Article
Change
Community
Development
6 min read

Tackling homelessness needs much more than promises and policies

While homelessness generates statistics and strategies around the world, Jane Cacouris asks what really is home.

Jane Cacouris is a writer and consultant working in international development on environment, poverty and livelihood issues.

A mother sits with a toddler standing in front of her. The father appears from the side lying on his back reaching an arm out.
A family play in a Rio favela.

“Mummy, are we homeless?” asked our six-year-old as we pulled away in the taxi. We had just eaten a final meal - a KFC family bucket of fried chicken - sitting on a sarong on the floor of our empty apartment in Rio de Janeiro, our home for almost four years.  

The question left me momentarily winded. Homeless. A word that instantly conjured up feelings of anxiety and uncertainty, of sands shifting under our feet. Technically, yes, we were. My husband had just left his job in Brazil, and we had two months with nowhere to live before we relocated back to the UK. With no permanent base anywhere in the world, we were about to use the time to travel in South America as a family. Whilst I did feel somewhat insecure, my husband in contrast found it freeing; the first time in his life that he didn’t carry a set of house keys in his pocket. We had nowhere to live, but we were free to go wherever we wanted. And this is where the analogy of us actually being homeless broke down. We had a freedom of choice in a way that the vast majority of people who experience homelessness do not.   

World Homeless Day on the 10th October was marked with the recent release of a landmark UN report on global homelessness. The UN define homelessness as:  

“where a person or household lacks habitable space with security of tenure, rights, and ability to enjoy social relations, including safety. [It] is a manifestation of extreme poverty and a failure of multiple systems and human rights.”  

According to UN-Habitat, a staggering 1.6 billion people in the world are estimated to be in inadequate housing and over 150 million have no housing at all.  

Global homelessness has been rising for the past decade, with temporary homelessness being increasingly caused by conflict and climate-induced displacement. However, according to the UN report, Covid-19 exacerbated the issue, deepening existing inequalities and causing already marginalised people to be even more vulnerable.  

In developing countries, the informal economy – self-made microentrepreneurs who sell everything from popcorn to shoe polishing - usually sustains the poor urban majority. But with many informal jobs vanishing during lockdowns, and with few assets and limited social safety nets, many urban dwellers were rapidly plunged further into poverty. Women and children suffering from domestic and gender-based violence had to remain in unsafe environments, with abuse escalating during lockdowns and curfews. Issues that encouraged migration and homelessness. 

There are approximately 150 million children living and working on the streets worldwide. Almost impossible to imagine, and so the number sometimes doesn’t compute with our hearts.

The extent of homelessness worldwide is notoriously difficult to quantify accurately, partly due to what is known as hidden homelessness. The hidden and isolated nature of children and adolescents living on the street, for example, makes statistics difficult to gather. A 2023 UNICEF report of street children in Dhaka estimated that the number of children living on the street just in Bangladesh could be in the millions. And according to UN sources there are approximately 150 million children living and working on the streets worldwide. Almost impossible to imagine, and so the number sometimes doesn’t compute with our hearts. The true horror of the isolation of child homelessness only truly hit me a few years ago… 

The residents in our block had finally had enough of the noise and called the police. They arrived in the middle of the night with their guns and shot at the children who dispersed.

Living at the top of a high-rise block in the middle of an urban neighbourhood in Rio, we were kept awake for a number of nights in a row. It started as a disturbance – children yelling in the street outside that would continue from the early hours until dawn. But as the days went on, the disturbance at night became more acute. One morning as I stepped out of our apartment in the morning, bleary-eyed and irritated, I was confronted by a small group of sleeping children lying huddled together in a row on the pavement next to a tree. Several pairs of bare filthy feet were sticking out of a blanket they were sharing. I looked down at them as I passed – they varied in age from about eight to twelve years old. The youngest was probably younger than my son at the time. He had knotted black curly hair and a streaked face. The next night we heard gun shots and then an eery silence. Another sleepless night, this time from worrying about the children, and then we discovered that the residents in our block had finally had enough of the noise and called the police. They arrived in the middle of the night with their guns and shot at the children who dispersed. The children never came back. 

The government pledge to end rough sleeping in England by the end of 2024 is woefully off track. 

