(CBC - image credit)
On Thursday night, a man came to the warming shelter set up in Cabot Square in downtown Montreal, his toes frozen and turning black.
The shelter sees one or two cases like that per night when it's extremely cold out, said Emmanuel Guay, who works at the warming tent.
The situation is made more difficult, Guay said, because many of the shelter's clientele — a large number of whom are Indigenous — don't trust places where medical care is available.
"They're afraid of the police and afraid of security guards," Guay explained. "They're afraid of the hospitals, so unless they're in crisis, we can't send them there against their will."
The challenges facing the homeless population and the shelters that serve them were brought into sharp focus in January with the death of Raphaël Napa André, to whose memory the Cabot Square tent was dedicated.
The 51-year-old Innu man was found steps away from the Open Door shelter in January, after public health officials had ordered it closed overnight.
Now, the frigid temperatures in Montreal mean homeless shelters — which have been under additional strain because COVID-19 — are again being pushed to their limits.
'Extra layer of complexity'
Sam Watts, CEO and executive director of Montreal's Welcome Hall Mission, said that implementing COVID-19 protocols on top of the additional effort required on colder winter nights "adds an extra layer of complexity for us."
Before the pandemic, Watts said, dealing with more people trying to escape the cold was relatively simple — let them in and find spaces for them.
"Now you've got to make sure there's proper social distancing in place," he said. "And so just bringing people in and having people in close proximity in the facility is not the answer."
Watts said they attempt to deal with the situation by working with shelters "across the whole network" to try to find available space.
At Cabot Square, Guay says space limitations means they sometimes need to make people wait outside when the tent is at capacity.
This week the city said the temporary shelter could stay in place until March 31, but money remains an issue. Guay says more funding could be used to add space and to have a nurse on duty.
"It would mean there would be somebody on site that could treat the wounds and prevent them from getting worse."
The man who showed up with frostbitten toes was treated by workers, Guay said, but without trained medical specialists the options are limited.
Both Guay and Watts said that cold nights reveal a need for warm coats, blankets and boots.
Issues with fingers and feet are common when the temperature drops, Watts said, and some people have shown up without shoes or in slippers at Hotel Place Dupuis, which currently serves as a shelter and is managed by Welcome Hall Mission.
"We become particularly vigilant at this time of year to ensure that people are warmly dressed."