Vatican City (AFP) - A visibly bruised Pope Francis created 21 new cardinals from five continents on Saturday, including bishops from Algiers, Tehran, Tokyo and Abidjan – many of whom may one day help choose his successor.

In the tenth such consistory since he became pope in 2013, Francis, 87, greeted the assembled cardinals-to-be with a large bruise on his right jaw, which a Vatican source said was caused after he fell from his bed.

“The Lord is looking to you, who come from different backgrounds and cultures, and represent the catholicity of the Church,” the pope told the group inside St. Peter’s Basilica.

The pope, who has suffered increasing health problems in recent years, appeared short of breath during the ceremony, but smiled and chatted with some of the cardinals.

The Vatican did not issue an official communication about the bruise, nor did it respond to a request for more information.

“He is calling you to be witnesses of fraternity, artisans of communion and builders of unity,” Francis told the new cardinals.

The Argentine pope – the first pontiff from Latin America – has championed a grassroots Church that values its faithful even far from the Vatican, and has sought to promote the clergy of developing countries to the highest ranks.

This year, Francis has selected five bishops from Latin America (Ecuador, Chile, Brazil, Peru and Argentina), and two from Africa (Ivory Coast, Algeria) to become cardinals.

The Asia-Pacific region, where Catholicism is growing the fastest, is represented with promotions of the archbishop of Tokyo and the bishop of the Ukrainian Catholic Church in Melbourne, Australia.

Francis has also selected Belgian prelate Dominique Joseph Mathieu, who serves as the archbishop of Tehran-Isfahan in Iran.

With the new promotions, Francis has chosen nearly 78 percent of the 140 so-called “elector” cardinals.

Twenty of the new group are under the age of 80, making them eligible to vote in the conclave that would be called to choose a new pope in the event of Francis’s death or resignation.

But there is no guarantee that his appointments would share his views.

- Cap and a ring -

The pope has exclusive responsibility for naming cardinals, the so-called “Princes of the Church”, whose role is to assist him in the government or Curia of the Holy See.

Some cardinals live in Rome and hold functions within the Curia, but most continue to exercise their ministry in their dioceses.

Held underneath the soaring dome of St. Peter’s, the cardinals-to-be knelt before Pope Francis to receive their biretta, or square scarlet cap, and a ring.

Francis implored the new cardinals to “make every effort to walk in the path of Jesus”, warning them not “to to be dazzled by the allure of prestige, the seduction of power”.

Following the ceremony, the new cardinals were to participate in the traditional “courtesy visit”, in which members of the public can meet them. The cardinals will then gather for a mass Sunday morning at St. Peter’s.

One of the new “princes”, archbishop of Algiers Jean-Paul Vesco, told AFP the pope’s new choices offered “rich diversity, geographical and sociological”, calling it a “positive” step, as long as the body of cardinals operates cooperatively.

Over the past decade, Francis has focused his attention on often overlooked dioceses from what he calls the “peripheries” – including where Catholics make up a minority, such as Indonesia, the world’s most populous Muslim-majority country, which he visited in September.

His pick of cardinals partially reflects these choices, and he has broken away from the custom of systematically promoting archbishops from large, prestigious dioceses such as Milan or Paris.

Vatican observers closely scrutinise the list, seeing in it a possible indication of the future priorities and values of the Church’s next leader and its nearly 1.4 billion faithful.

Francis has left open the option of resigning, like his predecessor Benedict XVI, should he be unable to carry out his duties.

But despite recurring health issues, from pain in his knee and hip to various recent episodes of bronchitis, he remains very active and has said that for now he is going nowhere.