Although homelessness is an overwhelmingly larger problem in poor countries, it also affects affluent nations, including the United Kingdom. This year the Kerslake Commission, an expert panel set up to scrutinise how rough sleeping is being addressed across England, pointed out that data on rough sleeping in London last year showed a 16 per cent increase in numbers of people sleeping rough. And that almost half (48 per cent) were sleeping rough for the first time. It concluded that the government pledge to end rough sleeping in England by the end of 2024 is woefully off track. According to Crisis, the homelessness system in England is at breaking point and the Homelessness Monitor 2023 reported that the cost-of-living crisis, rising rents and a lack of affordable housing are making it harder for councils to provide homeless people with effective support.  

It is about where you feel valued and understood… where you feel loved… and where you want to come back to. 

So, the problem of homelessness really is global. And what is the answer? Yes, governments must act; social safety nets and public policies to help alleviate poverty are critical. But even the richest countries with the most advanced governments have never been able to fully tackle this issue. Homelessness and poverty were rife in Biblical times. As Jesus said in the Gospel of John, “‘You will always have the poor with you”. And Jesus himself understands homelessness in a way many of us don’t; he started life in a stable, born to parents who were sleeping rough. He became a baby on the run to flee King Herod, homeless and seeking asylum in Egypt. When Jesus was older, after he was baptised by John the Baptist, he became homeless again, living life on the the road and in the open. In Luke, he says: “Foxes have dens and birds have nests, but the Son of Man has no place to lay his head.”  

He emphasised that his followers leave the trappings of “home” to follow him.  

I used to volunteer at a Christian charity, Casa de Maria e Marta, in a favela (slum) community in Rio, known for gang violence and drug trafficking. A larger-than-life Brazilian lady, Edimea, has run the charity for over twenty years. Almost a hundred children come to the charity each day, which provides three meals as well as extra tuition and care for the children. All of those who attend are either living in inadequate housing or are homeless. One day I asked Edimea whether she still sees the children after they leave her charity at age twelve. She laughed and said yes of course, they still come back to eat! And then she said, 

“I do an assessment before I take a new child in, to understand what they know, and work out how we can best help them. And I always say to them – we take beautiful children, and so we are taking you, because you are beautiful inside and out. They come back because they don’t forget those words.” 

Like Jesus, Edimea shows endless concern and love for those on the margins. She can’t solve all the practical problems she comes across or offer a permanent roof over a head, but she does provide a place where everyone feels a sense of safety and belonging. Perhaps home means more than the UN’s definition. It is about where you feel valued and understood… where you feel loved… and where you want to come back to.  

Interview
Change
Gaza
Israel
Middle East
S&U interviews
Suffering
War & peace
11 min read

Eye witness: life and death in Gaza’s European Hospital

Returning plastic surgeon Tim Goodacre reports on the struggles, the despair and the dignity of the people and the medics of Gaza during their long nightmare.

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

Medical staff stand beside a bed in which a man lies with an amputated leg.
Medics confer about a patient in Gaza's European Hospital.
Tim Goodacre

Tim Goodacre is a vastly experienced plastic surgeon who recently spent two weeks in a hospital in Khan Younis treating the extensive injuries of the people of Gaza. I caught up with him to ask about his experience there.  

Graham: Let me start by asking what was it like getting into Gaza? What was the process and how difficult was it to actually get in in the first place? 

Tim: We went in as an emergency medical team under the under the auspices of the World Health Organisation, which is coordinated with UN OCHR. It was easy obviously to get to Cairo. Then we joined a convoy, a group of cars convening in the small hours of the morning in Cairo and then being escorted across the Sinai desert. We got to the border in time for dusk. What was staggering at that stage was seeing the number of lorries lined up, waiting on the Egyptian side to get in. They were two deep on one side, one deep on the other with a thin passageway through which we could drive through for mile after mile after mile of these lorries. 

Was this humanitarian aid sent from other nations? 

Absolutely. It was aid labelled from different countries or agencies. Crossing Rafah the next morning was all pretty haphazard and chaotic, but we met our driver on the other side. We then had to travel to Khan Yunis on the coast road because it was the safest part of the south Gaza strip. We went through a route called the Philadelphia Road, which is a gap between the two borders. As we drove along, we immediately were jumped on by some young lads who had put razor wire across the road. We picked up two of them who hung onto the car each side, with our window s firmly shut. As we sped along, they were our ‘protectors’, taking a pitiful sum to ensure that we would not be stopped at further razor wire and our vehicle plundered. It was our first experience of the lawlessness that's inherent at the moment in Gaza. 

