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The BC Centre of Excellence in HIV/AIDS tracked rates of illicit drug use in Vancouver between 1996 and 2011. It found large fluctuations over this 15-year period, with the most recent trend being an overall decline in illicit drug use between 2007 and 2011.<ref name=UHRI2013/> However, Vancouver Coastal Health reported in 2014 that hospitalizations related to addictions had increased by 89% in four years at [[St. Paul's Hospital (Vancouver)|St. Paul's Hospital]], the closest hospital to the DTES.<ref name=Katic2014/>
The BC Centre of Excellence in HIV/AIDS tracked rates of illicit drug use in Vancouver between 1996 and 2011. It found large fluctuations over this 15-year period, with the most recent trend being an overall decline in illicit drug use between 2007 and 2011.<ref name=UHRI2013/> However, Vancouver Coastal Health reported in 2014 that hospitalizations related to addictions had increased by 89% in four years at [[St. Paul's Hospital (Vancouver)|St. Paul's Hospital]], the closest hospital to the DTES.<ref name=Katic2014/>

A 2016 study of youth who used illicit drugs in Vancouver indicated that 28% had tried unsuccessfully to access [[addiction treatment]] in the previous 6 months, with the lack of success mostly due to being placed on waiting lists.<ref name=DeBeck2016>{{cite journal|last1=Kora DeBeck, Thomas Kerr, Seonaid Nolan, Huiru Dong, Julio Montaner, Evan Wood|title=Inability to access addiction treatment predicts injection initiation among street-involved youth in a Canadian setting|journal=Substance Abuse Treatment, Prevention, and Policy|date=6 January 2016|volume=11|issue=1|doi=10.1186/s13011-015-0046-x|url=http://link.springer.com/article/10.1186/s13011-015-0046-x}}</ref>


=== Mental illness ===
=== Mental illness ===

Revision as of 20:46, 15 April 2016

Downtown Eastside
Urban Neighborhood
View of the Downtown Eastside and Woodward's site from Harbour Centre.
View of the Downtown Eastside and Woodward's site from Harbour Centre.
Nickname(s): 
DTES, Skid Row
Country Canada
Province British Columbia
CityVancouver
Population
 (2009/2011)
 • Total6,000 - 8,000 for the core area 18,477 for the total area
Time zoneUTC-8 (PST)
 • Summer (DST)UTC-7 (PDT)

The Downtown Eastside (DTES) is the oldest neighbourhood in Vancouver, British Columbia, Canada. Although the City of Vancouver defines the DTES area as encompassing a broad and diverse area, the term is often used in reference to the DTES core, a roughly 15-square-block area between Gastown and Chinatown that is centered at the corner of Main and Hastings Streets.[1][2] This area, with a population estimated at 6,000 to 8,000, is known for its poverty, drug use, sex trade, crime, public disorder, and urban decay, as well as a history of community activism.[3]

At the turn of the century, the DTES was the political, cultural, and retail centre of the city. In the mid-20th century, the city centre shifted westwards and the DTES became a poor, although stable, neighbourhood. In the1980s, the area began a rapid decline due to several factors including an influx of hard drugs, the de-institutionalization of the province's mentally ill, and a shortage of affordable housing for low-income residents. By 1997, an epidemic of HIV infection and drug overdoses in the DTES core led to the declaration of a public health emergency, which has since been brought under control.

Numerous efforts to revitalize the neighbourhood have largely failed, although some consider it to have improved in recent years. Since the early 21st century, the trend towards gentrification and the area's high concentration of social services have both emerged as controversial issues.

Geography

A Chinese temple in the heart of East Hastings shows the diversity of the neighbourhood. The building was originally a Salvation Army Temple.

The term "Downtown Eastside" is used in multiple ways:

For community planning purposes, the City of Vancouver considers the following zoning areas to be within the Downtown Eastside: Chinatown, Gastown, Oppenheimer Park (formerly Japantown), Strathcona, Thornton Park and Victory Square, as well as the light industrial area to the North.[4] With this definition, the DTES is bordered by Richards Street to the west, Clark Drive to the east, Waterfront Road and Water Street to the north and Malkin Street/Prior Avenue to the south, with Hastings Street running down the middle of the neighbourhood.

