Winter taking heavy toll on people who are homeless, from amputations to freezing to death

Thesmellofrotting flesh fillstheToronto shelter room where Pat Gallagher lives inthecity's north end.

He unwraps bandages that cover his left foot. His toes look like lumpsofblack coal.Thediagnosis: severe frostbite.

"I pretend that it doesn't bother me, but when you look at your foot and you realize: 'I've seen that attheRoyal Ontario Museum, that was on a dead mummy,'" he says.

"It starts to crawl up into your stomach and you get a little panic in and you feel a little sick."

Gallagher was set to have his toes and partofhis foot amputated this week.Thesurgery was to be preceded by consultations with nurses, doctors and psychologists, followed by a lengthy rehabilitation to learn to walk again.

Health-care practitioners say this isthesecond difficultwinterin a row for those who live outside. Pandemic pressures on an already-stretched shelter system as well as restrictions prohibiting eating and getting warm in fast-food restaurants have left many with nowhere to go on cold nights.

Gallagher's case is not unique, says Elizabeth Harrison, a nurse with Inner City Health Associates who treatsthehomeless.

She's seen a handfulofcasesofsevere frostbite this year and last. Many have lost fingers and toes.

"These injuries are life changing," she says.

Warmth is oneofthetreatments.

"Themost important thing for frostbite is to not get frostbite on it again," she says. "It's incrediblethedifference it makes if someone is able to get into oneofthese shelter hotels, or anywhere warm, compared to going back out on streets after getting frostbite."

No shelter beds available

Toronto's shelter system has been full or near capacity for years. Thiswinter, Harrison and others say they have often calledthecity's central intake office only to be told no beds are available.

Emergency departments have become ad hoc warming centres, says Dr. Stephen Hwang, a physician and researcher attheMAP Centre for Urban Health Solutions attheUnity Health Toronto hospital network.

He saysthenetwork has an outreach worker who calls intake on cold nights in an effort to find spots inside shelters.

"There's just been not enough space for people," he says.

Thecity says it has added 400 new shelter spaces and 165 spots in warming centres thiswinter. It has also kept warming centres open since Jan. 7, insteadofonly during extreme cold weather alerts.

Advocates say that's not enough.

At least two homeless people have died as a direct resultofthecold, although data onthesubject is hard to come by.

Hwang says Bernard Kelly, a 74-year-old man with impaired cognition and multiple physical health problems, froze to death at a bus shelter in late January.

"I knew him, he was a good man, but he was very vulnerable and it's just tragic to see people like that freezing to death," Hwang says.

Risk persists on moderately cold nights too

There were fewer than five homeless deaths at St. Michael's Hospital due to hypothermia between Nov. 1 and Jan. 31, a spokeswoman said, citing patient privacy asthereason an exact figure couldn't be given.

Toronto Public Health says three people who were homeless died from hypothermia between 2017 andthefirst halfof2021, although it notes there is no systematic data collection from police, hospitals or paramedics.

Hwang's research published in 2019 intheInternational JournalofEnvironmental Research and Public Health indicates that while frostbite and hypothermia are highest on extremely cold nights, dangers also exist on moderately cold nights.

His team found that 72 per centofcasesofhypothermia death or injury occurred whentheminimum daily temperatures were warmer than -15 C.

"People may not realize that there's still a riskofdying or injury on those nights," he says.

'I started to realize I'm in serious trouble'

It wasn't that coldthenight Gallagher's feet froze.

Snow fell quickly on Jan. 17 when a blizzard hit southern Ontario, butthetemperature hovered between 2 C and 3 C. Winds gusted upwardsof60 km/h.

He was out shovelling at a local grocer that pays him in food cards. He says he was warm and bundled properly. But he was sweating.

"I should have known better," he says.

Gallagher has spentthepast 20 years on and offthestreets. A bad car crash and a fall off a roof he was a roofer started him on opioids, which quickly became an addiction, he says.

He's become adept at staying warm and dry. He carries loadsofdry socks and extra gloves. He layers up under snow pants and aheavycoat.

"But with COVID, everything was shut down and I couldn't actually go into a Tim Hortons or another place to usethewashroom," Gallagher says.

"That stops any chanceofchanging socks, changing boots and drying stuff withthehand dryer."

That night he didn't want to return to his home a box inthewoods inthecity's west end. It would be too cold.

So he went to an all-night laundromat to warm up.

"When I took my boots off, I found what looked like my feet, except there was this glass surface on it," he says. "And it was like looking at a foggy glass tube. It was bizarre. And I started to realize I'm in serious trouble here."

He called 911 and waited fortheambulance.

Weeks later, while awaiting surgery on his left foot, he hoped his right foot still swollen, but a healthy pink heals.

"It may seem like nothing to lose toes," he says, "but it's harder to walk on just a little stump."