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Even for January in Toronto, this week has been bitingly coldÌýwith a bone-chilling freeze stretching for days. Temperatures on Thursday night plunged to -10 C, worse with wind chill. It’s the kind of weather that magnifies Toronto’s growing homelessness crisis,Ìýat a time when shelters are bursting at the seams and warming centres are operating beyond capacity, withÌýhundredsÌýleft surviving on sidewalks, in alleyways and among encampments.Ìý

With 412 encampments at the city’s last count on Jan. 3, temperature becomes a flashpoint issue: the cold is dangerous, carrying risks of frostbite, trench foot-like injuries and even life-threatening hypothermia. But officials also point to encampment fires and explosions as dramatic examples of the dangerÌýbrought on by commonly used heat sources like propane tanks.

People were on edge in this kind of cold, Cook said, and desperate for warmth. The night before,Ìýhis workplaceÌý—ÌýSanctuary º£½ÇÉçÇø¹ÙÍøon Charles Street — held a drop-in meal andÌýhe spent the entire time giving people socks, clothing layers and sleeping bags to steel against the night air. “I ran out of long johns,” he said.

In the square behind the Eaton Centre on Friday morning, another man asks if CookÌýhas a tent. He doesn’t, but offers anything from his backpackÌý— hand warmers, warmer clothes, naloxone kits, chocolate bars to keep his energy up? The man, in response, yanks his shirt up to reveal a fresh-looking scar on his stomach, which he attributes to a stab wound. Cook’s eyes widen, and he urges the man to head to Sanctuary’s headquarters for a warm coat and a sleeping bag at least. It’s not far, Cook says, rummaging through his pockets for TTC fare, but coming up short.

There are fewer people outside on Friday morning than usual, Cook says. He believes the warming centres and extra surge spaces opened as part of this year’s winter shelter plan have made some difference. Where º£½ÇÉçÇø¹ÙÍøhistorically opened warming centres only once temperatures plummeted to -15 C, the threshold has been changed to -5, with some additional spaces opening in worse chills.

Still, spaces fill fast. As of 4 a.m. Thursday, with overnight temperatures forecast to plunge toÌý-12 C,ÌýToronto’s warming centres were at 103.3 per cent capacity,Ìýcity data shows.

When shelter provider Dixon HallÌýopened a surge site to warm up on Tuesday night, housing services director Haydar ShoulyÌýsaid they filled nearly every bed in three hours.

“These weather conditions are super cold and extreme,” ShoulyÌýsaid in an interview. “You get to maximum capacity very quickly.”

Many people at their doorstep also arrive needing much more help than a warming centre can offer, Shouly said, offering the example of people struggling with acute mental illness or with other serious health needs.Ìý

Dr. Sahil Gupta, an ER doctor at downtown Michael’s Hospital, has seen how quickly cold weather injuries set in.ÌýHe has already treated two patients this winter with serious cases of frostbite. He has also seen four or five patients with what he called “trench foot-like injuries” to their hands and feet, after staying cold and wet over an extended period without reprieve.

“Our blood vessels lose the ability to warm up. Our skin becomes this red, rashy state. You become more prone to injuries,” Gupta said, pointing out that cracking skin also offered more entry points for infections.

Cold-weather injuries could cause lifelong disabilities, he said, and while there’s beenÌýsome advancement in treatment, with new medication that helped with frostbite, the interventions work best if peopleÌýseek care within 24 hours.

That didn’t often happen, Gupta said. He expects to see people turn up in the ER with injuries from this week’s cold over the coming weekend and beyond.Ìý

The freezing weather could also worsen other issues,ÌýGupta says, asÌýsome homeless Torontonians increase their substance use to try to numb to the cold, or suffer a worsening of existing mental health conditions due to stress.Ìý

Every day, he also sees patients turning up not for any medical issue, but simply to warm up, adding to the squeeze on their busy emergency room.

“There’s nowhere else to go,” he said. While staff can offer a jacket or gloves, maybe a coffee shop voucher, there’s only so much they could do,ÌýGupta said.

“More often than not, they are going unfortunately back out to the street after our evaluation,” he said. “You see this person looking for support and for help, and there’s nothing that we can really offer them.”

The methods people on Toronto’s streets use to keep warm can also result in injuries, Cook noted.Ìý“The frostbite goes up when you have stretches like this, but also the burns,” he said, listing common ways people try to warm their tents, from burning hand sanitizer to using propane tanks. The propane could explode, he said, while other options like candles could tip over and ignite.Ìý

“But it’s not, also, safe to be cold,” he said.Ìý

º£½ÇÉçÇø¹ÙÍøFire statistics showÌýencampment fires are happening more this winter than last. Looking at “uncontrolled” fires at encampments — which doesn’t include campfiresÌý— the service counted 23 in October, 28 in November and 53 in December, an increase of 51 fires year-over-year.Ìý

WhileÌýa years-ago inquest probing a fatal encampment fire in ScarboroughÌýrecommended providing safer heat sources, Cook noted there’s been little official consensus on what those safer heat sources could be.

In a camp tucked to the side of Sanctuary, whereÌýCook stops during hisÌýFriday morning outreach walk,ÌýRyan Hayashi has been trying to keep warm on body heat alone, squeezed in a tent with his wife and their dog.

The couple has been homeless for several years now, after a snowballing journey including a job loss on her end and his substance use challenges. Hayashi has been ensnared by opiate dependence since being prescribed powerful painkillers when he tore a ligament in his leg roughly 20 years ago.

Hayashi has spent a winter on the streets before, but this one is harder, he said, especially with the rainfall that preceded this frigid stretch. “If you ever get wet when you don’t have housing, it’s hard to get anything dry,” he says, pulling off his gloves and showing several cuts he says just won’t heal.

And the warmth of their three bodies huddled together, normally enough to withstand the night in a tent, was no match forÌýthis biting coldÌý— especially since their tent stopped closing properly.Ìý

“Luckily, we know a few places around here where we can go to the stairwell of a parking garage,” Hayashi said. On Thursday night, the pair left their tent for one such reprieve.ÌýHis wife also often fashioned a temporary structure for them from cardboard, which Hayashi said they would pack up when they moved again.Ìý

“It’s not super warmÌý— but it’s much warmer than outside.”