Mayor Ken Sim, City of Vancouver
Sandra Singh, Deputy City Manager, City of Vancouver
Commissioner Brennan Bastyovanszky, Board Chair, Vancouver Park Board
Brennan.Bastyovanszky@vancouver.ca
5 April 2024, xʷməθkʷəy̓əm, sḵwx̱wú7mesh & səlilwətaɬ lands
Re: Health implications of operations decamping people from Vancouver parks, streets and other public spaces
Mayor Sim, Ms. Singh, Commissioner Bastyovanszky,
The signatories to this letter are medical students within the University of British Columbia’s Faculty of Medicine, and we write to you today with concerns about the so-called “cleanup and compliance work” currently underway in Vancouver’s CRAB Park. It is, in our view, the latest in a series of several troubling events in which unhoused people have been forcibly decamped by city staff in the name of health and safety.
Regardless of the euphemism used to describe them – “cleanup and compliance work”, “by-law enforcement”, or “removal events” – these operations have the same results. Communities are fractured and people are separated from their shelters and belongings, which multiplies risks to health and places additional stress on an already overstretched health system.
As the physicians of tomorrow, we have an interest in ensuring that these decampment operations stop today.
Homelessness is associated with ill health and an increased risk of death. The median life expectancy for individuals experiencing homelessness in BC is between 40 and 49 years – approximately half the 83-year average life expectancy of the general population. In addition, complications arising from the growing problem of homelessness in this city represent a considerable use of health care resources. At any given time, the hospital wards that we work on are generally caring for one or more “social admissions”: patients with relatively straightforward health problems that could be managed at home, if only they had one.
Decampment operations amplify the health consequences of homelessness, and put the well-being of unhoused people further at risk. In the confusion and upheaval of these operations, people can have their prescribed medications taken or thrown away, including life-saving treatments for chronic conditions like HIV, heart failure, and opioid use disorder. If people living with chronic conditions — an estimated 80 per cent of people experiencing homelessness — are unable to access their medications, the results can be deadly.
People have also had their mobility devices impounded or discarded by city staff in decampments, putting them at risk of injury and impairing their ability to use health care and other essential services. Mobility aids can be costly and often require a prescription to be obtained free of cost or with subsidy, making them difficult to replace.
Cellphones and other devices necessary to use health services and programs like overdose prevention apps have been confiscated or lost during decampments. People can also lose the sense of community and security that often forms in established tent cities, putting them at greater risk of violence and accidental poisoning from the toxic drug supply, which last year killed more people in this province than ever before. In this way, these operations undermine evidence-based public health initiatives – and even those funded by the city itself, such as the distribution of take-home naloxone kits.
The stress of daily harassment and the emotional toll of having personal belongings effectively stolen can also exacerbate substance use and mental health disorders. These events may be especially traumatic for members of Indigenous communities, who have and continue to be forcibly displaced from their traditional territories, and who are routinely targeted with racist housing practices and policies.
Over and above the deleterious consequences for the health of unsheltered people, these actions by the city also place additional pressure on health care resources. Decampment operations lead to spikes in visits to emergency departments for acute worsening of existing health problems, injury, and drug toxicity.
This is happening at a time when health resources are spread perilously thin. In Vancouver and across the province, emergency departments are struggling to provide timely care to patients coming in, battling systemic challenges like overcrowding, staff burnout, and violence against health care workers. The result is worse health outcomes for anyone seeking medical attention.
While patient use of emergency rooms is not the cause of the current crisis in emergency departments, the city’s actions are putting more strain on already overstretched resources by precipitating health emergencies that otherwise would not have happened. In this way, decampment operations are placing the entire community — and its most marginalized members especially — at risk.
Particularly in light of the shortfall of decent, accessible housing in this city, establishing safe environments in which for unsheltered people to live is an imperative. But the concept of “health and safety” loses all meaning when measures to achieve it are imposed on people by force, to the detriment of their physical and mental well-being, and that of the wider community.
Thus, we urge you to adopt more compassionate and truly collaborative approaches toward unsheltered people and the encampments in which they live – approaches that respect procedural fairness, and are rooted in the principles of public health.
This includes halting this and further decampments, facilitating cleanup and maintenance efforts led by residents, and redirecting the considerable resources allocated to decampment operations to public health programming, sanitation infrastructure, fire safety and social support.
It is important to recognize the essential functions that encampments serve in Vancouver, which bears the unfortunate designation of the single least affordable city in Canada. In offering a measure of safety, community, and shelter to people who otherwise would not have access, they act as a buffer against the tremendous violence of housing inequality in this city – itself a health emergency.
Especially as the province experiences more and more weather extremes, the creation of more decent and accessible housing for all of Vancouver’s residents is an urgent necessity.
We will continue to collect signatures to this letter after you have received it. Please visit tinyurl.com/UBCmeds4CRABPark periodically for an up-to-date list.
