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Decision to deny tents to homeless people sparks health concerns

Health effects of cold weather exist even when cold-weather shelters are not open, experts say
Tents line a street in inner Southeast Portland on Feb.14, 2021. | SHUTTERSTOCK
February 23, 2023

This article has been expanded to incorporate additional reporting.

On Feb. 14, Portland City Commissioner Rene Gonzalez ordered Portland Street Response and other public safety services to stop providing tents to people experiencing homelessness, citing the number of tent-related fires in recent months.

In a press release announcing his decision, Gonzalez said people who are cold should seek shelter in public warming centers during cold weather events. 

But his initiative is raising concerns among health professionals. The threshold for opening cold-weather shelters in Multnomah County is a forecast of 25 degrees or less, an inch of overnight snow or below-freezing rain. In other counties, the threshold for opening shelters is higher: 29 degrees or even 32 degrees.

But even temperatures above those levels can lead to cold-weather-induced conditions that require medical care, especially if the people enduring lengthy outdoor exposure have no tents, according to experts, advocates and health agencies. Among the risks seen by emergency department physicians and providers who care for people experiencing homelessness are frostbite and trench foot, or immersion foot syndrome, a condition occurring at temperatures above freezing that can lead to foot decay and infection.

“We see trench foot/immersion foot at all temperatures,” said registered nurse Rachel Richmond, who serves as program manager for the Oregon Health & Science University’s Street Nursing Team. “Preventing hypothermia in the rough sleeping population is currently one of our main objectives, and cutoffs for imminent weather shelters are at very low temperatures.” 

Hypothermia “can occur even at cool temperatures (above 40°F) if a person becomes chilled from rain,” according to the Centers for Disease Control.

“People can still freeze to death,” said Haven Wheelock, a health service program coordinator who works with people experiencing homelessness at the nonprofit Outside In. “Being wet increases your chances of getting boot rot, having your feet destroyed.”

On the campaign trail, Gonzalez said he wanted to “take away” the tents of people experiencing homeless to compel them to enter shelters that don’t allow use of hard drugs, according to the Portland newspaper Street Roots.

But in making his announcement, Gonzalez, who manages the city public safety bureaus, insisted his decision was motivated by concern for people’s safety based on the possibility of fires.

“We issued this temporary moratorium after close consultation with Portland Fire and medical experts, including doctors at the Legacy Oregon Burn Center, who described in detail both the scope of the life-shattering injuries they’ve seen and how they’re at capacity," he said in an emailed statement to The Lund Report. 

Gonazalez said he realizes there are risks even when temperatures are above 25 degrees.

“Hypothermia and cold-related injuries are also a very real concern, which is why my bureaus will continue to distribute sleeping bags, blankets and other insulated warming supplies to support the move to sanctioned campsites with designated safe heating sources,” he said.

Gonzalez made his decision the day before Multnomah County health officials released “Domicile Unknown,” their analysis of deaths among people experiencing homelessness. The latest-available numbers report on deaths during 2021.

According to the report, hypothermia killed eight people during the winter of 2021 (up from three in 2020). 

“We see emergency department and urgent care visits for cold-related symptoms all winter long, including at temperatures well above freezing,” according to a statement released by the Multnomah County Department of Health. “When temperatures drop to the upper 40s, visits for hypothermia begin to increase, and they increase more when temperatures reach the low 30s. It is common to see references to wet clothes or sleeping on the ground in those visit records, but we do not track that specifically.

“Hypothermia can occur in a range of conditions, even in relatively high temperatures if there is rain and wind. That is why, in addition to shelter, appropriate clothing, gear and heating sources are also tools that help reduce risk to people exposed to the elements wind, water, and temperature.”

Critics say health effects of cold outweigh fire risk

“Of course, there are too many fires,” Wheelock said. “Denying people shelter is going to lead to more fires. People are lighting fires because they’re cold. Taking away their only sources of warmth and comfort is not going to make them not cold. I can’t see any way that this is going to reduce the number of fires.”

Wheelock was echoed by Jimmy Jones, the director of the Mid-Willamette Valley Community Action Agency in Salem.

“Fire safety is a very serious concern, but this is a justification to cover a bad policy. ... There are 10,000 car crashes a year in Portland. No one is trying to shut down Interstate 5 over it.”

“Fire safety is a very serious concern, but this is a justification to cover a bad policy,” he said. 

“When people are hungry or cold outside, they cook food or build fires to stay warm … They do that at 25 degrees, 35 degrees or 45 degrees. There are 10,000 car crashes a year in Portland. No one is trying to shut down Interstate 5 over it”

Portland Fire Marshal Kari Schimel supports Gonazalez' decision.

“Portland Fire has been called upon 1,015 times to respond to tent and tarp-related fires over the last two years,” Schimel said in last week’s press release.

“On each of these calls our first responders put their lives at risk,” she said. “Given the heat sources generating these fires and the flammable nature of the materials in question, I have unequivocally advised Commissioner Gonzalez that there is no such thing as a safe unsanctioned fire in a tent.”

Multnomah County Chair Jessica Vega Pederson didn’t address Gonzalez’s decision directly, but said a statement issued Feb. 16 that the county remains focused on creating stable housing.

“There are no plans for Multnomah County to change our policy, especially coming out of our third severe weather activation of the winter season,” said Vega Pederson in her statement. “My focus is in getting people out of tents and tarps and into brick-and-mortar housing, which is why we are moving forward with Housing Multnomah Now.”

That’s great, said Jones — for the long term. Meanwhile, it’s winter in Oregon. It’s rainy and wet. People are sleeping outside with no shelter from the elements. Warming shelters at 25 degrees are not a realistic alternative for many people, he said.

“The homeless are not cattle to be driven into a shelter by placing their lives in danger, should they choose to stay outside,” he said. “Many of the homeless are disabled, cognitively impaired or often struggle with significant mobility limitations… They often cannot get to the warming centers. Many more suffer from traumas that make forced residency in large congregate facilities simply unbearable.”

Rory Love knows the suffering personally. The 17-year-old has been homeless most of the past two years. She said depriving people of tents puts people’s health at risk.

“It gets really scary,” Love told The Lund Report. “It's 10-times scarier for a homeless person to get sick because it could last longer or it could lead to something else. You’re just overall going to feel like hell because you have no place to live and most of the time you’re hauling all of your stuff around, especially if you’re in camps.”


Tom Henderson can be reached at [email protected].