Water and health insecurity among people experiencing homelessness in Germany: Challenges, and potential solutions

Abstract

Access to clean drinking water, sanitation and hygiene infrastructure (WASH) and related health benefits are widely enjoyed in high-income countries. WASH access is closely related to housing, which makes provision, financing, regulation and maintenance of WASH the responsibility of property owners. As a result, people without a permanent home, including people experiencing homelessness in urban areas, are often excluded from WASH services. For hundreds of thousands of homeless people in Europe, homeless shelters and public toilets are sometimes the option to access appropriate WASH infrastructure.

What is already challenging under “normal” circumstances is made even more difficult during extreme weather events: heat waves require more water for hydration and cooling; flooding makes public toilets inaccessible; extreme cold disrupts water supply. People affected by homelessness suffer particularly from the failure of the infrastructure and the resulting disease burden.

Despite the high societal relevance according to the United Nations Sustainable Development Goal 6 to “ensure water and sanitation for all”, and despite the human right to water and sanitation, the needs of people experiencing homelessness are not yet fully met; WASH inequalities and the resulting burden of disease remain hidden and under-researched in official statistics. And despite the increasing frequency, intensity and unpredictability of extreme weather events, and evidence that extreme weather events threaten the daily life and health of homeless people, the impact on WASH infrastructure, the consequences for homeless people and their health are not yet fully understood.

This transdisciplinary and participatory citizen science project aims to fill both knowledge gaps and involves homeless people as key actors to identify appropriate solutions and interventions. We combine a literature review with empirical data collection, analysis and triangulation, and apply a mixed method approach that includes photovoice and participatory mapping alongside interviews with homeless people and inspections of publicly accessible WASH infrastructure