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GATINEAU, Que. -- Prime Minister Justin Trudeau said Monday that violence against Indigenous women and girls is sadly not a relic of Canada's past, and the justice system has failed them.

But he stopped short of calling the damage and death a genocide -- despite being called out to do so -- when he spoke after accepting the report of the national inquiry into missing and murdered Indigenous women and girls.

The report uses the term dozens of times, starting in the first paragraph of its preface: "This report is about deliberate race, identity and gender-based genocide," chief commissioner Marion Buller writes. Other commissioners pointedly use it and the report devotes pages to developing the argument that the deaths of Indigenous women and the generations-long suppression of their rights and cultures is genocidal.

"We will conduct a thorough review of this report, and we will develop and implement a national action plan to address violence against Indigenous women, girls, and LGBTQ and two-spirit people," Trudeau told hundreds gathered for the formal release of findings from the inquiry.

The safety, security and dignity of Indigenous mothers, daughters, sisters and friends are "routinely threatened," Trudeau said, adding Canada has heard time and time again about disappearances, violence, or even deaths being labelled as low priority, or just ignored.

"We have heard of their human rights being consistently and systemically violated," Trudeau said. "It is shameful. It is absolutely unacceptable. And it must end."

Trudeau received the inquiry report containing more than 200 recommendations in Gatineau, Que. morning from four commissioners after they performed a traditional ceremony, including coating its pages with medicine and wrapping it in a blanket.

The tragedy, Buller said, is a direct result of a "persistent and deliberate pattern of systemic racial and gendered human- and Indigenous-rights violations and abuses, perpetuated historically and maintained today by the Canadian state, designed to displace Indigenous people from their lands, social structures and governments, and to eradicate their existence as nations, communities, families and individuals."

"This," she said to a growing chorus of cheers and applause, "is genocide."

Buller said Monday she and her three fellow commissioners are holding up a mirror to the country, reflecting what they heard from more than 2,300 people over two years of cross-country public hearings and work to gather evidence.

"Your truths cannot be unheard," she said to a crowd including Trudeau, Crown-Indigenous Relations Minister Carolyn Bennett and Indigenous Services Minister Seamus O'Regan.

A complete change is required to dismantle colonialism in Canadian society, said Buller, who is Cree from the Mistawasis First Nation in Saskatchewan.

"This paradigm-shift must come from all levels of government and public institutions," she said.

"Ideologies and instruments of colonialism, racism and misogyny, both past and present, must be rejected."

The report contains a number of calls to multiple levels of government and institutions, including that health-service providers develop programs that could help young people recognize the signs of being targeted for exploitation.

Commissioner Qajaq Robinson said Monday that the process had tested her to her core as a non-Indigenous person, struggling to come to terms with her "role in Canada's genocide."

Robinson was born and raised in Nunavut, speaks Inuktitut and practises Aboriginal law, but her appointment as a member of a commission that had no Inuk member was controversial.

Addressing other non-Indigenous people, she said she has felt the same feeling "you non-Indigenous people in the room or watching may be feeling."

"Shame, guilt, denial, that urge to say, 'No, no, no, that's not what this is,"' she said.

"But it's the truth. It's our truth. It's my truth, it's your truth. The families, survivors, and Indigenous peoples across this country have brought this truth to light."

The report, the culmination of a three-year effort often beset by controversy, delays and personnel problems, documents what Buller calls "important truths" -- including that Canadian laws and institutions are themselves to blame for violating the human rights of Indigenous Peoples.

"I hope that knowing these truths will contribute to a better understanding of the real lives of Indigenous people and the violations of their human and Indigenous rights when they were targeted for violence," Buller writes in the report.

She also makes a point to acknowledge potential criticisms.

"Skeptics will be fearful and will complain that the financial cost of rebuilding is too great, that enough has been done, that enough money has been spent," Buller writes.

"To them I say, we as a nation cannot afford not to rebuild. Otherwise, we all knowingly enable the continuation of genocide in our own country."

The steps necessary to "end and redress this genocide" must be no less monumental than the combination of systems and actions that have been used to "maintain colonial violence for generations," the commissioners say.

The recommendations -- framed in the report as "calls for justice" -- include developing an effective response to human trafficking cases and sexual exploitation and violence, including in the sex industry. They are not optional, but constitute legal imperatives, the report says.

Additional calls include the need to establish a national Indigenous and human rights ombudsperson and a national Indigenous and human rights tribunal.

It also recommends the development of a national action plan to ensure equitable access to employment, housing, education, safety, and health care, as well as long-term funding for education programs and awareness campaigns related to violence prevention.

The report also strongly focuses on the need for actors in the justice system and in police services to acknowledge that the historical and current relationship with Indigenous women, girls, and two-spirit people has been largely defined by "colonialism, racism, bias, discrimination, and fundamental cultural and societal differences."

"We further call upon all police services and justice system actors to acknowledge that, going forward, this relationship must be based on respect and understanding, and must be led by, and in partnerships with, Indigenous women, girls, and 2SLGBTQQIA (two-spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual) people."

Missing and murdered Indigenous women are believed to number in the thousands in Canada, but the report says that despite the commission's best efforts to quantify the extent of the tragedy, "no one knows an exact number."

In 2005, the Native Women's Association of Canada created a database tracking cases and produced a 2010 report documenting 582 missing and murdered Indigenous women. In 2014, the RCMP released a national overview and pegged the number of cases between 1980 and 2012 at nearly 1,200. Other unverified estimates are far higher.

Responding to the conclusions is the responsibility not only of federal and provincial governments and law enforcement agencies, but all Canadians in both the immediate and long-term, the report says.

"Individuals, institutions, and governments can all play a part ... We encourage you, as you read these recommendations, to understand and, most importantly, to act on yours."