All along that side of the road there were people putting up new tents after a recent further mass displacement, as far as the eye could see. It made a huge impact on me - the devastating plight of the people who were there. It looked like those pictures of Glastonbury or Woodstock, where as far as you could see, the rolling fields or sand dunes or whatever were totally covered in makeshift dwellings. It was pretty cold and windy. And subsequently, while we were there, it rained an awful lot and your heart just went out to these people.  

So these were people living in tents and temporary shelters? 

 Well, not really. They're barely tents. They're just finding flimsy bits of wood, putting them up and nailing them together. And these are not just the very poorest of the poor. This is everybody. Many of them were people from very well-to-do houses whose families have been displaced. I've worked in many parts of the world where there's poverty, but I’ve never seen so many people displaced.  

One of the things that's remarkable however is the relative cleanliness, the desire to maintain dignity in the most appalling circumstances. But a young lad who’s now a young doctor (who I have worked with for a decade now) came to see me and he was the most dejected person I've ever met. He said to me ‘they've taken away my dignity’. The abject pain in his face was something that I won't forget.  

You’ve been to Gaza many times before. What was different about this time? And you've seen it in the aftermath of previous wars and conflicts. What was what was particularly different this time? 

 It's utterly different – it’s the displaced population with nowhere to go and seeking shelter. When I first went in 2014 after Operation Protective Edge, I was taken to a huge neighbourhood of northeast Gaza, which had been flattened and at the time the impact on me was extraordinary. When I’ve visited subsequently over the last decade, they will show you this bombed out building and that flattened area, but I've never seen such vast numbers of displaced people. On the second day we moved into the European Gaza Hospital (EGH), which is where we were going to stay for the two weeks we were there. Inching slowly along amidst endless hordes of people walking around, seeing the dejection, despair, the hopelessness with nowhere to go - this for me is what defines this whole episode and makes it very different from others. This is in no way a diminution of other conflicts and human tragedies, but when there was bombing in Baghdad or in Kiev and Ukraine, people might go into underground shelters - there are places they can perhaps go to escape. Even in massacres such as in Darfur or Congo, there are places to run to. There is nothing like that in Gaza. 

Was there a pattern to the kind of medical emergencies and wounds that you were having to deal with? 

 The vast majority of injuries were the impact of high explosives, so we naturally saw quite a lot of burns, although the majority of severe burns alone were being managed by the Red Cross team also at EGH. Some of them were people who had been crushed and pulled out of buildings which had collapsed. But that was that was the minority. The majority of our cases were direct results of bomb blasts. Every time you hear a bomb, somebody is being killed, yet many others are caught on the fringe of that. Shrapnel travels at astronomical speeds and hits people in in a completely random way. These injuries are devastating. There were scores of people coming in with limbs missing. Seeing somebody with a leg off at the thigh, a leg off below the knee, an arm ripped off was all too common. It was hard to take in - you have to become somewhat immune to the backstory behind each dreadful injury, and concentrate on the carnage in front of you, to be able to deal with the constant onslaught of cases. 

How were the medics coping with it? You were there for two weeks. They are there for months, presumably on end? 

 I think it's incredibly important that we don't focus on the visiting medics. I usually peeled off at about 9pm or so in the evening - I had to go to bed and had to have a rest, but there were people trying to work through the night. What I want to focus on is the local people, particularly a young colleague, Ahmed, who was 36 years-old. He was statesmanlike in his ability to pull things together. His family are actually mostly in Dublin as they've got Irish passports. I cannot tell you how much admiration I have for that young Gazan man who shared his room with me.  

He has been managing to create a team who work alongside him, since many of the staff who had worked at the hospital before (some of whom we had trained over several years in limb reconstruction) were not there. That is because they might not be alive, or having to support their displaced families, or simply are afraid to travel in daily to the hospital, or whatever. It is a huge demand on individual doctors to leave a family group (who invariably try to stay together, so that if they are bombed, they all die together and do not have to be a sole survivor.) to then work away from such possible loss of all their family members. It's an incredible sacrifice to be working in medical care when your family are all huddled together in a place where they may all lose their life, and that gets to them in the end.  

The orthopaedic side is almost on its knees. Most of the system in the hospital is utterly on its knees. There were early years medical students who had been taught quickly how to manage wounds and to skin graft. They haven't got any pay, but some people have given a little money to my colleague’s account to try and give them some support. There were IT students and all sorts of others pulling together. How people can work in in such adversity and make things happen is quite a testament to the to the strength of humanity.  

