Los Angeles saw disease outbreaks and 1,000 homeless deaths last year.
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Skid Row is 53 square-block area of downtown Los Angeles where more than 2,500 homeless individuals reside on the streets.
"Skid row is the worst manmade disaster in the United States. There's human waste on the sidewalks. There's all kinds of disease," says Rev. Andy Bales, CEO of Union Rescue Mission on Skid Row, the nation's largest private homeless shelter. He lost his leg to staph infection he contracted while serving the homeless on Skid Row.
But California's homelessness crisis extends far beyond Skid Row and Los Angeles. The state's homeless population has jumped by more than 12 percent in the last five years, and it's part of a national crisis.
More than 1,000 homeless people died on the streets of Los Angeles county last year, according to government figures.
In 2016 Los Angeles voters approved a referendum to spend more than $1.2 billion dollars building new housing for the homeless. It's part of a plan championed by Los Angeles Mayor Eric Garcetti, who declined our interview request.
The city set a target of 10,000 new housing units within a decade that were supposed to take between 3 and 6 years to build. But three years in, just one percent of those apartments will be ready for occupancy by the end of 2019.
"It's going to be too late when they get through spending the money," says Jimmy Anderson, who's lived on Skid Row for 40 years and currently sleeps at Union Rescue Mission. "There's going to be triple the homeless who're out here now."
Building anything in California isn't easy.
The state legislative analyst's office found that "increasing competition for limited housing is the primary driver of housing cost growth in coastal California."
The shortage drives up prices, and some living on the margins are priced out and turn to the streets.
And even after voters approved the more than a billion dollars specifically to build housing for the increasing homeless population, a recent report by LA's controller's office attributed the delays and cost overruns largely to regulatory barriers, permitting challenges, and bureaucratic confusion.
Meanwhile, the existing shelters are running out of space.
"Women and kids are going to take over the [Union Rescue Mission] and all the men are going to have to move back out here onto the street," says Anderson.
The city initially ballparked the permanent units at a median cost of $350,000 a piece. Three years later, the estimated cost rose to more than half a million per unit. Some units are approaching $700,000 each.
Andy Bales says he saw it coming.
"I was a critic 10 years ago of this plan even before it came about," he says. "A very expensive way of spending all the resources on a few and leaving the many out in the cold."
Bales says that given the current emergency the city should reconsider its heavy focus on finding a long term solution.
Property owners in Skid Row and elsewhere in the city would like to see the police clear homeless encampments out of their neighborhoods, which could also help to avert the emerging public health crisis.
But past court settlements prevent that, and a September ruling on a case out of Idaho from the U.S. 9th Circuit Appeals court found that doing so constitutes cruel and unusual punishment when cities don't have "adequate shelter" to accommodate everyone living on the streets. Los Angeles City and County have signed onto a lawsuit challenging that ruling.
"We just firmly believe that the police are not an answer to homelessness," says Becky Dennison of the Venice Community Housing Corporation, which opposes the criminalization of sidewalk camping in Los Angeles.
Dennison says that the focus should remain on building more housing, not arresting people for being unable to find shelter. But proponents of the lawsuit say the city needs guidance from the courts on what constitutes "adequate shelter" before investing in solutions that might free them to enforce anti-camping laws.
Under the increasing pressure in recent months, the city has erected a few of its own Sprung structures to address the crisis. Bales says it's still not nearly enough.
"It's ridiculous. I mean, who would want to leave 44,000 people on the streets to die while you stick with your very expensive plan to help a few?"
Produced by Zach Weissmueller. Camera by Benjamin Gaskell and John Osterhoudt. Music by Kai Engel.