For two years, San Diego’s fought a losing battle against the homeless camps that now dominate some downtown streets and canyons citywide.

Throughout the fight, San Diego has made a series of decisions that all send the same message: Homeless encampments are not permanent. Don’t get comfortable.

From installing rocks meant to deter homeless people from settling under an overpass to apparently warning groups against public feedings and conducting weekly encampment sweeps, the city is doing all it can to ensure no one thinks the present state is sustainable, all while failing to put forward anything resembling a long-term solution.

And now, it’s confronted with a growing public health crisis that underlines just how unsuccessful those efforts have been.

San Diego homelessness crisis helped spawn an unprecedented hepatitis A outbreak that’s disproportionately battered San Diego’s homeless population and left 15 dead.

The crisis has likely been exacerbated by homeless San Diegan’s lack of access to public restrooms – another outcome of the city’s approach.

The city’s efforts have been aimed at keeping visitors and residents separated from homeless people, supporting businesses that have taken their own steps to keep the homeless away – and keeping homeless people from getting too comfortable on the street.

Those residents and businesses can’t ignore the surge in people living on the street. This year’s point-in-time count showed a 35 percent spike in street homelessness countywidesince 2015. A downtown business group census conducted recently showed the population staying in those neighborhoods more than doubled from August 2015 to August 2017.

Yet efforts to address basic needs for that growing population with amenities such as public restrooms or most recently, temporary hand-washing stations to fight the hepatitis A outbreak, are often met with resistance – and comments one might expect about household pests.

Take two San Diego Metropolitan Transit System officials’ most immediate concerns following the county’s request last month to install two hand-washing stations at an East Village transit hub.

“My only thoughts are that this would probably become a magnet for homeless people to come onto our property just to use the sink (take a bath, brush their teeth, wash their dishes, etc.), especially during non-revenue hours,” MTS security director Manuel Guaderrama wrote in an Aug. 15 email.

An MTS spokesman has since said the agency might be open to alternative locations or methods, including hand wipes, which health experts say aren’t as effective at combating the virus.

Last year, former City Ballpark Administrator John Casey and City Traffic Engineer Linda Marabian joked in a series of emails about wanting rocks the city later installed under the Interstate 5 underpass at Imperial Avenue ahead of last year’s All-Star Game to “look mean.”

Mariabian also acknowledged those settled in tents under the underpass would likely just end up moving elsewhere.

The city’s website also offers public advice on ways to keep away the homeless.

San Diego Police Department web page lists landscape trimming and bench design tips, among other suggestions, to help San Diegans “avoid problems with homeless people.”

Police and park rangers play whack-a-mole on the streets too.

Police are increasingly using a city code meant to address stray trash bins to force homeless San Diegans to move. The city has stepped up patrols on Fiesta Island and around Mission Bay Park, where homeless people in cars and RVs started to settle overnight in greater numbers.

Homeless San Diegans see these scenarios, and the lethargic local reaction to the hepatitis A outbreak, as more evidence of how some of their fellow citizens view them.

“The homeless are the lowest of the low as far as humanity in this city,” said Julie Porter, who’s spent stints on the street and who now moves an old RV from place to place daily to try to avoid tickets from police.

Indeed, Porter and others say, homeless San Diegans often struggle to find restrooms or a safe place to simply be.

Most homeless people I’ve spoken with over two years writing about homelessness say they’re not satisfied with life on the street. They’d prefer a permanent home.

But the more immediate options that are available, such as shelter beds offered by police, can be even less ideal options than the street. They don’t want to abandon partners or pets, stay in a packed shelter or follow rules that seem too rigid to them.

City officials, business owners and residents are caught in their own binds.

There aren’t many permanent solutions available, and the prospect of permanent encampments isn’t part of anyone’s idea of a vibrant downtown.

Residents and businesses describe uncomfortable encounters, drug use, feces and assaults outside their doorsteps. They say homeless people who set up tents or hang around their businesses are deterring visitors or customers.

The city’s taking their complaints. And city officials say those homeless camps often come with crime and public-safety concerns they must address.

Stacey LoMedico, the city’s assistant chief operating officer, has been a player in years of the city’s dealings with its homeless populations.

LoMedico acknowledged public restrooms downtown and elsewhere have been plagued with challenges including prostitution, drug use and instances where blood and urine have been spread on bathroom walls.

LoMedico said the city’s trying to balance the needs of homeless people who simply want to use the restrooms with others who misuse them. And she said those who misuse them may even increase health risks, including hepatitis A, for others.

“Illegal activities, unprotected sex and drug activities actually is not lending itself to help the (hepatitis A) virus and not transmitting the virus,” LoMedico said.

For that reason, LoMedico said, the city’s open to deploying hand-washing stations to combat hepatitis A but is concerned about quickly adding more public restrooms.

Joel Rocco, who co-owns an East Village boxing and mixed martial arts gym, is all too familiar – and dissatisfied – with the city’s balancing act.

He wishes the city would do more – and learn from other cities.

“They need to be examining other cities and how they’ve done it and implement a program that actually works,” Rocco said. “Obviously, what they’re doing now doesn’t work.”

Other cities have tried sanctioned campgrounds and safe parking lots where homeless people can access services and stay overnight without fear of police citations.

San Diego’s poised to start more seriously discussing those options.

A City Council committee is set to hear a report this month on what it would take to establish safe parking and so-called care zones, as part of a broader look at potential short-term homelessness solutions.

A spokesman for Mayor Kevin Faulconer has said his team’s also looking at possibilities. The hepatitis A crisis may add more urgency to such conversations. In some ways, it already has.

On Friday, Faulconer promised city staff would quickly sign off on a county request to deploy temporary hand-washing stations across the city to help combat the crisis.

Faulconer and other city leaders have said homeless camps aren’t ideal.

But the city is learning the hard way that not addressing the basic needs of those living in them can come with side effects too.

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Originally posted at Voice of San Diego.