Annemarie Brown is worried about her health center’s homeless patients.

“The air quality is very poor, and they are people who do not have a lot of mobility,” said Brown, the director of communications at Santa Rosa Community Health Center. “The ability to get to other places to evacuate…those systems are not as accessible to them.”

Brown isn’t just worried about one patient group. Patients with chronic diseases and breathing issues, high-risk pregnancies…they’ll all need care and attention.

But for some people in particular, including many experiencing homelessness, the Kincade Fire has particular resonance.

Many of the health center’s patients weren’t homeless until after the Tubbs Fire, which tore through Santa Rosa in October of 2017, destroying 5% of the city’s housing. After the fire, rents skyrocketed. The number of homeless shot up.

In addition, the blaze was traumatic, directly contributing to post-traumatic stress disorder and other mental health issues in the larger community.

Santa Rosa Community Health even lost one of its locations – newly rebuilt and reopened in August of 2019 – to the Tubbs Fire.

Late last week, the Kincade Fire didn’t seem like an immediate threat to Santa Rosa. Shelters had even been set up within the city. But strong winds and high heat have helped the blaze flourish. Currently, it’s more than 66,000 acres in size, and only about 5% contained.

And as the fire grows nearer, it threatens a community that’s already struggling to recover from last time.

Brown estimated that 80% to 90% of Santa Rosa Health Center’s staff have been evacuated. The center is temporarily closed, although Brown hopes they’ll be able to open one or two sites on Tuesday – along with a much-needed pharmacy – to provide care to walk-ins, people who need vital prescriptions, and patients dealing with asthma, COPD, and other breathing conditions.

At the best of times, wildfires are disastrous to community health. Immediate dangers aside, the poor air quality that can extend for many miles around a fire zone affects everything from asthma to cardiovascular disease.

Patients forced to evacuate without vital medications – like insulin for diabetes – can quickly see a previously well-managed condition flare into an emergent crisis.

And crowded shelters are breeding grounds from everything from viruses – flu season is just beginning – to scabies.

But in the wake of another catastrophe, it’s essential to add mental health to the list of community needs. Post-traumatic stress disorder, anxiety, and depression are all common after natural (and unnatural) disasters.

“It’d be safe to say we’re anticipating seeing more [mental health needs] this week and the following week,” Brown said.

Pedro Toledo is chief administrative officer at Petaluma Health Centers, which is currently providing medical care to all three designated shelters in Petaluma – along with a few informal shelters that have popped up at community organizations.

People at the shelter are mostly focused on the present, he said. Many have been evacuated, then re-evacuated as the Kincade Fire quickly gained strength and size. “Right now, they just don’t have a place to live. They’re just trying to figure out what’s happening now,” he said.

When people at the shelters seek mental health, Toledo explained, they primarily want help coping with the stress and uncertainty of their current situation.

But that will change in the coming days and weeks, he anticipates. “I think it’s just so traumatic to go through this again. It just compounds the trauma of last time,” he said.