Calls grow to declare Toronto homelessness a public health crisis after extreme cold

Councillors in Toronto are set to consider keeping warming centres open 24-7 for the rest of the winter amid growing calls for homelessness to be declared a public health crisis in the city.

Most of Ontario was under extreme cold warnings late last week, with frigid temperatures presenting greater risks for those without proper shelter.

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Calls to keep warming centres open around the clock in Toronto have been growing, with community workers and medical providers saying the city policy to open them once temperatures reach -15 C, or -20 C with wind chill, is cruel, not based in evidence and could be causing preventable cold-related injuries.

The centres open at 7 p.m. on the day an alert is issued and stay open until noon on the day an alert ends.

Coun. Alejandra Bravo -- who helped introduce a motion that recommends the city provide 24-7 indoor warming locations until April 15 -- said a lack of available spaces to take shelter from the cold means those experiencing homelessness are taking refuge in unsuitable public spaces.

"We're in a situation where public libraries, the transit system, 24-hour restaurants, all manners of buildings people can access are actually de facto shelter spaces right now," said Bravo.

"They're showing up in emergency departments, putting a huge strain on emergency departments simply because they want to get inside ... that's not a recipe for the health of anyone or social harmony."

Bravo's motion -- set to be considered Tuesday -- includes a call for the declaration of homelessness as a public health crisis. It further requests a review of the procedures for the opening of city-run warming centres.

According to the city's daily data on shelter occupancy, 99 per cent of warming centre spaces were occupied on Friday when an extreme cold warning was in effect -- with only one space unoccupied.

The Ontario Human Rights Commission on Friday expressed concern about the "significant lack of cold weather services in Toronto, and across the province, for people experiencing homelessness." It called on all levels of government to limit what it called "historic and ongoing systemic discrimination" faced by homeless people.

"Keeping members of our community from freezing to death on the streets is part of that essential work," it wrote in a statement.

City spokesperson Alex Burke said the four city-run warming centres don't turn anyone away.

"If a location is at capacity, staff facilitate referrals to other spaces as space became available and support with transportation," Burke wrote.

In a statement Friday, the city said it had increased its warming centre capacity from 142 spaces to 195, while opening 237 temporary contingency spaces at various shelter sites. It also said it added 432 additional spaces to the shelter system.

The city was not able to provide specific costs associated with operating the warming centres, stating they vary depending on factors like location and the number of days a site is open.

Unity Health Toronto, a hospital network in Toronto, said last month that it has seen an increase in cold-related injuries like hypothermia and frostbite this winter. It said its hospitals have also seen injuries from strategies used to survive outside, like sleeping in unsafe areas, overdoses due to substance use or unhoused patients coming to emergency departments to warm up.

"Without places to go, many of our patients face unnecessary challenges completing their recovery," it wrote in a statement. "At the same time, keeping patients in the emergency department or on a hospital ward for longer than is medically necessary reduces the availability of acute care beds."

A 2019 research review of coroner's records and emergency department charts from five downtown Toronto hospitals found that most cases of injury and death due to cold happen in moderate winter weather. The research by the MAP Centre for Urban Health Solutions found that between 2004 and 2015, 72 per cent of hypothermia cases in people experiencing homelessness occurred in temperatures warmer than -15 C.

Diana Chan McNally, a harm reduction case manager at the non-profit All Saints Church, said the city needs to prioritize funding for more spaces for unhoused people over increases to the police budget.

Toronto Mayor John Tory announced a proposed $48.3-million increase to the police budget, which would in part go toward the addition of about 200 officers and bring police funding to just over $1.1 billion for 2023.

"Why is it that we're arguing for something as basic as a warming centre, a place for people to go to not freeze to death?" Chan McNally said.

In nearby Hamilton, the municipality said it is re-evaluating its cold response policy after "a realized gap" in its winter response services in December, when recreation centres used as warming centres were closed for staff holidays, as well as increased demand for shelter spaces.

Hamilton city council voted in January to spend an expected $415,000 to add daily overnight warming spaces and keep them open until the end of March.

However, Rob Mastroianni, manager of homelessness and housing support, said the 21 available spaces at the Hamilton's only coed overnight drop-in centre have generally been at capacity in recent days. As a result, users have to be cycled in and out every hour, he said.

In St. Catharines, Ont., outreach worker Emily Spanton said options for homeless individuals are limited.

The city's only warming centre runs from 8:30 a.m. to 3:30 p.m. daily, she said, and there aren't enough shelter beds or overnight emergency shelter spaces to accommodate hundreds of unhoused residents.

At the city's breakfast program for unhoused individuals recently, Spanton said she attended to many people with frostbite, including one man whose toe came off when she changed his socks.

"It was fully blackened," she said. "He told me that he was considering breaking into an abandoned building just to stay warm."

Adriana Di Stefano, a Toronto doctor and member of Health Providers Against Poverty, said cold-related injuries like the one Spanton saw are preventable, and can be traumatic for people experiencing homelessness, who often don't have access to followup care.

"The solution seems very simple: provide shelter, provide warming centres, provide supportive housing, provide long-term housing," she said.

"There's a lot of talk about these things but we need action now, because it's cold now. The injuries are happening now, the hospitals are overloaded now."

This report by The Canadian Press was first published Feb. 5, 2023.