Special report: Death and despair on Ireland's streets

It's been just over a year since a general election that was run on the twin issues of housing and homelessness. In that year, an unprecedented global pandemic has utterly changed Irish life. With people confined to their houses, those without homes are dying in unprecedented numbers. More people known to homeless services are dying — and everyone wants to know why, and how to stop it, writes Noel Baker
Special report: Death and despair on Ireland's streets

Volunteer Ryan sorting the food at Penny Dinners on Little Hanover Street, Cork. Picture: Dan Linehan

It's been just over a year since a general election that was run on the twin issues of housing and homelessness. In that year, an unprecedented global pandemic has utterly changed Irish life. With people confined to their houses, those without homes are dying in unprecedented numbers. More people known to homeless services are dying — and everyone wants to know why, and how to stop it, writes Noel Baker.

"It's growing, growing all the time," Caitriona Twomey says of the deaths of people known to homeless services.

Given her work with Cork Penny Dinners, she is in the know. She refers to a woman who passed away not that long ago, whom she believes was only in her 30s. 

She speaks of people who were found collapsed in the street, people who died in B&Bs and later turned out to have been moving between different types of emergency accommodation. She thinks more than 10 people died in these circumstances in Cork last year.

"If you put it all together the number would probably be way more than that," she says.

Also in today's special feature:

  • Reaching out on Limerick’s streets by Ryan O’Rourke

Coming up in part two of our special feature tomorrow:

  • Profile: Gary Dineen, lost in music, by Noel Baker 
  • Profile: Michail Moisejenkov, a proud dad, by Aoife Moore 
  • Profile: Iggy Rybka, shy and polite, by Ryan O’Rourke 
  • Interview with Housing Minister Darragh O’Brien by Aoife Moore

Dr Dermot Kavanagh, director of Cork Simon Community, also believes the number of deaths has risen in the past year. Asked for figures by the Irish Examiner, Cork City Council did not provide data but said "any death is a source of upset and concern to the staff working with the homeless services".

Limerick Council confirmed that it had engaged with nine rough sleepers in the course of the year, with one, a Polish man aged 69 known to locals as ‘Iggy’, found dead in the city centre in January. 

One person availing of emergency accommodation is known to have died in Galway during 2020.

In Dublin, we know the number of deaths has increased. Figures provided to Dublin City Council by the Dublin Region Homeless Executive (DRHE) ahead of last week's local authority meeting showed 79 deaths in the capital last year. 

Of those, eight people died while rough sleeping, 44 people died in emergency homeless accommodation — supported temporary accommodation and private emergency accommodation — and 27 people died in long-term supported tenancies where there are on-site medical services, including three from Covid-19. 

DRHE said further five deaths involving rough sleeping involved people who had not been connected into homeless services in Dublin. The total of 79 was 30 higher than the figure for 2019.

And yet even with these numbers, there is uncertainty. 

The Mendicity Institution, based in Dublin, has been operating for more than two centuries. Its CEO, Louisa Santoro, believes the figure of 79 is an underestimate. 

First, the five deaths not known to homeless services: "I would just say that nobody ever asked us, so we can't say that.

"What measure of checks and balances did you use to determine they were not known to some services? They may not have been known to Dublin Simon Outreach, who do amazing work, but they can't be everywhere."

She says the description of people not known to services is troubling:

It implies blame, that they were outside and unwilling to engage. 

"I would be keen to dispel this idea that homeless people are a bunch who don't want to talk to you."

As for the figure of 44 people who died in emergency accommodation, Louisa says more details are required, including average age and crucially, whether they were in accommodation that was supported, or not. 

She makes the distinction between supported services, such as those run by Focus Ireland, the Peter McVerry Trust and others, and the "more than half" provided by "for profit providers with no support on-site".

"It's not about throwing rocks," she continues, but it seems the answers provided about deaths among those without a home just raise more questions.

Pandemic response 

The DRHE told Dublin City councillors that it "is concerned at the significant increase of deaths in the latter months of 2020 (from July) and a comprehensive review of such deaths for the full year is under way in conjunction with the HSE". 

That review, due in the coming weeks, is being carried out by Dr Austin O'Carroll, a founder of Safetynet Primary Care and currently the clinical lead for Covid-19 and homelessness in Dublin.

The management of the pandemic among people who are homeless has been a success, at least in terms of its primary aim. 

