08/02/2016 3:50 PM AEDT | Updated 15/07/2016 12:51 PM AEST

Sex Abuse Survivors Outraged As George Pell Remains In Rome

ANDREAS SOLARO via Getty Images
Australian Cardinal George Pell, Prefect of the Secretariat for the Economy of the Holy See, attends a press conference on March 31, 2014 in Vatican. Cardinal George Pell and Italian writer Francesco Lozupone presented the book 'Co-responsability and transparency in the administration of church property'. AFP PHOTO / ANDREAS SOLARO (Photo credit should read ANDREAS SOLARO/AFP/Getty Images)

Survivors of abuse at Catholic orphanages say they are bitterly disappointed by a decision by the Royal Commission into Child Sex Abuse to allow Cardinal George Pell to give evidence via video link.

The Royal Commission into Institutional Responses to Child Sexual Abuse on Monday excused Pell from giving evidence in person, instead allowing him to appear before the inquiry via video link from Rome.

He is expected to give evidence on church abuse and the management of abusive priests in Ballarat.

Commission Chair, Justice Peter McClellan, said he accepted medical evidence there would be a risk to the 74-year-old's health if he is forced to fly to Australia to give evidence.

"There is a risk to his health if he undertook such travel at the present time," McClellan said while delivering his ruling on Monday.

"Having regard to the nature of his ailments it could not be expected that his health is likely to improve and remove those risks.

"Although it remains preferable that he gives evidence in Australia, when the alternative that he give evidence by video link is available the Commissioners are satisfied that course should be adopted."

Survivors of abuse at Catholic orphanages say they are disappointed by a decision to allow George Pell to give evidence via video link

Pell has consistently denied any knowledge of child sex abuse in the Ballarat archdiocese, and his lawyers have told the commission he is keen to give evidence to the inquiry.

It is understood he had been scheduled to give evidence in Melbourne in December, but cancelled due to his worsening heart condition.

McClellan previously denied a similar request and indicated it was his preference for Pell to appear in person.

Outside the commission on Monday, survivors of abuse at Catholic run orphanages expressed their disappointment at Mondays decision.

Leonie Sheedy, Executive Director of the Care Leaver's Association Network, told reporters outside the commission, said the cardinal's reputation was in tatters.

"This is not an arduous journey for a 74-year-old man. I think it is absolutely disgraceful. I think the Pope should order him on a flight back here," she said.

"The victims have had to go public with their story regardless of their health, and their mental health, and he gets away with it staying in Rome."

CLAN members outside the Royal Commission in Sydney on Friday, ahead of the the decision

Nicky Davis, an advocate for abuse survivors, said she did not believe the doctor's report.

"For survivors this issue is about accountability," she said.

"It's about officials who have been covering up very serious crimes on a wide-spread scale and who think themselves above the law. For survivors we are very clear on this -- those who have been doing this must man up, come to Australia, get out of the nursing home they are hiding in, and come and face the music."

The former Bishop of Ballarat, Ronald Mulkearns, has also been ordered to give evidence and will also be questioned via video link.