A drug user makes his way into the night after receiving food and medical attention from Iniciativa Comunitaria volunteers. Christopher Gregory for Al Jazeera America

SAN JUAN, Puerto Rico — Rafael, 36, tried to run when he saw the van carrying coolers of chicken soup, orange drink and sweetened hot coffee park at one of the final stops of its Friday night rounds. The sun had just come up, a soft morning light revealing the disheveled figure who limped speedily toward the volunteers. Kamille Camacho Monclova, 23, a public health student whose easy rapport with the city’s homeless and drug addicted has been developed over several years of doing these overnight rounds, yelled out for him to hurry. “I can’t run with two ulcers,” the man called back. When he finally reached the van, Rafael — who, like other street people in this story, Al Jazeera America is identifying only by first name — collapsed onto nearby steps and rolled up the left leg of his soiled black pants to reveal an ulcer that extended from his knee to ankle, the raw flesh eroded deep into the tissue and muscle but not yet to the bone. The odor from the wound was as unrelenting as the swarm of flies around it, which Rafael shooed away, to little effect. He pulled up the right leg of his pants to reveal a similar gaping lesion. He tried going to the municipal hospital, he explained, but there he was told the doctors don’t clean wounds for tecatos, a derogatory term for drug addicts. “If they are complaining, it’s because it does happen,” Camacho said of people being refused treatment at hospitals. “They are not going to complain for nothing. They’re people used to handling a lot of bad situations and pain.” Puerto Rico’s middle class is bearing the brunt of the island’s $73 billion public debt and attending economic crises, which have led to sales and property tax hikes, fueled already high crime rates and sparked large-scale migration to the U.S. mainland. Although 45 percent of the population lives below the poverty line, according to American Community Survey estimates, lower socioeconomic classes have so far been buffered from the effects of the current crisis by the island’s high rates of public assistance, in the form of food stamps and subsidized rent, electricity and water. But repercussions from the economic crisis will now undoubtedly affect the most marginalized members of Puerto Rican society too, leaving homeless, mentally ill and drug-addicted residents even more vulnerable than they already are. Camacho said, “If people right now have problems because of lack of service, I don’t want to imagine.”

Dr. Jose “Chaco” Vargas Vidot, center, speaks to volunteers before they head out on their Friday night rounds. Christopher Gregory for Al Jazeera America Iniciativa Comunitaria was founded in 1992 by José “Chaco” Vargas Vidot, a doctor, university professor and longtime public health professional and humanitarian aid leader. The nonprofit provides health, education and harm-reduction services to people marginalized by traditional health systems, particularly the homeless, drug addicts, sex workers and people with HIV. The group has seen a 20 percent reduction in federal funding since last year. “They cut first 20 percent on prevention and then another 20 percent on direct services” such as detox, drug treatment, said Vargas. “Usually we provide services in terms of demand of services,” he continued. “Now we put a cap. We don’t serve everybody, because we don’t have sufficient personnel and hours of intervention that could facilitate a very efficient intervention.” In response, the organization has eliminated positions, consolidated workspaces and increased the number of volunteers as well as fundraising efforts. “The physical and mental deterioration of people is a result of poor access to services,” Vargas said. As that access is further strained by budget cuts, he fears societal phenomena such as outmigration, mental illness, domestic violence and crime will intensify.

‘It’s a lot more difficult now for them to cover their basic needs, whether it’s drugs or food or clothing.’ Diana Aponte volunteer, Iniciativa Comunitaria

Six to 10 drug users live under an overpass in Carolina, a frequent stop for Iniciativa Comunitaria volunteers. Christopher Gregory for Al Jazeera America

Participants who made their way to the Iniciativa Comunitaria van on a recent Friday night for food, condoms, medical attention or just some casual conversation along with a handshake or hug said they are feeling the squeeze of a collapsing economy. “Everything is going downhill,” said Beatriz, 43, who makes money “running errands” (fetching drugs for customers who are too afraid to enter the punto, or drug spot, a volunteer explained), selling loose cigarettes and cleaning yards and houses — all informal economy gigs. “Before, it used to be a lot easier to make money,” Beatriz said, adding that she expects it will only get harder. “I live alone, and I don’t have anyone to help me.” “It’s been bad, and it’s going to get worse,” said Juan, 37, sitting up in his bed made of cardboard to light a stubbed-out cigarette butt. “It’s been harder finding stuff that we usually need.” For Alana and Burba, who sat outside a gas station on a desolate strip known for cross-dressing prostitutes, business has slowed considerably over the past two years. “You don’t make the cash like before,” said Alana, who lives in the borough of Queens in New York City but travels to Puerto Rico regularly. “Before, we used to have a lot of clients. Now there are few. Maybe one car passes by, then another. Sometimes you stand on the corner for hours — dead hours.” On a good night, Alana said, she can earn over $200. “If it’s a bad night, $20, $60 or nothing — you go home with zero.” “Most of the girls have left already to the States,” she said, adding that the 10 or so women that worked this strip two years ago have been whittled down to five. But as for that night, “so far so good,” she said. As she stood up, a thin wad of folded cash fell out of her leopard-print capri pants. Diana Aponte is one of the regular volunteers on the overnight rounds. It was only a year ago that she was on the other side, receiving rather than offering food, condoms, hygienic supplies and other services. “I was a crack addict 24/7,” she said of her days on the streets, where she’s still known as Candy. “Right now, I cannot tell you how deep the impact is on homeless people, because I’ve been out of that system since October,” said Aponte, who has moved into a shelter. “But what I hear, if it was difficult before [to get money], it’s a lot harder now. Now if they beg for money in a lot or in front of a store, the first thing people say is, ‘I can’t because they raised the taxes’ or ‘Oh, I’m sorry. I have no money.’” “It’s a lot more difficult now for them to cover their basic needs, whether it’s drugs or food or clothing,” she added.

Photos: A night out with Iniciativa Comunitaria volunteers