Historic sites in this area, the city's oldest, include Chinatown, the popular tourist destination Gastown, and the Dr. Sun Yat-Sen Classical Chinese Garden. The area includes 20% of the city's heritage buildings. Its parks include Oppenheimer Park and CRAB Park.

The term is often used to refer to a much smaller core area – approximately 15 square blocks in size – in the vicinity of Main and Hastings Streets, where urban decay, addiction, and poverty are most acute. In 2008, the Globe and Mail described the DTES core as "a world of misery crammed into 10 blocks."[5]

History

The corner of Hastings and Main, c. 1912

After the Great Vancouver Fire of 1866 destroyed most of Vancouver's buildings, residents rebuilt their town at the edge of Burrard Inlet, between Cambie and Carrall Streets. This townsite now forms Gastown and part of the DTES.[6] At the turn of the century, the DTES was the heart of the city, containing city hall, the courthouse, banks, the main shopping district, and the Carnegie Library.[7] Travellers connecting between Pacific steamships and the western terminus of the Canadian Pacific Railway used its hundreds of hotels and rooming houses.[8] Large Japanese and Chinese communities settled in the adjacent communities of Japantown and Chinatown.

During the Depression, hundreds of men arrived in Vancouver in search of work. Most of them later returned to their hometowns, except workers who had been injured or those who were sick or elderly.[9] These men remained in the DTES area – at the time known as Skid Road – which was a non-judgemental, affordable place to live. Among them, drinking was a common pastime.[10][11] In addition to being a major cultural and entertainment district, Hastings Street was also a centre for beer parlours and brothels.[12]

In the 1950s, the city centre shifted to the west when the interurban rail line through the DTES closed. Theatres and shops moved towards Granville and Robson Streets.[13] As tourist traffic declined, the neighbourhood's hotels became run-down and were gradually converted to low-income residential housing, a use which persists to this day.[14] By 1965, the area was known for prostitution and for having a relatively high proportion of poor single men, many of whom were alcoholic, disabled, or pensioners.[15]

1980s

Carnegie Community Centre at the corner of Main and Hastings.

When we deinstitutionalized, we promised [mentally ill] people that we would put them into the community and give them the support they needed. But we lied. I think it's one of the worst things we ever did.

— Larry Campbell, former mayor of Vancouver, [16]

In the early 1980s, the DTES core was an edgy but still relatively calm place to live. The years immediately before and after Expo 86, however, brought both a loss of low-income housing and an influx of high-purity cocaine and heroin.[17] In efforts to clean up other areas of the city such as Granville Street and the West End, police cracked down on the cocaine market and street prostitution, but these activities resurfaced in the DTES.[18][19] Within the DTES, police officers gave up on arresting the huge numbers of individual drug users, and chose to focus their efforts on dealers instead.[20]

Meanwhile, changes in provincial government policy saw the mass discharge of Riverview Hospital's patients with the promise that they would be integrated them into the community, while the province considered the land for development.[21] Between 1985 and 1999, the number of patient-days of care provided by B.C. psychiatric hospitals declined by nearly 65%.[16] Many of the de-institutionalized mentally ill moved to the DTES, attracted by the accepting culture and low-cost housing, but floundered without adequate treatment and support and soon became addicted to the neighbourhoods's readily-available drugs.[22][23][24]

1990s to present

For the police, success is measured in how well the drugs are kept corralled on Hastings between Cambie and Main, where they can expect the fewest complaints. Arrests are infrequent, and when they occur they are counterproductive... Like a hydra, direct enforcement paradoxically crowds the streets with the incarcerated dealers multiplying replacements.

