toronto's homeless need full-time warming centres, advocates say

warming centres are only open in extreme cold. but many cold weather-related injuries happen in mild weather.

by maija kappler

published jan 25, 2023

4 minute read

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4 minute read

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toronto health providers urge city to expand warming centre hours. getty

the greater toronto area has three warming centres: one downtown, one in north york, and one in the eastern borough of scarborough. warming centres are different from homeless shelters in that they’re only open temporarily — they’re places for people to sleep when it’s minus 15 degrees or colder, or a windchill of minus 20, and they have no other option. warming centres usually have a capacity of about 45, and they’re generally open from about 7 p.m. until noon, or whenever a cold weather warning is terminated. but a group of healthcare providers say that’s not good enough, because preventable injuries from cold weather exposure don’t just happen in extreme weather. in fact, data from toronto’s map centre for urban health solutions demonstrates that most cold-weather injuries don’t happen when it’s very cold: 72 per cent of cases of hypothermia, for instance, happen when daily temperatures are above minus 15.

“opening the warming centres at a threshold of negative 20 does not necessarily mean negating the hypothermia that we’re seeing in emerg[ency rooms] — frostbite injuries, infections and deaths from the cold weather,” says dr. adriana di stefano.

di stefano is a locum doctor in downtown toronto, meaning she moves between several medical clinics as needed. she’s also a member of health providers against poverty (hpap), a group of doctors, nurses, psychologists, therapists, social workers, medical researchers and other healthcare professionals who aim to eliminate the poverty-related barriers to health. the group’s newest initiative: lobbying the city to keep warming centres open consistently.

‘being homeless is a risk factor’

“being homeless is is a risk factor — anytime you get any kind of illness or cold-related injury, infections can happen with any wounds that are exposed to cold or being outside or unhygenic conditions,” di stefano explains. “if you have bad infections that aren’t cared for in a timely manner, you can develop sepsis, which is a widespread body infection that becomes very dangerous, and people can die. and we’ve already had someone die from cold exposure this year in toronto.”

in 2021, 221 people died while homeless, according to the city. that number is steadily climbing from 2020, when 144 people died, and 2019, when 128 did. (the most recent data is from mid-2022 — by late june, there were 22 deaths among homeless people.)

these numbers can be hard to track: in b.c., deaths are only counted when the deceased isn’t under a doctor’s care. so if an unhoused person dies in a b.c. hospital, their death isn’t included in the official count.

and toronto, as a city, and the province of b.c. are among the very few canadian regions that make this data publicly available, and the tracking is fairly recent. a similar grassroots project has popped up in hamilton, after dr. inna berditchevskaia — who had attended medical school in toronto — was shocked to discover it didn’t already exist. there are some tracking efforts in b.c., but very few elsewhere in the country. there are no national statistics.

“this is a population that there are a lot of services directed toward,” berditchevskaia told the globe and mail in november. “if we don’t have data, how do we know where to direct the services to prevent morbidity and mortality?”

that lack of data also means it’s difficult to push the government for change, tim richter, executive director of the canadian alliance to end homelessness, also told the globe.

“these people are living invisibly and dying invisibly,” he said. “we can’t solve a problem we can’t see.”

homeless deaths are on the rise

what’s most frustrating to hpap, di stefano says, is that so many of these deaths are preventable. “they can be prevented by having spaces for people inside,” she says. a common refrain is that warming centres aren’t necessary given the existence of shelters. but shelters are at capacity: the number of people turned away from homeless shelters in toronto because they were full was about ten times as high in june 2022 as the previous june, the star reported.

without opening warming centres, hpap says, people without homes will continue to die or suffer preventable diseases. and while homelessness makes these injuries more likely, it also makes them harder to recover from.

di stefano paraphrases a friend of hers, who recently found housing but was unhoused for a long period of time.

“he actually phrased it this way: homelessness becomes a mass disabling event. you have people who are losing limbs, losing toes from frostbite, and it becomes difficult to recover from when you’re homeless and don’t have access to support — access to housing, or access to food or care. if people don’t have a phone to get updates on appointments for their wound care, it really becomes a mass disabling event.”

hpap maintains that permanent housing for people is the ultimate goal. housing-first strategies, where previously homeless people are given the stability of a permanent address, have worked in cities including houston and helsinki, finland. a small trial in five canadian cities — vancouver, winnipeg, toronto, montreal and moncton — was successful between 2008 and 2014. but the policy hasn’t been widely adopted.

“long-term housing options are really the solution to provide keep not only keep people warm, but allow them to build their life and form meaningful connections and really thrive in the community,” di stefano says. but in the mean time, she says, warming centres are crucial.