Reports / Articles
Friday December 14, 2001
Worst Christmas Ever
In October 2000, TDRC researched
and wrote a report describing the appalling situation for homeless people
in the City of Toronto. State
of the Disaster: Winter 2000 revealed
a homelessness situation spiraling out of control, and a shelter system in
We found that shelters are
dangerously overcrowded and filled with seriously ill people. Many shelters do not meet minimum United Nations standards
for refugee camps. We
identified a need for approximately 1000 additional shelter beds to
accommodate all those who need safe shelter (including harm reduction
options) and to reduce crowding and disease.
One year later, the city’s response to our report
and its recommendations can be summarized in two words: denial and inaction.
recommend that Toronto City Council direct the Commissioner of the
Community and Neighbourhood Services Department to do the following:
Order a moratorium on shelter closures for the duration of
the homelessness disaster.
2) Open 1000 shelter beds:
a. Immediately open four emergency shelters or warming centers, to be run by an aid organization such as the Red Cross, and able to accommodate up to 150 men, women and couples each. They should be available for the duration of the homelessness disaster.
Open a number of appropriate smaller
shelter facilities (for example, which are
smaller, more private, with increased supports on site) to meet the needs
of women, people with disabilities, aboriginal people, youth, people with
serious addictions or health/mental health problems, and people living
with AIDS, to make up the remaining 400 beds required.
Included in these beds should be at least one “wet hostel” for
women and other harm reduction facilities to meet the needs of people in
the above groups with addictions.
Ensure that the above facilities and
existing facilities meet the United Nations standards for refugee camps.
For example, an adequate number of toilets must be accessible; beds
or cots and not mats on the floor must be provided; adequate space
allocation must be provided; food must meet nutritional needs; health
services should be provided on site.
Ensure that the above facilities and
existing facilities operate from a harm reduction philosophy.
There must be adequate staffing levels and adequate staff training
with respect to mental health issues, harm reduction and crisis
de-escalation to ensure both safety and the meeting of standards.
5) Direct the Medical Officer of Health to carry out a special investigation of health standards in the shelter system to ensure that they meet international public health standards.
Definition: An outbreak is
the occurrence of more cases of a communicable disease than expected in a
given time period, within a given population.
An outbreak of TB was predicted by
activists in the mid 1990s.
Between the Spring of 2001 and
August 2001 there were 9 linked cases of TB found in Seaton House, the
largest men’s hostel in Canada. All were Canadian born. 1 person was
co-infected with HIV. 1 person has since died. Cases were linked by DNA
testing. Street nurses know of 3 other cases preceding this outbreak
within the same block.
60% of the men tested at Seaton
House tested positive, indicating exposure to TB. This is up 57% from the
38% figure in a 1996 TB testing pilot.
What has been done?
Treatment of individuals. Fans have been installed to promote
air-exchange. Windows opened to maximize ventilation.
What was not done? No notice or communique or alert to community health workers, street nurses or former members of the Tuberculosis Action Group. No warning to Hostel Services Department to not increase the crowding in existing shelters. No alert to the Out of the Cold programme even though shelter crowding, poor ventilation and forced migration are the major causes of TB infection and transmission.
In 1991 the Centre for Disease
Control and Prevention (Atlanta) recommended that low income
populations (i.e. homeless) should be screened using a TB skin test.
In 1992 the Morbidity and
Mortality Weekly Report (MMWR) recommended that TB case finding should
be part of the regular health care provided to homeless persons.
To this day the Department of
Public Health has no program for routine screenings in the homeless
population in the City of Toronto. Without doubt, the Seaton House
outbreak is the tip of the iceberg.