At the end of December, there were just 88 confirmed cases in homeless services, although this number has since increased significantly.

In the context of more than 10,000 people being homeless at the start of 2020, the spread of infection was limited, and other measures to mitigate against Covid has meant an increase in bed capacity, certainly in Dublin, even as the total number of people who are homeless dropped to 8,200 last December. 

Caitriona Twomey of Cork Penny Dinners.
Caitriona Twomey of Cork Penny Dinners.

DRHE said it anticipates that the additional beds which it sourced in response to Covid-19 will be retained for at least a further six months. 

Yet while family homelessness has thankfully decreased, the number of single homeless in the Dublin region rose from 2,865 in January 2020 to 3,027 by last December.

Dr Dermot Kavanagh believes while the effort to limit the impact of Covid-19 on those in emergency accommodation has been successful, it has come at a cost, primarily a lack of social and one-to-one contact, especially through day services which have been curtailed or suspended by different providers around the country on public health grounds.

"I do think the response from [Cork] City Council when Covid arose was very, very swift and extremely helpful," he says. 

"It's difficult because it involved reducing capacity in the shelter and they did that in other places as well, but the city council did come up with alternatives for people."

Cork did not have the same scale as Dublin in terms of numbers or in terms of response, so people had to be moved around. 

According to Cork City Council: "The accommodation placement service provided by the council has remained opened to the public throughout the restrictions and continues to provide emergency accommodation and advice to anyone facing homelessness.

"The service providers have had to adjust their services to allow for social distancing requirements and this has had an impact on bed capacity, but alternative emergency accommodation has been provided through the accommodation placement service, so there clearly is accommodation available to anyone who needs it."

Limerick Council put into place 10 extra beds for rough sleepers, while Galway City Council established 13 new rough sleeper beds in 2020.

Ultimately, however, the low level of deaths of homeless people from Covid nationally has not meant a fall in overall deaths.

"It was 79 people in Dublin and no doubt many more right across the country besides the very, very low number who passed away from Covid," he says. 

It shows homelessness was and is a huge crisis for people.

"The frustrating thing is we know what works, anecdotally, but I can tell you the people who have passed away in Cork in homelessness are by and large on the streets or in emergency accommodation.

"The people who have been housed, those people are having far, far better outcomes, even though they themselves were homeless long-term with all the challenges that come with that."

What works, he says, is minimising the time spent by people in homelessness and reducing harm. 

Cork Simon has housed 156 people over the past seven years, many of whom were at some stage long-term homeless. Just 5% of them are homeless again now and more than 80% never re-entered the system.

"One of the factors very strongly at play here is we don't have anything like enough one-bed units, small units in the city or probably in most parts of the country and that is one of the huge challenges," Dermot says.

He said Cork Simon will have another eight units coming on stream later this year. 

"If you are single and can't find an affordable place to live and you get stuck there [in homelessness], that leads to all kinds of bad outcomes over time.

"The big challenge for us and everyone else is to ensure more housing and the right kind of housing."

Duration of the crisis 

There is something else to be considered: the sheer duration of the homelessness crisis. 

While many people have entered homelessness over the past seven years and then subsequently exited it, it was by no means a quick process. Even the most recent quarterly report issued by the department showed that 25% of families had been in emergency accommodation for more than two years. 

The proportion for single people is considerable, and within that group there is the long-term homeless. 

The deleterious impact of living without stable housing for a long period can't be overstated.

Last year Merchants Quay Ireland (MQI) published a study called Old Before Their Time, based around research by Dr Clíona Ní Cheallaigh, profiling the health of homeless people in the 45-50 age bracket. 

The findings were stark: on average, the grip strength was equivalent to that of a 65-year-old. They had only half the functional mobility of someone 65 and older. 

Nearly one-in-three were described as frail. More than a third reported falling in the previous six months and there were high rates of diabetes, depression, hypertension, stroke, and seizures.

"Worldwide, study after study shows people who are homeless have higher rates of mortality, disease, and hospitalisation.

"Sometimes — but not always — compounded by addiction to drugs or alcohol, the struggle for survival is fertile ground for the speeded-up ageing process called ‘weathering'," the report found.

Some of the most vulnerable people on Ireland's streets in the country's hostels and B&Bs have been assailed by multiple 'weather' fronts. 

