The judge who sentenced the former USA Gymnastics team doctor Larry Nassar to up to 175 years in jail for the sexual abuse of more than 250 women and girls has condemned the lack of meaningful change in the decade since Nassar’s crimes were exposed.

Against the backdrop of the World Gymnastics Championships, taking place in Rotterdam this week, Judge Rosemarie Aquilina told the Guardian that human rights must be prioritised over the desire for sporting success.

“Nassar was 10 years ago and there have been very few changes that are meaningful,” said Aquilina, who insisted on all 169 impact statements being heard in her courtroom after Nasser’s guilty plea. “I’m not looking for little changes that a lot of people get credit for, I want meaningful change, a lot of meaningful changes, and we’re just not there yet, not in sports, not in life, not in the courtroom, not in the classroom or in the legislature. I have to ask why? It’s the same answer: it’s money, medals and notoriety over the safety of children, and safety is a human right, it’s not a question mark.”

Aquilina joined activists, survivors and advocates from Gymnasts for Change International (GCI) in Rotterdam, who gathered to question why the level of change has been inadequate 10 years on from Nassar’s arrest and what can be done.

Claire Heafford, a survivor of abuse within the sport and the chief executive of GCI, said: “We’re still in a place 10 years on from Larry Nassar where survivors aren’t being listened to and where the scale of the reform hasn’t met the scale of the revelations.”

Heafford puts the unwillingness to engage with systemic change post-Nassar as “institutional fear, blinkeredness, and the fact that people who work in sport are not very creative.

“It’s incredibly difficult for anybody in the system who wants to create change to do so if there’s resistance above them. It’s incredibly difficult for people in the system to feel empowered as change makers when you’re in such fixed hierarchies.”

The event was timed to reflect an opportunity for genuine change as World Gymnastics seeks ⁠to appoint a secretary general in the coming months.

Minky Warden, of Human Rights Watch, said the reckoning sport faced since Nassar, took the wrong form.

“On the one hand, I think you can measure progress in athlete voice and advocacy, in some whistleblower protections, in safeguarding rules across sport – though the rules are there, but the implementation is not,” said Warden.

“Then, on the other hand, I think you can measure it in the impact that gymnastics had in all other sports. I’ve interviewed hundreds of survivors in about 50 sports, winter and summer, from water polo to football to basketball and, 10 years on, I think just the scale and the severity and the duration of the abuses by the so-called Olympic doctor, Larry Nassar, caused a reckoning across sport. But, the reckoning often took the wrong shape, it took the shape of defence.

“Except, this is not a small problem, it is a severe problem and I think any fair assessment would have to say that sport, broadly speaking, including gymnastics, retains the exceptionalism that the Catholic church and schools once had. There was a time when it was really hard to get rid of the abusive priest or the abusive teacher because they were moved around to different jurisdictions and continued abusing, and that is why the scale and the duration of those abuse catastrophes was so great and I think sports still has the same problem.”

The former elite acrobatic gymnast Eloise Jotischky, who became the first person to win a civil case against British Gymnastics for the abuse she experienced between 2016 and 2018, which included inappropriate weight management techniques and verbal abuse, said there have been some changes, but even then the issue is with implementation.

“There’s still a lot to be done,” she said. “For example, British Gymnastics have come out with a number of policies, they’ve got their hydration policies, they’ve got their weight management policies. That’s brilliant, but let’s implement them. It’s the implementation that matters because if you don’t implement them and if you’re not monitoring them, then what’s the point?”

Kim Shore, of Gymnasts for Change Canada, who is a survivor of abuse within the sport and an independent safe sport advocate, said World Gymnastics needs to adopt and implement huge cultural reforms if things are to improve.

“There’s a crisis of abuse across sport in Canada and yet we’ve seen really no reform and I would say that same lack of action, that same apathy is happening at World Gymnastics,” she said. “Sure, they’ve taken some steps, but they could literally post new rules anywhere that say: ‘No more weighing of gymnasts. No more gymnasts returning to competition without a doctor’s note. No more coaches moving from one country to another country, if you’re banned in the US, you can’t just take a gymnast from Mexico to the Olympics’.

“So, they could have a whole list of rules and regulations, even if they don’t have any sort of legislative jurisdiction in an area, that’s still going to influence the culture because as soon as the leading body says we’re not weighing gymnasts any more, then when the weighing gets done, those coaches know they’re breaking the rules.

“If World Gymnastics would come out with a whole list of cultural reforms and started to normalise those within the national federations and then give them backing so that the national federations can go to the clubs all the way down to grassroots, I think we would see faster reform and less resistance.”

World Gymnastics, USA Gymnastics, Gymnastics Canada and British Gymnastics have been contacted for comment.