The conditions are often cramped and chaotic. People stretch out across mats, in chairs or on cots. Many have difficulty sleeping and report fears of violence or theft.

There is limited access to bathrooms and showers, few spaces to safely store belongings and there’s an increased chance of becoming seriously ill.

“There is a much higher likelihood of simple coughs and colds, but also in this season of severe influenza, outbreaks are more likely. Then there is lice, scabies, bedbugs, which can all be a result of overcrowding,” said Dr. Samantha Green, one of the authors of a new report on city drop-ins and winter respite centres.

“It is unacceptable for people to be sleeping side-by-side-by-side without access to a shower or enough toilets.”