MQI chief executive Paula Byrne believes it may be having an impact regarding fatalities: "The average age of death for homeless women is 38, for men, it's 44.

"Now that's staggering, when you think about it. It's very young, put it that way. It's the impact."

You see homeless people and think they must be in their 50s and 60s and they're only in their 30s. It's only a half-life.

The DRHE said that it was making increased efforts to limit the risk of death for those rough sleeping and in emergency accommodation. 

"In collaboration with the HSE, the DRHE has strengthened supports being provided to homeless households in emergency accommodation," it said. 

"For single households, living in NGO facilities, social and housing supports are provided on-site by the operators. For single households, living in private emergency accommodation, supports are provided by a number of services providers.

"This team covers all of the private emergency accommodation sites in Dublin City by providing a clinic onsite once weekly.

"The team is led and managed by HSE Homeless Clinical Lead, Dr O'Carroll, and managed by nurses and MHSC staff. This work in PEAs is supported by 14 staff from Ana Liffey Drug Project who provide supports in relation to addiction and harm reduction. 

"Intensive housing supports to singles are also provided by the DRHE Housing Support Workers and, up to the end of December 2020, 777 single people had been assessed for housing and given advice/assistance regarding a move to more permanent social housing supports."

 Caitriona Twomey and chef Philippe in the Kitchen at Penny Dinners on Little Hanover Street, Cork. Picture: Dan Linehan
Caitriona Twomey and chef Philippe in the Kitchen at Penny Dinners on Little Hanover Street, Cork. Picture: Dan Linehan

In Cork, the city council said there had been "significant progress made in 2020 in reducing the numbers of families and individuals in emergency accommodation", stressing the importance of Housing First and wraparound services in assisting those who need help, and acknowledging "the lack of suitable, affordable private rented accommodation for single people" in Cork and elsewhere.

In Limerick, Limerick Council says that between 1 January and the end of November 2020, 98 individuals and 96 families moved on from homeless services. 

Galway City Council’s homeless services unit dealt with an average of 217 people each month during 2020. Figures for how many people exited homelessness in Galway during 2020 were not available.

For its part, the Department of Housing said it takes the deaths of people known to homeless services "very seriously".

The Department of Health has recently requested the Health Research Board (HRB) undertake a study to collect data on deaths among people who were homeless at time of death, to be completed by the end of 2021. 

The HRB is undertaking a one-year feasibility study to collect relevant data from coroners’ records and the report will build on a previous study published in 2019 in the British Medical Journal.

A departmental spokesperson also referred to additional funding of €11m under Covid-19 specific initiatives that would assist people who are homeless. 

Last year's exchequer funding allocated to housing authorities was €271m, up €36m on the sum for the previous year. The budget allocation for homeless accommodation and related services for 2021 is €218m.

The department also referred to the last rough sleeper count in the capital, which found an average of 40 empty beds throughout the city. 

"There is a bed for everyone," it said. "The challenge is to get people into these beds, and the outreach teams which are funded by Government and the local authorities are on the street doing this."

Complex problems 

The problems that chase after some of those without a home are not new — addiction, mental health, ailing physical health. For migrants, throw in lack of access to social welfare and associated supports. 

Dr Fiona O'Reilly of Safetynet Primary Care speaks of involuntary admissions on mental health grounds at a rate of one a month. 

She says the risk of violence has not really diminished, despite the lack of footfall on the streets. 

In its report to Dublin City Council this month DRHE said that since the outbreak of the pandemic, it moved away from night shelters, and converted all facilities to 24-hour accommodation, with the unintended consequence that migrants or people presenting to Dublin from other counties no longer had a place they could access directly without an assessment of their eligibility, housing need and requirement for emergency accommodation.

This was highlighted in the recent RTÉ programme where the 'local connection' was cited as a reason for some people not getting a bed. 

It's not a situation limited to Dublin, with Dr Dermot Kavanagh saying it is also an issue in Cork. Another problem. 

And then you have Covid — the primal fear, but more likely its role in limiting access to services which, ordinarily, keep people connected, keep them alive.

"Covid is barely in the top 10 things in your mind in terms of someone who is homeless," said Louisa Santoro who thinks the pandemic may have widened the tiers that exist within homelessness.

"We would have rough sleepers occasionally who are [Covid] contacts or suspected Covid, they're plucked from a sleeping bag, taken to a posh hotel, and at the end of their 14 days they're released back onto the footpath.