It all begins to play on your mind, and you start thinking is there another one coming? And you get no warning when the attacks are unleashed. 

What was it like living under the bombardment, which was presumably pretty constant during your time there? 

There may have been the odd period of four or five hours when there was no sound of close bombardment at all, although during that time there was probably small arms fire going on somewhere. But otherwise, it was relentless. One became somewhat used to the bombs in the distance, but when they're close by… Every time one of these bombs goes off, there are people dying. And that really that played on your mind. So huge numbers were seeking shelter anywhere in the vicinity of the hospital. If you can imagine a hospital corridor where every route is full of makeshift shelters, and you just go up around a stairwell and on the corner of each stair, there will be a family which will be hanging drapes up, trying to find some sort of privacy and dignity among the utter destitution.  

I found it very difficult to sleep during those times. The hospital is in a quadrant, a square. On one corner there was a supermarket which latterly was hit by an F16 delivered weapon. You could hear the sound of the rocket go off alongside the scream of the low flying fighter jet, and the whole building shook. There's also the incessant sound of drones. It all begins to play on your mind, and you start thinking is there another one coming? And you get no warning when the attacks are unleashed.  

It made me realise what soldiers undergo when they get what used to be called shell shock. There, even if you're not injured yourself, this constant shocking damage gets to you. I knew we had the knowledge that after a short time, we would be getting out - but it made me realise how tough Ahmed and others working there have to be. It will be having a devastating impact on the population, and for a nation.  

I imagine the psychological effects of that are going to last for a long time in the lives of these people. You don't get over that quickly. If you live with that level of tension, thinking any moment now, I could die, that must stay with you and the marks of that stay for a long time. 

I'm sure that's true. I'm not an expert in PTSD and things like that. Ahmed is a Muslim and said to me more than once that when you believe in an afterlife, you believe that your time will come at some point, and you accept that. We don't know when it is or where it is, but it will come. I have frequently wondered whether any of the fighter jet pilots have ever experienced themselves what it’s like to be underneath the impact of one of their weapons? Having felt somewhat what it is like to be on the other side of such an onslaught, I do wonder whether very many of those involved in ordering conflict really have any kind of understanding of what devastation feels like, when there is nowhere to run? I fear for what this conflict does to the humanity of both sides. 

I genuinely don't feel brave, I don't. I'm not the kind of person who sees lights in the sky, but I know it was God’s calling to go there. It was simply the right thing, 

Did you see any sign of hope or anything that gave you a sense of the way out of this? 

 The sense of hope is within the people who are there. There are many people who say they still really don't want to leave. They feel this passionately. It's their land. They do want to see a new Gaza. I tried to be somebody who lifted spirits. Communities can be rebuilt and there may be a new future which will come from the dust. I've been in touch with people in my University Medical school in Oxford to see whether we can do something about getting these young people's education continued.  

You can imagine there wasn’t a lot of laughter in the whole environment, but on the few occasions when I did gather together with my colleague’s small group of young students and volunteers, usually late into the night, we would eat whatever food goodies they had to hand, and their sense of fun would burst out. Together there was a very strong sense of community amongst them. 

How did your Christian faith inform the way you interacted with the situation? How did your Christian faith help you process what you were seeing and experiencing there? 

 I must say it was a deeply spiritual time for me. It was absolutely powerful to me to know that God cares and loves each and every one of these people. I longed to organise a football game with the kids. I was told that they had tried to do that, and it had become too dangerous. So there seemed to be no organisation around looking after the well-being of the children, their education, or the deeper impact on them of this war. People were jammed into the hospital, obviously because it was seen as a safe space, and it was humbling to think that us (as foreign workers) being there made them feel somewhat safer. It humbled me immensely.  

I felt nothing but a sense of privilege in being a witness to all this. I was reading the Psalms regularly in daily prayer. There's also something about that land being the place where God himself suffered in Christ and went through his own agony, and that the Holy Family escaped through Gaza to Egypt.  

I genuinely don't feel brave, I don't. I'm not the kind of person who sees lights in the sky, but I know it was God’s calling to go there. It was simply the right thing, a privilege and an honour to have such access which comes with having my particular background of skills and past history with Gaza. God is over all these matters, and we are compelled to respond. 

 

Tim Goodacre is a Reconstructive Plastic Surgeon based in Oxford, with extensive experience of working in diverse environments outside the UK. He is immediate past Vice President of the Royal College of Surgeons of England.