Sincerely,
- Sandra Smiley MSc MPH, Class of 2025, Vancouver-Fraser Medical Program
- Kathryn Haegedorn, Class of 2025, Northern Medical Program
- Preet Gandhi MSc, Class of 2025, Vancouver-Fraser Medical Program
- Christina Schwarz BIE, Class of 2026, Vancouver-Fraser Medical Program
- Davy Lau, Class of 2024, Vancouver-Fraser Medical Program
- Adrianna Paiero MPH, Class of 2026, Vancouver-Fraser Medical Program
- Jarvis Neglia, Class of 2027, Island Medical Program
- Carmen Huang, Class of 2025, Northern Medical Program
- Gaelen Snell MScPH, Class of 2025, Vancouver-Fraser Medical Program
- Sebastian Lopez Steven MSc, Class of 2026, Vancouver-Fraser Medical Program
- Elaine Hu, Class of 2026, Vancouver-Fraser Medical Program
- Grahan Hill, Class of 2027, Vancouver-Fraser Medical Program
- Zohaib Merali BSc, Class of 2026, Vancouver-Fraser Medical Program
- Torin Halvorson BSc (Hon), Class of 2025, Vancouver-Fraser Medical Program
- Vivek Gill BHSc, Class of 2026, Vancouver-Fraser Medical Program
- Savannah Swann MSc, Class of 2027, Island Medical Program
- Ted Schokking BASc, Class of 2025, Northern Medical Program
- Cristina Jamieson, Class of 2025, Vancouver-Fraser Medical Program
- Keerthana Kumar, Class of 2026, Vancouver-Fraser Medical Program
- Katherine Sliwowicz, Class of 2026, Vancouver-Fraser Medical Program
- Diana Kagan, Class of 2027, Vancouver-Fraser Medical Program
- Sanya Grover BHSc, Class of 2025, Vancouver-Fraser Medical Program
- Lyndon Rebello BHKin, Class of 2026, Island Medical Program
- Rosa Balleny BSc, Class of 2025, Vancouver-Fraser Medical Program
- Annie Foreman-Mackey BHSc MPH, Class of 2024, Vancouver-Fraser Medical Program
- Winnie Fu, Class of 2024, Vancouver-Fraser Medical Program
- Soren Meeuwisse HBSc MSc, Class of 2026, Southern Medical Program
- Christie Zhang MPH, Class of 2026, Vancouver-Fraser Medical Program
- Ishmam Bhuiyan, Class of 2025, Vancouver-Fraser Medical Program
- Precilia Kong, Class of 2026, Vancouver-Fraser Medical Program
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Quotes from other health care and public health organizations regarding the health impacts of decampments:
- “There’s just no question that the result of decampment last week will be more people visiting emergency rooms, more people putting pressure on community health services, and as we know those services are already stretched to the max.” - Mike Old, Spokesperson, Hospital Employees’ Union, reacting to decampments in the Downtown Eastside in April 2023
- “These costly, publicly-funded decampments and street sweeps have occurred almost every year since 2014, causing significant harm and trauma to those impacted, and have no positive public health or public safety outcomes.” - Kilala Lelum Urban Indigenous Health and Healing Cooperative, reacting to decampments in the Downtown Eastside in April 2023
- “As workers providing direct care, we were not forewarned about this operation. This lack of communication meant that we could not always create appropriate care plans for our clients who may be impacted, either as residents of the encampment, or those living and spending time within sections of the streets that have been closed off. Care has deferred as police attempted to halt outreach services via the barricades, which has impacted our ability to connect with clients. During this time, deferring outreach-based healthcare has meant potential for increased risk of adverse health and psychosocial events (i.e., onset of sepsis and the worsening of a mental health crisis) for populations who are already marginalized.” - Letter from 116 Vancouver Coastal Health employees, reacting to decampments in the Downtown Eastside in April 2023
- “Tent cities should not exist because no person should ever be denied stable, dignified, and adequate housing. Tent cities will continue to exist as long as housing is viewed as a commodity to be earned, instead of a basic right for all. In the absence of housing, tent cities are the safest option possible for some, due to the public health and safety concerns of SROs and shelters. For many, tent cities offer safety through accessibility to health care, harm reduction services, community and cultural supports, and proximity to loved ones…. Forcibly displacing people from tent cities — especially with police violence — does not support a safer or healthier city for all.” - Vancouver Aboriginal Health Society, reacting to decampments in the Downtown Eastside in April 2023
- “It might not be the first thing you think of, but decampments have implications for viral hepatitis. They can increase community risk of viral hepatitis transmission or disrupt people who are receiving ongoing hepatitis B treatment or curative hepatitis C treatment. [...] BC Hepatitis Network condemns the recent and ongoing decampments and street sweeps in Vancouver and communities across BC, as they perpetuate harm and discrimination and create vulnerabilities for people living with or at risk of viral hepatitis and other blood-borne infections.” - BC Hepatitis Network, reacting to decampments in the Downtown Eastside in April 2023