I have had a few guys saying 'I wish I did have Covid', and when you hear somebody say that, you realise their circumstances are pretty poor.

She believes everyone — including private providers — need to be at the table, to avoid duplication and fragmentation, to provide a guide for people in homelessness, to know where they can eat, shower, charge their phone, access training, find a way out.

In Cork, Caitriona Twomey sums it up: "A lot of people misunderstand what homelessness is and what its causes are. It can be a word for people who are homeless, and obviously it is, but it's more than that. We are all human beings and we are all supposed to be equal."

This year has already seen homeless deaths in Dublin and Limerick. Just a few more times when even the half-life slipped away.

(Additional reporting by Aoife Moore and Ryan O’Rourke)

Reaching out on Limerick's streets

By Ryan O'Rourke

It's nearly 7pm, but the cold, dark, February night, combined with the wind and the rain, makes it feel much later.

People impacted by homelessness, food poverty, or just those who have fallen on hard times come in ones and twos to grab some much-sought food from the Novas outreach van, parked up on Limerick’s Lower Gerald Griffin Street.

The warm aromas of hot meals, soups and sandwiches fill the air. The food gets donated by the Greenhills Hotel and the Hook and Ladder cafe and is distributed by Novas volunteers, whose kind faces are hidden by masks, necessary protection in the current pandemic.

Aisling Kelleher, Novas Limerick. Picture Brendan Gleeson
Aisling Kelleher, Novas Limerick. Picture Brendan Gleeson

Two of these volunteers dish out meals. In the space of an hour, they feed 20 to 30 people. For many, this meal will have to see them through the night, wherever they may find themselves sleeping.

Familiar faces are greeted with unique bits and pieces. A fresh scone to make someone’s day. A chocolate bar for the sweet tooth. Shoes in the right size for the person who has been looking. 

All these little things seem to add to the sense of community which gathers around the Novas van.

A man asks for a hat, unfortunately, they have none to give him. The current restrictions which have seen department stores, such as Pennys, close because of their “non-essential” status means that items such as this need to be ordered in.

Una Burns, head of policy and communications with Novas, explains that if not for the rain, or the pandemic, people would often sit and have their meals together. The communal aspect and the socialising are all part of the service that the van offers.

“The number of people who come out varies from night-to-night. It could be 10 people, it could be 30 or 40. We would have people who are just over 18 years of age, to people who are in their 50s and 60s, so its right across the age range,” Ms Burns explains.

The volunteers would know most people by name. They would know the things they like, maybe it’s a fresh scone or something they are looking for — the volunteers would know.

Ms Burns mentions the death of an elderly homeless man, Ignacy Rybka, and the impact that has left on the community after his passing in January.

She brings attention to the wet weather she stands in and explains the risks that those who will sleep on the streets that night will face.

“It’s horrendous. On a night like tonight, it’s cold, and it’s wet. 

They are exposed to the elements, without cover, without a roof. They are exposed to potential violence.

“In Limerick, we have about 10 people sleeping rough on any given night. But obviously, 10 people is 10 too many.”

Ms Burns explains that although, in large, most people want to access emergency accommodation provided. However, this is not the case for everyone.

“Some times people have significant mental health issues, or addiction issues. They may be nervous, they may never have experienced homelessness before, a hostel might overwhelm them,” she said.

The tents where some homeless people are residing on the Condell Road, Limerick. Picture: Brian Arthur
The tents where some homeless people are residing on the Condell Road, Limerick. Picture: Brian Arthur

The evidence of this comes in the form of a newly established campsite, in a wooded area near the Condell Road, which sits just outside the city centre.

Here a small group of around four individuals affected by homelessness have gathered, pitching tents among the undergrowth and trees.

“This isn’t the first time we have seen those affected by homelessness move out of the city centre like this. It might be, that because they have room to camp up together, they are feeling safer in numbers,” Ms Burns said.

Homelessness: The facts

10: How many homeless people have died in Cork since last February (estimate) 

79: The number of homeless people who died in Dublin last year 

72%: The drop in the number of people using hotels as emergency accommodation in Dublin in 2020 

8,200: The number of individuals in emergency accommodation in Ireland in December 2020 

970: The number of families in emergency accommodation in December 2020 

2,327: The number of children in emergency homeless accommodation with their families in December 2020

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