As Winter Storm Lorraine moved through the U.S. Northeast this week, snowy, frigid weather caused canceled flights and school closures. While 2024 is expected to be an El Niño winter with warmer than normal temperatures, the coldest days of the year in some places have measured tens of degrees below zero with severe wind chills.

The bitter weather is a nuisance for most but can create dangerous health and living conditions for the nation’s growing, unhoused population. Chicago experienced severe cold weather in mid-January, coupled with a wind chill, or the rate of heat loss from exposed skin, at 40 degrees below zero, according to the National Weather Service. Experts in cold-weather states and working with people who are unhoused are addressing health concerns, but say the number of people with housing needs is growing.  

The frigid temperatures increase the risk of frostbite, and wounds on extremities are more frequent for people sleeping outside and those walking long distances.

“For me, when it snows in the morning, my day is disrupted because I have to drive in the snow and my commute is a little bit longer. But for [people who are unhoused], those challenges are tenfold, sometimes 100-fold, because where they stay is outside,” said Nedda Elewa, President of Street Medicine Detroit. “They stay in the cold, they stay on the streets, even those who are fortunate enough to find themselves in a bed in a shelter, that’s not guaranteed every night.”

Street Medicine Detroit provides quality medical care for Detroit, Michigan’s unhoused population. Elewa, who is also an MD candidate at Wayne State University School of Medicine, said that Street Medicine Detroit provides wound care during the colder months: frostbite, laceration repairs, infection prevention and control, and dressing changes. Elewa says these health conditions are in addition to the many chronic diseases they try to provide care for, including hypertension, asthma, and diabetes.

“Sometimes the treatment is just getting them into a warm space, which is a challenge a lot of times,” she said.

Others patients need more intensive interventions like surgery. However, most don’t have access to consistent medical care, due to social barriers like lack of identification, reliable transportation, and cell phones.

Social issues have compounded the nation’s housing and homelessness challenges.

In New York, local government has shifted policies around homelessness, like suspending the Right to Shelter rule, which requires a bed for those in need, and implementing a 60-day rule, requiring houseless people to reapply for shelter space after 60 days. The changes followed an influx of migrants in the city, who were expected to find shelter in an open field with minimal personal space. The city was already facing mass evictions after national, Covid-related housing protections were dropped and housing affordability decreased.  

“Housing instability definitely increased significantly after all of those protections were gone,” said Nathalie Interiano, Director of Policy and Advocacy at Care for the Homeless in New York, adding that the increase in homelessness over the last year and a half has been “pretty significant.” That’s concerning to Care for the Homeless, which provides health care, advocates on behalf of, and houses New York’s unhoused population.

“Health issues are so intricately linked with the population that we specifically serve,” Interiano said. “People who are dealing with unstable housing are also dealing with a variety of other health issues.”

The nationwide point-in-time count was conducted in late January. The count identifies the number of people sleeping outdoors on a single night and is used to inform federal policymakers on the scope of homelessness across the nation. In December 2023, the Department of Housing and Urban Development forewarned that the numbers from the January 2024 count would be 12% higher than in previous years.

However, some experts say the count doesn’t share the full scope of homelessness, since it is not a controlled study and is limited to those sleeping outside rather than houseless individuals and families who constantly sleep in different locations.

In 2023, New York’s point-in-time count for households experiencing homelessness was 59,572 and individuals totaled 103,200. Over 53,000 unhoused people in New York are in families with at least one child. Even though the city has over 173,000 beds year-round for families, adults, and children, they are spread out across the city and don’t always have space at each location for an entire family or individuals who would like to stay together.

Others may not want to be in a shelter environment. “Some of (the) reasons why people enter into homelessness or housing insecurity situations are attempting to find means of safety,” said Carol Sharp, President and CEO of the Night Ministry in Chicago. “That means the difference between visualizing a safe space inside of a home versus a safe space. And having the freedom to move at will and freedom to find people (who) might have similar circumstances and finding comfort in that.”

In Chicago, the Night Ministry served 600 more individuals in 2023 than previous years. Sharp said that Chicago is experiencing similar issues around homelessness as other cities, including limited affordable housing. However, she noted that people looking for a “safe space” also include those who experience mental illness or misuse substances, people who have experienced domestic violence, people who identify as transgender and non-binary, veterans, and those living with HIV/AIDS.

In Illinois, almost 1,500 homeless people were identified as having experienced domestic violence, according to HUD. The Night Ministry makes a point of meeting people where they are, using mobile units and volunteer physicians to see patients on the streets of Chicago and at partner-affiliated buildings. Similar to organizations in Detroit and New York, they treat wounds, frostbite, Covid, and influenza, and provide care for chronic diseases during the severely cold months.

Direct Relief supports health facilities and organizations across the U.S. focused on street medicine, including Street Medicine Detroit, Care for the Homeless, and the Night Ministry.