The conditions are often cramped and chaotic. People stretch out across mats, in chairs or on cots. Many have difficulty sleeping and report fears of violence or theft.

There is limited access to bathrooms and showers, few spaces to safely store belongings and there’s an increased chance of becoming seriously ill.

“There is a much higher likelihood of simple coughs and colds, but also in this season of severe influenza, outbreaks are more likely. Then there is lice, scabies, bedbugs, which can all be a result of overcrowding,” said Dr. Samantha Green, one of the authors of a new report on city drop-ins and winter respite centres.

“It is unacceptable for people to be sleeping side-by-side-by-side without access to a shower or enough toilets.”

Green is a family physician and was part of Health Providers Against Poverty, a group of doctors, nurses, social workers and psychiatrists who visited eight of the city’s winter drop-ins or respite centres, as well as two year-round, 24/7 drop-ins for women, and spoke with dozens of clients and staff members in late December and early January.

With the city’s emergency system at its limit, the drop-ins are becoming makeshift shelter for hundreds of people. Over Monday, 870 people went into the 24/7 drop-ins, warming centres and the Out of the Cold program at five faith-based locations across the city.

What HPAP observed was people sleeping just feet away from each other on mats, without proper blankets or pillows, or adequate access to toilets and showers, in some cases no showers at all. People who end up on mats or cots, or chairs, or on the floor, include seniors, pregnant women and people with chronic health conditions, the authors reported.

About 40 per cent reported getting less than three hours of sleep, almost 70 per cent reported seeing some kind of physical, verbal or sexual violence, and more than 80 per cent said they had been turned away at least once from a shelter in the past year.

The conditions, the group said, can worsen people’s physical and mental health and in some cases prompted people to choose to stay on the street.

The findings of the group are outlined in An Evaluation of Toronto’s Warming Centres and Winter Response to Homelessness.

Members of the team are planning a news conference at city hall on Wednesday, in the lead up to a council vote that is expected to result in a sweeping review of the city’s emergency response to homelessness.

The motion has the support of Mayor John Tory. If passed, council will direct city staff to provide a detailed breakdown on need and how services are funded from all levels of government. Staff will also be asked to examine the potential creation of 1,000 new shelter beds. Last week, the city’s budget committee committed to creating 1,000 over three years, far short of what advocates say is needed.

The budget for the city’s shelter support and housing administration division has stayed the same and actually gone down over the past 10 years, once adjusted for inflation. Staffing levels have also stalled.

At least 94 people died from issues tied to homelessness last year, Toronto Public Health reported last week.

Toronto’s emergency shelter system has strict guidelines about space and people must be provided with a bed, but drop-ins are not required to meet those standards.

Tory has said he was “not satisfied” with the conditions in winter respite centres, but the goal was that nobody be left out in the cold, while work continues on expanding the shelter system and the creation of more long-term housing with wraparound supports.

Councillor Kristyn Wong-Tam wants medical and mental health services at all drop-ins and warming centres. While people are in the city’s care, even for a short time, they should have access to whatever is needed to help them stabilize, she said.

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HPAP members did not identify the sites by name. The first seven, including five winter drop-ins and two 24/7 drop-ins for women, were visited prior to or during a record-breaking cold snap in early January. Conditions at the newer Better Living Centre, the Regent Park Community Centre and the Moss Park Armoury were summed up in a different part of the report.

The authors stressed that city staff and drop-in volunteers and service providers do the best they can with available resources, but stronger and clearer standards would benefit all involved.

“There are a lot of really vulnerable and sick people who have nowhere to go and are utilizing these spaces,” said HPAP member and psychiatrist Michaela Beder. “I think we were frankly really alarmed by some of the things we saw.”

Just two sites met Toronto Shelter Standards rules of 3.5 square metres per person in sleeping areas to “decrease the transmission of communicable diseases and conflicts between clients.”

That is the same standard set out in the emergency response handbook by the United Nations High Commissioner for Refugees, the authors note.

City standards require one toilet for every 15 people and one shower for every 20, up to 100 people. The bulk of the seven sites met toilet requirements. Four had no showers, the authors reported.

HPAP is calling for 1,000 interim cots or beds and 1,500 permanent beds and for the city to boost property taxes to help pay for these and other demands.

The province needs to increase social assistance rates, and the federal government should commit to spending the $11.2 billion set aside for the National Housing Strategy over two years, rather than 11, the authors wrote.

Sonia Zyvatkauskas, policy development officer with the city’s shelter division, said any proposed drop-in sites are first visited by city staff and Toronto Fire.

“For winter respite programs, which are low-barrier services featuring as few rules as possible in order to appeal to those who do not regularly access the shelter system, the overarching expectation is that operators will deliver services 24/7 in a safe and welcoming environment for all clients,” said Zyvatkauskas, in an email.

HPAP members also visited the newer Better Living Centre, the Regent Park Community Centre and Moss Park Armoury, now closed. Those sites were opened this winter and had better spacing and cots, but still fall short of what should be provided, they said.

Two new winter drop-ins on Davenport Rd. and a former youth detention centre on George St. were opened last weekend. George St. has space for 100 people and 11 toilets and four showers.

The Davenport site can hold up to 100 people and has six toilets and one shower, but city staff said they are looking into whether adding more is possible. In April, that site will be renovated and become a permanent shelter with space for 90 people.