When people lose their homes, they can lose their health, too. In medicine, we worry about the impacts of housing instability on our patients. It can cause increased injuries and infections, as well as loss of medications and other resources.

What if your home is a nylon tarp and a sleeping bag?

This is the reality faced by too many residents of our city. It is no longer rare for patients to discharge from the hospital to a tent after facing a grueling medical illness. And unfortunately, these Portland residents face the daily threat of losing their homes to city-directed bulldozers.

We recently visited a local encampment to provide medical care and wound care kits. All resources were appreciated, from cleaning wipes to bottled beverages. Those living in the encampment are doing their best to take care of themselves and their community. Many of them are battling significant medical issues, without even a phone to coordinate check-ups. Residents say that the recent encampment destruction caused them to lose important documents, identification cards and more.

Forcibly relocating resident encampments is often called “sweeping,” as if the city is engaging in lawn cleanup. For those who live in these encampments, these “sweeps” have more in common with riptides during a hurricane, threatening to pull them under the waves. When encampments are destabilized, the impacts on health are devastating. Studies show that residents are often forced into more hazardous and isolated spaces after abatements. A recent analysis from JAMA shows that forcible displacement causes rising infection rates, loss of lifesaving medicines like insulin and disconnection of people from community resources. These impacts directly worsen the health of people experiencing homelessness. Access to life-saving naloxone is limited during forced abatements, isolation increases and overdose deaths skyrocket under these circumstances.

We are witnessing a housing crisis unfold across Portland. Besides a dearth of shelter beds, we also lack permanent housing options that offer access to mental health resources and substance use disorder treatment. Dismantling encampments with forced relocation is not a safe or compassionate strategy for this crisis. It is also not effective. Some research indicates that when undergoing forced relocation, residents are less likely to seek shelter with the city because of eroded trust. Encampment abatements also drive an increase in negative interactions between law enforcement and people experiencing homelessness. Interactions with the criminal legal system often increase trauma and harms instead of enabling meaningful connection with social resources and medical treatment. We cannot arrest our way out of homelessness.

We can instead focus on making encampments safer. In 2020, the Centers for Disease Control and Prevention recommended providing and maintaining portable toilets, handwashing stations and public information at encampment sites to reduce infection risks. In the wake of an uptick in hepatitis A cases as well as with the threat of a looming influenza season and new COVID-19 variants, these recommendations should be applied to our city’s encampments. Additionally, increasing access to harm reduction resources at stable encampments can dramatically reduce overdose deaths. These community programs, such as India Street Harm Reduction Center, Portland Needle Exchange and Church of Safe Injection, help collect syringes, provide wound care, offer vaccinations, prevent overdoses, test for infections and provide care after overdose. They cannot do so if their clients are scattered, scared and inaccessible after forced camp clearances.

Supporting existing community resources and bolstering funding for both public health initiatives and accessible, affordable housing are areas that deserve our attention in this crisis. We agree with Preble Street’s proposal requesting expansion of housing resources and funding more paid outreach workers. Focusing on street outreach not only builds trust but also can save cities millions of dollars. Most importantly, these strategies save lives.

When you are living outside, a tent is a lifeline. We hope the city decides to prioritize public health and reconsiders displacement tactics that destroy these lifelines, in favor of judgment-free and housing-first approaches.

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