Toronto Star, October 30, 1998

In the calculation of real disasters homelessness has easily won its place

By Cathy Crowe

I am a ``street nurse.'' My specialty, if you will, is homeless
health care. This should be a perverse concept because I am a
community health nurse - in Canada.

1998 has been a turning point in the way I engage in my nursing. You
see, I experienced a nursing epiphany - that homelessness is in fact
a national disaster. How I reached this understanding of
homelessness is significant. I have nursed, researched, and written
in the area of homelessness for many years.

For myself and my colleagues, our perspective is that homelessness
is intolerable and at the same time solvable. We move from battle to
battle, fighting to get health cards for homeless people, fighting
tuberculosis, fighting to have trailers installed as shelter, even
fighting in the coroner's court to produce recommendations that
would stop further homeless deaths.

All the signs of an acute disaster are evident: clusters of
infections, a rise in over-all morbidity including malnutrition, and
a rapid rise in the number of deaths

Yet, it took the gruelling 1998 ice storm in Eastern Ontario and
Quebec to shock me into realizing that homelessness is a national
disaster. Glued to the television coverage of the ice storm, I
seriously contemplated going to Kingston or Montreal to help in the
relief efforts.

Despite having never worked as a nurse in a recognized disaster zone
I was convinced I could contribute. I had 11 years' experience
working in crowded drop-ins and shelters providing health care to
homeless people in emergency conditions - often working alone and
without running water, proper supplies or adequate light. I was
adaptable and good in a crisis. I worried though - was my French
good enough to get by? Would I be able to get time off work to go?
These questions plagued me daily. Yet, the more I followed the ice
storm coverage, the more I was convinced I must go.

As soon as I made the decision to go, I was hit with a wave of
emotion - my gut told me something was seriously wrong. I realized
that to go was to deny that homeless people here were living in a
disaster!

I realized that the images on television that had moved me were the
daily circumstances of homeless people's lives. I was overcome with
grief and nausea as this truth hit home.

The comparison to the ice storm was a painful reminder to me that
homeless people, no matter where they are in Canada, quite simply
have no home, no central ``heart'' of support or base. Many have had
no home for years.

All the evidence pointed to an enormous national problem. All major
cities facing escalating numbers of homeless people, many forced to
migrate to cities like Toronto.

With my new insight, I realized that all the signs of an acute
disaster were evident: clusters of infections, a rise in over-all
morbidity including malnutrition, and a rapid rise in the number of
homeless deaths. At the same time there was evidence of suffering
and exhaustion of both homeless people and workers.

For homeless people across Canada in this disaster:

The electricity is not going to magically turn on, giving them the
freedom to ``go home'' or back to work or school.

The emergency shelter stay is not temporary. Many people - women,
families, children even - have been in shelters for five to 20
years.

Hostels are overcrowded and intolerable. The homeless are forced to
stay in temporary emergency shelters such as church basements or
school gymnasiums. Each night homeless people follow the path of a
forced migration to whichever temporary facility happens to be open
that night. Then the spring comes and the program shuts down. Once
again alleyways, grates, squats, parks and under bridges become
``home.''

For couples who wish to stay together, sleeping outside is often the
only alternative for intimacy and companionship.

There will be no compensation for suffering and loss - instead,
government officials say that welfare cuts are good for homeless
people and will help them get off the street.

To be homeless is a daily life and death situation. To be homeless
is to risk tuberculosis infection. In Vancouver, the spread of HIV
infection or AIDs is due to the consequences of homelessness. In
Toronto, front-line workers report two to four deaths of homeless
people per week.

There will be no relief efforts that include public health nurses in
emergency shelters doing early case identification of serious health
problems; or crisis intervention teams to deal with the emotional
trauma of congregate living; or hospitalization of those who are
elderly or very ill and unable to tolerate the shelter conditions.

Surprisingly, few complain.

The tensions apparent on televised accounts of ice storm victims'
faces after two weeks in shelters triggered me, reminding me of the
tensions, anger, frustration, grief and sadness that I see every day
on the faces of homeless people.

People who have spent three hours in one drop-in before it closes,
forcing them to move on to the next centre. People who are forced to
sign up and line up for showers, to see the nurse, to see the lawyer,
to get a bus ticket, for food, for the bathroom.

And then there's the nighttime - uncertainly about where you will
find shelter, or who you will be sleeping next to. To be homeless is
to risk one's mental health and feeling of self-worth. Not
surprisingly, severe depression emerges.

In June, 1998, a group of front-line health and community workers,
AIDs activists, formerly homeless people, housing experts,
academics, church people, came together to write a declaration,
calling for all governments to view homelessness as a national
disaster. We call ourselves the Toronto Disaster Relief Committee.
On Oct. 8, we released a public call.

The report calls for immediate short-term ``rescue'' measures as
well as the 1 per cent solution, adding an additional 1 per cent of
government budgets to housing. After all, in a real disaster, people
are returned to their homes.

To date, 300 organizations and 700 individuals have endorsed the
declaration, including, this week, Toronto City Council.

As professor Ursula Franklin eloquently said, ``This is a man-made
disaster and we have the legal and technical means to end it.''

There are now at least 200,000 people homeless in Canada. Many of
these people will suffer an experience which will harm them for life
- children particularly. The Anne Golden report says that 80,000
people in Toronto are at risk of becoming homeless. The Toronto
Disaster Relief Committee report says, ``The homeless situation is
worsening daily at an alarming rate, as the factors creating it
remain unchecked.

``Any delay in firmly and massively responding will only contribute
to compounding the present crisis of suffering and death which is
already an epidemic which no civilized society can tolerate.''

If there was a flood in Toronto, would the city send officials to
house only the people who were affected by the flood and leave
behind all the rest who were affected because they were poor? If I
was a city official, no amount of money would be enough to accept
that job. Delay in action means long-term consequences.

The Canadian winter is coming.

---------------

Cathy Crowe is a nurse and member of the Toronto Disaster Relief
Committee.
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Dennis Raphael, Ph.D.
Associate Professor and Associate Director,
Masters of Health Science Program in Health Promotion
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
McMurrich Building, Room 101
Toronto, Ontario, CANADA M5S 1A8
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