— Reid Shier, [13]

In the 1990s, the situation in the DTES deteriorated further on several fronts. After many years of financial losses, Woodward's, an anchor store in the 100-block of West Hastings street, closed in 1993. The closure had a devastating impact on the formerly bustling retail district.[25] Meanwhile, a crisis in housing and homelessness was emerging. Between 1970 and the late 1990s, low-income housing in other parts of the city had been steadily converted into more expensive condominiums.[16] In the same time period, the DTES itself saw a loss of about 60 units per year of housing suitable for low-income single people.[16] In 1993, the federal government stopped funding social housing, and the rate of building social housing in B.C. dropped by two-thirds despite rising demand for it.[16] By 1995, reports had begun to emerge of homeless people sleeping in parks, alleyways, and abandoned buildings.[16] Citywide, the number of homeless people climbed from 630 in 2002 to 1,300 in 2005.[26]

Without the presence of a viable retail economy, a drug economy proliferated, with an accompanying increase in crime.[13] Around 1995, crack cocaine arrived in Vancouver.[27] In 1997 the local health authority declared a public health emergency in the DTES: Rates of HIV infection, spread by needle-sharing amongst drug users, were worse than anywhere in the world outside Sub-Saharan Africa and more than 1000 people had died of drug overdoses.[28][29] Efforts to reduce drug-related deaths in the DTES included the opening of a needle exchange in 1989[30] and Insite, North America's first safe injection site, in 2003. These interventions succeeded in bringing the rates of HIV infection from 8.1 cases per 100 person-years in 1997 to 0.37 cases per 100 person-years by 2011.[31] By 2015, the 40-block area surrounding Insite had also seen a 35-per-cent decline in overdose deaths.[28]

In the 21st century, considerable investment was made in DTES services and infrastructure, including the redevelopment of the Woodward's Building and the acquisition of 13 hotels for conversion to social housing. In 2009, the The Globe and Mail estimated that governments and the private sector had spent more than $1.4 billion since 2000 on projects aimed at resolving the area's many problems.[32] Opinions vary on whether the area has improved: A 2014 National Post article said, "For all the money and attention here, there is little success at either getting the area’s shattered populace back on their feet, or cleaning up the neighbourhood into something resembling a healthy community."[33] Also in 2014, BC housing minister Rich Coleman said, "I’ll go down for a walk in the Downtown Eastside, night time or day time, and it’s dramatically different than it was. It’s incredibly better than it was five, six years ago."[34]

Demographics

Mosaic sidewalk art on East Hastings Street

Using the local area boundaries defined by the City of Vancouver, the DTES was home to an estimated 18,477 people in 2011.[35] In comparison to the city of Vancouver overall, the DTES had a higher proportion of males (60% vs. 50%), had half as many children and youth, had slightly fewer immigrants, and had more Aboriginals (10% vs. 2%).[35] Approximately 10% of the city's Aboriginal population lives in the DTES.

A 2009 study by the Globe and Mail focused on a smaller area of just over 30 city blocks in the DTES core.[3] It indicated that 14% of the residents were of Aboriginal descent, and 9% are status Indians.[3] The average household size was 1.3 residents; 82% of the population lived alone. Children and teenagers made up 7% of the population, compared to 25% for Canada overall.[3] Estimates of the population of the DTES core range from 6,000[32] to 8,000.[36]

Culture

DTES residents say the area has a strong sense of community, and connection to "a rich and authentic cultural heritage."[37] They describe their neighbours as being accepting, with empathy for people with addictions and health issues.[37] Volunteerism, social justice advocacy, and involvement in the arts are strong.[37] In 2010, Sam Sullivan, former mayor of Vancouver, said that in the DTES, "Behind the visible people who clearly have a lot of troubles, there’s a community. Some very intelligent people say this is the cultural heart of the city."[2]

In 2010, the V6A postal area, which includes most of the DTES, had the second-highest concentration of artists in the city.[35] Artists made up 4.4% of the labour force, compared to 2.3% in the city as a whole.[35] The DTES is the location of several annual arts and culture festivals, art galleries, artist-run centres and studios.

Current issues in the DTES core

Drug use

Vancouver police making an arrest in a DTES alley.

A 2010 BBC article described the DTES core as "home to one of the worst drug problems in North America."[38] Illicit drugs commonly used include heroin, cocaine, crack cocaine, crystal methamphetamine, and injected prescription opioids [31] such as fentanyl and OxyContin. Vancouver's drug culture is unusual in that its cocaine users typically inject, rather than snort, the drug.

