling revelations helped them make sense of unexplained symptoms of trauma that had burdened them their whole lives.

Lawyer Francesca Satta, who represents several alleged victims, told the BBC that among her clients are “the families of two men who did remember, and who ended up taking their own lives.”

Olivia Mons of the France Victimes association spoke to many of the alleged victims and said several only had blurry recollections of events which they were never able to “find the words to explain”.

When the surgeon’s case came to light, “it provided them with the beginning of an explanation,” Ms Mons said.

But she added that most of the alleged victims were people who had no memories of being raped or assaulted, and who were living ordinary lives before police contacted them. “Today, many of these people are understandably very shaken,” Ms Mons said.

One woman told French media that when police showed her an entry under her name in Le Scouarnec’s diary, memories instantly flooded in. “I had flashbacks of someone coming into my hospital room, lifting the bedsheets, saying he would check if everything had gone well,” she said. “He raped me.”

Margaux Castex, a lawyer for one of the alleged victims, told the BBC her client is “traumatised that he ever gave his trust to a medical professional, and that’s been hard to shake”.

“He wishes he had never been told what happened,” Ms Castex said.

Another woman called Marie, now a married mother in her mid-thirties, said that police came to her house and revealed that her name appeared in the diaries of a surgeon who was accused of child abuse.

“They read out what he had written about me and I wanted to read it back myself but it was impossible,” she told outlet France Bleu. “Can you imagine reading hardcore pornography and knowing that it is about you, as a child?”

Marie said she had seen mental health specialists for years because of “issues” she had with regards to men, and that doctors had wondered whether she had experienced childhood trauma.

“I have to believe that my memory protected me from that. But the [police] examination brought it all back to the surface – images, sensations, memories came back to me day by day,” she said. “Today, I feel this as if it had just happened.”

Marie added that when she was shown a photo of Le Scouarnec, “everything came back to me… I remembered his icy gaze.”

She wondered how the surgeon had been able to commit his alleged crimes unnoticed for so long.

It is a haunting question that is bound to be explored at length during the trial.

The first court proceedings heard claims that several members of Le Scouarnec’s family had been aware since the mid-1980s of his disturbing behaviour towards children, but did not intervene.

His ex-wife has denied knowing what her husband – and father of their three children – allegedly did until he was arrested.

Le Scouarnec – a medical professional and a lover of opera and literature – had long been the pride of his middle-class family. He was a respected small town medical practitioner for many years, which may have afforded him a significant degree of protection in the workplace.

“A huge degree of dysfunction allowed Le Scouarnec to commit his deeds,” lawyer Frederic Benoist told the BBC.

Mr Benoist represents child protection advocacy group La Voix de L’Enfant (The Child’s Voice), which is pressing to highlight what it calls the “crucial institutional and judicial missteps” which allowed Le Scouarnec to allegedly continue abusing children for decades.

In the early 2000s, an FBI alert to the French authorities that Le Scouarnec had been accessing child abuse websites only resulted in a four-month suspended sentence with no obligation to follow medical or psychological treatment.

Mr Benoist said prosecutors never shared this information with the medical authorities and there were no consequences for Le Scouarnec, who continued in his role as a surgeon, often operating on children and managing their aftercare.

When a colleague – who already harboured suspicions against Le Scouarnec – read about the charges against him in the local press in 2006, he urged the regional medical association to take action.

All but one doctor – who abstained – voted that Le Scouarnec had not violated the medical code of ethics, which states that doctors “must in all circumstances be trustworthy and act with integrity and devotion to duty”. No sanctions were imposed.

“We therefore have proof that all these colleagues knew, and none of them did anything,” Mr Benoist said. “There were many circumstances which meant he could have been stopped; he wasn’t, and the consequences are tragic.”

The BBC has approached both the regional medical association and prosecutors for comment.

Le Scouarnec was eventually arrested when the six-year-old victim told her parents that he had assaulted her. By then, he was living like a recluse in a large derelict home, surrounded by child-sized dolls.

Ms Driguez, the nieces’ lawyer, sat opposite Le Scouarnec during the 2020 trial in the south-western town of Saintes. “His answers were cold and calculated,” she said. “He is extremely clever, but showed no empathy whatsoever.”

The trial uncovered more allegations of child abuse within Le Scouarnec’s family, Ms Driguez said, but the former surgeon never had any particular reaction and mostly looked at the floor.

At one point, the court was shown lurid videos of Le Scouarnec and his dolls. “Everyone was watching the screen but I was watching him,” Ms Driguez said. “Up to that point he had always kept his gaze down. But at that moment, he looked up, staring intently at the video. His eyes were twinkling.”

As the city of Vannes prepares to host the trial, three lecture halls in a former university building nearby have been made available to accommodate the hundreds of alleged victims, their legal representatives and families. The trial starts on 24 February and is due to last until June.

Whether the press and the public are allowed in will depend on all of the alleged victims giving up their right to a closed trial.

Many lawyers believe the trial could be a moment of reckoning for the authorities that failed to take provisions against Le Scouarnec, as well as an important moment for the victims to voice their trauma.

Ms Satta said that although many people involved in this case have no memory of what happened to them, they were still victims, adding that the former surgeon had enjoyed the “impunity of silence” for too long.

“The trial will be a moment for the victims to speak out,” Mr Benoist agreed. “It would be terrible, in my eyes, if it was held behind closed doors.”