What do we know about the Toronto
q In 1994 there were 170-180 TB cases/year in the City of Toronto
q In 1994 Dep’t of Public Health Dep’t followed 7 active cases that were homeless. From 1990 to1994 there were 6-16 cases of TB/year that were homeless.
q In 1996 a TB Pilot Subcommittee (combination of community and City staff) completed a survey and issued a Report on the Tuberculosis Pilot Project in the Homeless and Underhoused. This report stated that the prevalence of active TB among homeless persons is estimated to be, in some areas, as high as 150-300 times greater than the general population (i.e. housed population).
q The 1996 report showed that 38% of the homeless people tested positive meaning they had come in contact with someone with active TB. St. Michael’s Hospital issued a statement in March, 1996 “the statistical findings of the pilot project….should be considered a wake up call.”
The 1996 report made several
important recommendations relevant to today’s TB outbreak:
4.1: That the department should
intensify efforts in TB case finding which would include Public Health
Nurse liaisons with agencies working with the homeless; symptom screening
and targeted Mantoux skin testing on a regular basis at agencies serving
the homeless and underhoused.
Recommendation 5.1: “The
Toronto Department of Public Health develop a resource center and a means
of keeping the broader health and social service community up to date on
information and trends.”
Recommendation 5.2: “The
Toronto Department of Public Health continue to research the literature on
environmental factors related to TB transmission including ventilation,
bed-spacing and ultra/violet lighting and to advocate for
infection control measures in spaces where people are congregating.”
Up to and including 1996
many activists from the Tuberculosis Action Group appealed to the
Department of Public Health for a more active and aggressive TB prevention
program. In 1996 Cathy Crowe,
a street nurse warned “the conditions are ripe for an epidemic."
q In 1998 there were 450-500 cases of TB/year in Toronto (Dr. Jeff Edelson, St. Michael’s Hospital)
q In 2000 there were 376 cases of TB
q Millions of people continue to die from TB around the world
1 in 10 people infected will go on to
develop active disease. This number is higher if conditions of
immune suppression exist. The conditions of stress, malnutrition, poor
access to health care or proper shelter contribute to weakened immune
systems, as do infections and disease such as HIV, Hepatitis, cancers and
chronic illness such as diabetes or arthritis.
Activists, homeless people, health
care workers come together to share their concern and to appeal to the
Department of Public Health and the Homeless Advisory Committee of the
City of Toronto to act.
Their concerns and recommendations
are based on fact, experience and the knowledge that in New York City
measures which included TB screening were essential to prevent TB
outbreaks. The Canadian Tuberculosis Standards, issued by Health Canada in
2000 recommends that groups
that should be considered for systematic screening include the poor,
especially the urban homeless. (p.189)
Three different organizations
applied to the City for Supporting Community Partnerships Initiatives (SCPI)
funds to set up transitional housing at 525 Commissioner Street for
homeless people. The development of these proposals cost many thousands of
dollars and the energies of skilled and talented homeless people and
professionals. In the end,
Homes First was given the go-ahead to work on the project.
Homes First, the homeless people,
and the Tent City Relocation Group (of which TDRC is a member) have been
meeting to achieve this much needed interim strategy while waiting for
The sad part of this story is that
the plans for the innovative proposal which largely came out of looking
for a solution to the Tent City situation has been left in limbo.
At the last City Council meeting this December 4-6, nothing more
than a city staff report was submitted.
Now the land which the City had identified and selected for this
project is in question. City staff name several planning concerns relating
to the site including the existence of a restrictive covenant on the site
from the 1994 Agreement of Purchase and Sale between the Toronto Port
Authority (a Federal body) and TEDCO.
Now, any resolution cannot be
decided upon until the next City Council meeting in February, thereby
pushing the development of housing further and further back. In fact, begging the question, will this project ever get off
the ground and transitional housing built?
Will the continuing negotiations and plans of Tent City dwellers,
Homes First and the Tent City Relocation Group all come to naught?
This process that has been going
on for over a year has so far led to only the exchange of words, expense
of money, endless paperwork, and the dashing of hopes of homeless people
who very much need a transitional inexpensive housing strategy.
We wait as Christmas nears and
For more information, contact TDRC at firstname.lastname@example.org