In 2003, the DTES was home to an estimated 4,700 injection drug users.[35] Studies in 2009 and 2010 estimated HIV prevalence in this population at between 17% and 30%,[31] and studies from 2005 and 2007 estimated the prevalence of Hepatitis C infection at up to 90%. In 2006, DTES residents incurred half of the deaths from illegal drug overdoses in the entire province.[39] Citywide in 2013, illicit drug users were approximately eight times more likely to die than the general population.[31] According to a 2011 study, approximately 20% of injection drug users were also sex workers.[31]

The BC Centre of Excellence in HIV/AIDS tracked rates of illicit drug use in Vancouver between 1996 and 2011. It found large fluctuations over this 15-year period, with the most recent trend being an overall decline in illicit drug use between 2007 and 2011.[31] However, Vancouver Coastal Health reported in 2014 that hospitalizations related to addictions had increased by 89% in four years at St. Paul's Hospital, the closest hospital to the DTES.[29]

A 2016 study of youth who used illicit drugs in Vancouver indicated that 28% had tried unsuccessfully to access addiction treatment in the previous 6 months, with the lack of success mostly due to being placed on waiting lists.[40]

Mental illness

According to a City of Vancouver report in 2012, 40% of homeless people living in the DTES suffer from a mental illness.[41] The Vancouver Police Department reported in 2008 that in its district that includes the Downtown Eastside, mental health was a factor in 42% of all incidents police were involved in.[24]

In recent years, a relatively new trend has emerged in which many of the mentally ill also are also addicted to drugs:

  • A 2016 study of the 323 most chronic offenders in the DTES found that 99% had at least one mental disorder, and more than 80% also had substance abuse issues.[42]
  • A 2013 study of 300 SRO residents in the area found that 95% were substance-dependent, nearly two thirds used injection drugs, nearly half had psychosis and nearly half had a neurological disorder.[43]

Possible explanations for the trend include the vulnerability of the mentally ill to the neighbourhood's drug dealers, and a recent rise in the use of illegal amphetamines such as crystal meth, which can cause permanent psychosis.[44]

In 2013, the city and police department reported that in the previous three years, there had been a 43% increase in people with severe mental illness and/or addiction in the emergency department of St. Paul's Hospital, the closest hospital to the DTES. Violent incidents involving mentally ill people, and apprehensions under the Mental Health Act, had also increased. Mayor Gregor Robertson and police chief Jim Chu called for senior levels of government to "urgently step up" with increased facilities and staff for mental health.[45] Robertson described the mental health crisis to as "on par with, if not more serious than" the DTES HIV/AIDS epidemic that had led to a declaration of a public health emergency in 1997.[45]

Efforts to relocate some of these individuals into halfway houses, such a proposed 39-bed house on Fraser and 39th, have been met with Nimbyism, although residents selected for such projects would be low-risk individuals.[46]

Prostitution

In my 12 years of work as a physician in the DTES, I never met a female patient who had not been sexually abused as a child or adolescent, nor a male who had not suffered some form of severe trauma... Addictions are attempts to escape pain.

— Gabor Maté, [47]

Sex trade workers call the DTES core, and contiguous industrial areas near Vancouver's port, the "low track". Many of the sex workers in this area are survivors of traumatic childhoods, sexual abuse and horrific levels of violence. Most use prostitution to support their drug addictions.[48]

Although they make up only 2% of Vancouver's general population, approximately 40% of Vancouver's street sex workers are Aboriginal.[35] In one 2005 study, 52% of the prostitutes surveyed in Vancouver were Aboriginal, 96% reported been sexually abused in childhood, and 81% reported childhood physical abuse. Some researchers and Aboriginal advocacy groups have linked the overrepresentation of Aboriginals in Vancouver's sex trade to Canada's colonial history, and in particular to the residential schools that previous generations of indigenous Canadians were forced to attend.[49]

Crime and urban decay

As of 2006, reported crime rates in the DTES were higher than in the rest of the city, due mostly to assaults, robberies and public intoxication.[50] Although the DTES is home to 3% of Vancouver's population, it was the location of 16% of the city's reported sexual assaults in 2012.[35] It is widely accepted that rates of crime reporting vary considerably and that vulnerable populations such as DTES residents are less likely to report.[35]

