The latest in our series answering readers’ questions about inequality in California:

Patricia Dunn, a reader in Sonoma wrote: “I have witnessed open urination in San Francisco on the public streets and wonder why portable toilets at minimum are not on city streets.”

We’ve heard from residents about sidestepping human waste on their way to work, and some, including Dunn, have wondered why there aren’t more portable toilets.

A 2017 report by the city of Los Angeles on the state of toilets on Skid Row found that there were just nine public toilets available for its 1,964 homeless residents. By contrast, the United Nations’ standard for refugee camps requires there to be one toilet for every 20 people.

When there is a lack of public toilets, as there is in California, people are forced to relieve themselves elsewhere. Sidewalks become a breeding ground for infectious diseases.

“It really is a human rights issue,” said the Rev. Andrew Bales, of Union Rescue Mission, about the current state of sanitation on Skid Row. In 2014, Bales had an open wound that came into contact with human waste while he was conducting homeless outreach. The wound became infected with flesh-eating bacteria and as a result, his leg was amputated in 2016.

Bales estimates that the population of Skid Row has swelled to around 2,800 people and the number of toilets is still lacking. The shelter he heads recently added 11 toilets for 120 women to use.

“It really is a health hazard, especially for people living on the streets,” Bales said.

In addition, many homeless people are hesitant to use existing public toilets and portable toilets because they pose risks. The 2017 report illustrated how people are afraid of being robbed or attacked in restrooms at night. Some toilets lack locks or even doors. In San Diego, one 24-hour restroom was removed after it became a public nuisance.

In efforts to mitigate the health hazard caused by human waste on the streets, the cities of San Francisco and Los Angeles started public toilet programs.

Facilities are maintained by paid attendants who make sure restrooms are clean and safe for people to use.

Bales thinks these attendants are key to the success of the programs. Though their jobs are to monitor the facilities, they are often the first people to respond to and prevent fatal drug overdoses and to intercept crime.

Since implementing the program in 2014, San Francisco has seen a decrease in requests related to cleaning human waste from the street. There are now 24 facilities throughout the city. The city recently announced that it will keep three restrooms, called Pit Stops, open all day, every day because of the growing demand.

“This is not complicated — when people have access to a clean, safe restroom, they will use it,” Mayor London Breed said in a statement.

Restrooms don’t have to be mobilized to be effective. A report found that adding an attendant to an existing underutilized restroom in LA resulted in an increase of daily uses, to 80 from 30, in the first four months.

In LA, a single Pit Stop site, which includes toilets, a hand-washing station and an attendant, costs $339,000 a year.

It would cost about $450,000 a unit to build subsidized affordable housing in California.

This article originally appeared in The New York Times.

© 2019 The New York Times Company

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