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SANTA CRUZ — The 31-year-old woman who died Monday at the homeless camp near Gateway Plaza Shopping Center marked the camp’s fourth fatality since Nov. 1, authorities confirmed.

Elizabeth Fowler’s cause and manner of death are under investigation, said Sgt. Dee Baldwin, spokesman for Santa Cruz County coroner.

Santa Cruz Fire Chief Jason Hajduk, whose agency often is the first to respond to emergencies at the camp of more than 150 people, declined to speak about the specifics of any single fatality at the enclave. But he said drugs and paraphernalia have been observed when medics have addressed some of the five deaths at or near the camp.

There have been 76 calls for service to the crowded swath at Highway 1 and River Street since Nov. 1 — when the camp emerged after the city-operated, 50-space camp at 1220 River St. shut down. The River Street camp opened in March 2018. The 911 reports reflect a small percentage of the department’s 9,000 calls for service last year.

“In other cases, people have had significant health status that was pretty challenged,” Hajduk said. He said there are concerns about how densely packed the camp has become.

“There’s no separation between them,” Hajduk said. “This is a really complex problem. There are no easy solutions. At the end of the day, we are dealing with human beings.”

Those human beings include four others who died near or in the camp: a sprawl of junk, tents and permanent plastic structures linked by a web of tarps. A punching bag is also dangling from a tree near the riverfront property. The skeletons of bicycles lay against some of the temporary homes that have been the building subject of Santa Cruz dialogue in recent months.

Shortly after 3 p.m. Nov. 18, police and paramedics found Ernest Nash, 73, of no known address unconscious in his vehicle at the Gateway Plaza parking lot — not far from the camp, police spokeswoman Joyce Blaschke has said. A relative had found him unresponsive in the vehicle and believed drugs may have been factors, police said.

The next fatality happened Jan. 22. Raymond Rodriguez died of natural causes “with an underlying cause of drug use,” Baldwin said.

Connie Loraine Cantrall Cunningham, 57, died at the camp March 4.

Asa Mosley, 50, died the next day.

The toxicology results are pending in those cases.

Hajduk said the campers are an at-risk population in terms of public safety and public health.

“There’s a lot of people there,” Hajduk said. “Five fatalities and three fires at one address; percentage-wise, that’s a lot.”