Between 1980 and 2002, more than 60 women went missing from the DTES, most of them sex workers. Robert Pickton was charged with the murders of 26 of these women and convicted on six counts in 2007. He claimed to have murdered 49 women.[51] As of 2009, an estimated 39 women were still missing from the Downtown Eastside.[52]

Efforts to reduce the supply of drugs, through the National Anti-Drug Strategy, have had minimal impact on the easy availability or low prices of illicit drugs in Vancouver.[31] By former mayor Mike Harcourt's estimate, police intercept only 2% of the drugs that enter Vancouver.[53] A large-scale police crackdown on DTES drug users in 2003 made no difference except to displace drug use to adjacent neighbourhoods.[54]

In addition to reported crime, the DTES core has highly visible street disorder in forms such as open drug use and drug dealing, public urination, panhandling, and petty crime. The Strathcona Business Improvement Committee reported in 2012 that area businesses and residents were finding it difficult or impossible to buy affordable property insurance, due to the area's reputation.[55] Some storefronts along the DTES stretch of Hastings Street are still empty, with entire buildings often up for sale.

Poverty

Using the local area boundaries defined by the City of Vancouver, the DTES is significantly poorer, with a median income of $13,691 vs. $47,229 for the city as a whole.

According to a 2009 survey of the DTES core, the median yearly income for single people who live alone is $14,024, but only $6,282 if "government transfer payments" were excluded.[3] In comparison, the Canadian average for this group was more than $21,000.[3] 62% of the residents over the age of 15 were not considered participants in the labour force, compared to 33% in Vancouver as a whole.[3]

The DTES is often referred to as "Canada's poorest postal code", although this is not the case.[5][56][57]

Housing

Hotel Empress at 235 East Hastings is one of the many single-room occupancy hotels in the area. In the fall of 2006, residents were issued eviction notices.[58]

Both homelessness and substandard housing are major issues in the DTES, that confound the neighbourhood's problems with addiction and mental illness. In 2012, there were 846 homeless people in the DTES area (including areas outside the core), including 171 who were on the street rather than in shelters.[35] The DTES homeless made up approximately half of the city's total homeless population.

The area is known for its single room occupancy hotels (SROs),[43] which provide low-cost rooms without private kitchens or bathrooms. In 2011, the DTES area had the following inventory of SROs:

  • 3,975 privately-owned SRO units (101 buildings) renting at an average of $416 per month [35]
  • 1,522 non-profit SRO units (31 buildings) renting at $375 per month, which is the "shelter allowance" portion of welfare for non-disabled single people[35]

Although conditions in SROs vary considerably, they have become notorious for their squalor and chaos. Many are over 100 years old and in extreme disrepair with shortages of basic necessities such as heat and functioning plumbing. In 2007, it was reported that four out of five rooms had bed bugs, cockroaches, and fire code violations.[8] Even at their best, the lack of living space in SROs leads to tenants spending more time in the public spaces of the DTES, including its street-based drug scene.[31]

Local advocacy groups have battled what are known as slum landlords, who have been accused of failing to fix dangerous problems[59][60] and contributing to the growing problem of area homelessness by illegally evicting tenants. In recent years, the city has been slow to force SRO owners to make major repairs, stating that some repairs would be so expensive that owners could not afford to make them without raising rents.[61]

Despite the well-known problems with SROs, the city has implemented a bylaw to discourage their redevelopment, as SROs are for many people the last-available option before homelessness.[62] Advocates for SRO tenants argue that the city's bylaw does not go far enough, as it does not prevent rent increases that can make SROs unaffordable for the poorest residents.[62] Amongst government and community groups, there is widespread agreement that any lost SRO units should be replaced with better-quality social housing, and that there should be at least 10,000 units of housing for low-income single people in the DTES area.[37]

Migration patterns

It is widely believed that many DTES residents would do better in other areas, away from the neighbourhood's predatory drug pushers and pimps.[33] However, DTES residents often have difficulty transitioning away from the neighbourhood. Vancouver Coastal Health, in its 2015 strategy report, said "Many clients with complex health challenges, including mental health and addiction issues, prefer to live in communities outside the DTES. A common barrier that prevents mentally ill and addicted people from living outside of the DTES is a lack of appropriate services and supports, and too often clients who do secure housing outside the neighbourhood return to the DTES regularly because of the lack of supports found in other communities."[63] Ernie Crey, president of the Aboriginal Life In Vancouver Enhancement Society, said in 2014, "We’ve made it Fortress Downtown Eastside; easy to get in, exceptionally hard to get out of."[33] Other DTES residents say that the sense of community and acceptance that they have found in the DTES has made it a unique place of healing for them.[64]

The DTES also has a history of attracting migrants with mental health and addiction issues from across B.C. and Canada.[24][47][63] A 2016 study found that 52% of DTES residents who experience chronic homelessness and serious mental-health issues had migrated from outside Vancouver in the previous 10 years, a proportion that has tripled in the last decade.[65] The same study found that once in the DTES, the conditions of the migrants worsened.[65] A 2013 study of tenants of DTES SROs found that while 93% of those surveyed were born in Canada, only 13% were born in Vancouver.[43]

Gentrification controversy

A protestor's sign during a march for housing

The DTES core is just three blocks from Vancouver's central business district, the most expensive commercial estate in the city.[66] Since the mid-2000s, new development has pushed eastward and into the DTES core, bringing a mixture of market-rate housing (primarily condos), social housing, office spaces, restaurants, and shops.[67] To a lesser extent, development has also accelerated west, south, and north of the DTES core. Prices at the newer retail establishments are typically far higher than low-income residents can afford.[67]

The city requires new large housing developments in the DTES to set aside 20% of their units for social housing. There is no requirement for how many social housing units must be rented at welfare rates; some units rent at rates up to hundreds of dollars a month more.[67]

The position of the city and the provincial government is that new developments improve the quality of life and provide new social housing.[67] Local community groups are sharply divided on the issue. The Carnegie Community Action Project, representing low-income residents of the DTES core, is opposed to the addition of market housing and upscale businesses in the belief that they will drive up prices and displace low-income residents. Property values in the DTES area increased by 303% between 2001 and 2013.[68] The Strathcona Revitalization Committee, representing the family-oriented neighbourhood south of the core, favors new market housing as a way to encourage a stronger retail environment and a stabilizing street presence.[37]

Early 20th-century buildings on East Hastings St

Location of services controversy

Compared to other parts of the city and surrounding areas, the DTES has a high concentration of health and social services. Non-profit organizations and religious groups provide a wide range of services such as free meals and clothing, health care, assistance in dealing with welfare offices, adult education, children's programs, emergency housing, arts and recreation, and legal advocacy. There are organizations specifically addressing the needs of pregnant women, Aboriginals, sex workers, and youth. Proponents of the high level of services say that it is necessary to meet the complex needs of the DTES population.[34]

Although many of these services do help the individuals involved, their location - mostly in the DTES core - has been criticized for attracting vulnerable people to an area where drugs, crime, and disorder are entrenched. In 2014, the Vancouver Sun reported that there were 260 social services and housing sites in the DTES, spending a total of nearly $1 million per day, and that the experts they interviewed "could think of no other Canadian city with a similar concentration of services in one small area."[34] Former Vancouver mayors Philip Owen, Larry Campbell and Mike Harcourt have called for services and social housing to be spread out across the city and region.[33][34][69] Vancouver Coastal Health, in its 2015 strategy report, said that it "remains dedicated to fully supporting clients who wish to remain in the DTES", but that it also favors increased housing and support options outside the area.[63]

The City's 30-year plan is to locate two-thirds of new social housing in the DTES area, partly due to the wishes of the DTES residents it surveyed, and partly due to opposition to social housing in other neighbourhoods.[34] In the DTES Strathcona neighbourhood, there is significant opposition to an expansion of local social services or a concentration of social housing. A 2012 report co-authored by the Strathcona Business Improvement Association and other DTES community groups expresses the view that "Years of experience in other urban centres make it clear that maintaining the DTES as a high or special needs social housing enclave, over the long term will not help to stabilize either the community or the city as a whole."[55]

See also

  • Through a Blue Lens, a documentary shot in the DTES that follows interactions between police officers and drug addicts

References

  1. ^ "Canada's Olympic city has notorious skid row". NBC News. 1 January 2010. Retrieved 1 April 2016.
  2. ^ a b Bishop, Greg (4 February 2010). "In the Shadow of the Olympics". New York Times. Retrieved 2 April 2016.
  3. ^ a b c d e f g Patrick Brethour (13 February 2009). "Exclusive demographic picture: A comparison of key statistics in the DTES, Vancouver, B.C. and Canada". Globe and Mail. Retrieved 3 September 2015.
  4. ^ "2005/06 Downtown Eastside Community Monitoring Report" (PDF). 10th Edition. City of Vancouver. Spring 2007. Retrieved 10 March 2009.
  5. ^ a b "Canada's poorest postal code in for an Olympic clean-up?". The Globe and Mail. 15 August 2008. Retrieved 3 September 2015.
  6. ^ Campbell, chapter 1
  7. ^ Campbell, chapter 1
  8. ^ a b Paulsen, Monte (29 May 2007). "Vancouver's SROs: 'Zero Vacancy'". The Tyee. Retrieved 6 April 2016.
  9. ^ Campbell, chapter 1
  10. ^ Campbell, chapter 1
  11. ^ "Demolish City's Skid Road, Murder Protest Demands". Vancouver Sun, 6 April 1962. p.1
  12. ^ Douglas, chapter 1
  13. ^ a b c Douglas, Introduction
  14. ^ Campbell, chapter 1
  15. ^ Campbell, chapter 1
  16. ^ a b c d e f Campbell, chapter 6
  17. ^ Campbell, chapter 3
  18. ^ Campbell, chapter 3
  19. ^ Campbell, chapter 10
  20. ^ Campbell, chapter 13
  21. ^ "Sanctuary of hope?", Vancouver Courier, 5 March 2008, retrieved 18 October 2012
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  27. ^ "Campbell, chapter 6"
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  33. ^ a b c d Hopper, Tristin (14 November 2014). "Vancouver's 'gulag': Canada's poorest neighbourhood refuses to get better despite $1M a day in social spending". National Post. Retrieved 6 April 2016.
  34. ^ a b c d e Culbert, Lori and Peter McMartin, (27 June 2014). "Downtown Eastside: 260 agencies, housing sites crowd Downtown Eastside". Vancouver Sun. Retrieved 6 April 2016.{{cite news}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  35. ^ a b c d e f g h i j k "Downtown Eastside Local Area Profile 2013" (PDF). City of Vancouver.
  36. ^ Douglas, chapter 1
  37. ^ a b c d e "Vancouver Downtown Eastside Putting it All Together: Plans Policies, Programs, Projects, and Proposals: A Synthesis". Building Community Society of Greater Vancouver. July 2010. Retrieved 5 April 2016.
  38. ^ Mirchandani, Rajesh (10 February 2010). "Vancouver: 'Drug Central' of North America". BBC. Retrieved 4 April 2016.
  39. ^ "Stepping Forward – Improving Addiction Care in British Columbia" (PDF). British Columbia Medical Association. March 2009. Retrieved 11 April 2016.
  40. ^ Kora DeBeck, Thomas Kerr, Seonaid Nolan, Huiru Dong, Julio Montaner, Evan Wood (6 January 2016). "Inability to access addiction treatment predicts injection initiation among street-involved youth in a Canadian setting". Substance Abuse Treatment, Prevention, and Policy. 11 (1). doi:10.1186/s13011-015-0046-x.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  41. ^ Thomson, M.; Woodward, J.; BIllows, S.; Greenwell, P. (20 June 2012), "6th Homeless Count in City of Vancouver – March 2012 Significant changes since 2005" (PDF), City of Vancouver {{citation}}: Missing or empty |title= (help)
  42. ^ Woo, Andrea (6 January 2016). "Vancouver subset struggling to escape corrections system's 'revolving door,' study says". The Globe and Mail.
  43. ^ a b c Lupick, Travis (10 August 2013). "Study finds steep drug and mental health challenges for Downtown Eastside single-occupancy tenants". The Georgia Straight. Retrieved 5 April 2016.
  44. ^ Luk, Vivian (13 October 2013). "How drugs, lack of safe housing fuel Vancouver's mental-health crisis". Globe and Mail. Retrieved 6 April 2016.
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