Last year, 640 unhoused people died in shelters, hospitals or the streets, 4 percent higher than in 2020, when COVID-19 first struck New York City. The rise in fatalities was fueled by an uptick in drug overdoses, and occurred even as the city’s shelter population reached its lowest level in a decade. 

The 2021 fiscal year was the deadliest on record for New York City’s homeless population, with 640 unhoused people dying in shelters, hospitals or the streets, city data shows. 

A rise in drug overdoses fueled the lethal increase and accounted for at least 237 deaths between July 1, 2020 and June 30, 2021, up from 131 the previous year, according to an annual report compiled by the city’s health and social services agencies.

The overall death toll was 4 percent higher last year than in 2020, when COVID-19 first struck New York City, and more than quadrupled the total a decade ago in the 2011 fiscal year, when 157 homeless residents died. The rise in fatalities occurred even as the shelter population reached its lowest level in a decade, the result of a declining number of families staying in shelters.

Still, at least seven infants died in city shelters last year—down from 17 in the 2019 fiscal year, the report found. Another 16 people under age 24 also died, along with 180 people between ages 25 and 44. Men between ages 44 and 65 accounted for about half of all deaths as the population of single adults in city shelters continues to rise.

About three-quarters of the homeless New Yorkers who died, 489 people, were living in city shelters. About a quarter, or 151 people, were living in public spaces. 

Just over half of the deaths occurred in hospitals, while 174 people died in shelters. 

Another 71 people were found dead on the streets, the report shows.

“That’s astronomical,” said Shams DaBaron, a homeless rights advocate who has lived in shelters and in public spaces. “My biggest fear in the streets was to die homeless.”

He said many of the people who died were likely cut off from friends and family and languishing without adequate housing options or sufficient treatment services. 

“It’s so lonely,” said DaBaron, who goes by the nickname Da Homeless Hero. “That’s just not the way people should die.”

The city’s Departments of Homeless Services (DHS) and Health and Mental Hygiene (DOHMH) have published a joint report on deaths among New Yorkers without a “known street address,” including people who live in DHS shelters or in public spaces, every fiscal year since 2006. City officials posted the latest analysis, which has not yet been reported, to the city’s online open records system in January. 

“We mourn the lives of each and every individual who we served who passed away last year," a DHS spokesperson said in a statement. "Our annual report continues to reflect the numerous challenges the unprecedented COVID-19 pandemic presented across the DSS-DHS system, which, in addition to its impact on the physical health of our clients, also exacerbated the ongoing challenges related to mental health and substance use that New Yorkers experiencing homelessness—and our nation writ-large—are increasingly encountering."

DHS said the agency has improved coordination with local hospitals, trained all shelter staff in Mental Health First Aid and reopened medical clinics at single adult intake facilities to assess client needs and make referrals for treatment. The agency said it has also stepped up health and safety education for parents.

The Human Resources Administration (HRA) publishes additional data on the number of people who died while staying in transitional housing run by the HIV/AIDS Service Administration (HASA). At least 124 HASA clients died last fiscal year—52 more than in 2020—but their causes of death and any other identifying information are not included in the city’s annual report. The document notes that all 124 were living in Single Room Occupancy (SRO) apartments. 

Drug-related overdoses overtook “alcohol misuse or dependence” as the leading cause of death in the DHS/OCME count in 2014, and have since remained the main killer among homeless New Yorkers, reflecting a nationwide increase in fatal drug use.

Not even a lethal pandemic killed more homeless New Yorkers than drugs like fentanyl-laced opioids. 

COVID-19 accounted for about 20 percent of the deaths in the 2020 fiscal year, but dropped to about 5 percent last year, making the coronavirus the fifth leading cause of death. Since the start of the pandemic, at least 135 New Yorkers experiencing homelessness have died of COVID-19, according to DHS data.

Advocates and service providers had braced for a disturbing report as deaths among unhoused New Yorkers mounted last year. In December 2021, the organizers of an annual memorial for people who died while experiencing homelessness received nearly 400 names—more than ever before.

“In 2020 we gathered a record number of names and in 2021 we were surprised to see that the list of names was even longer,” said Nathalie Interiano, the director of policy and advocacy at Care for the Homeless, one of the memorial organizers.

“We know that homelessness robs people of quality of life, of dignity, and in the end, robs people of their health and years off their life,” she added. “This is ultimately a failure of our support systems to meet the needs of our neighbors.”

Poverty, and homelessness in particular, are determinants of poor health outcomes the report notes. People who experience homelessness have a greater incidence of chronic illness, a lower rate of preventive health treatment, a higher risk of violence and a decreased life expectancy than the general population, the report continues. Black and Latino residents account for the majority of the homeless population in New York City.

Coalition for the Homeless Policy Director Jacquelyn Simone said the report illustrates the need for permanent housing, as well as more robust drug treatment interventions. She urged New York City lawmakers to expand access to life-saving opioid overdose tools, like naloxone, and to establish more overdose prevention centers across the five boroughs. Staff at two such facilities that opened last November in Harlem and The Bronx reversed more than 100 overdoses by mid-January, according to city officials. 

“We need to do more to expand access to harm reduction services and we hope the opening of the overdose prevention centers in the city at the end of last year will be the first step in recognizing substance use is a health crisis and should be met with harm reduction responses as opposed to a punitive legal response,” she said.

A 2016 DHS directive required all shelter staff to take overdose prevention and naloxone administration training. At least one HASA site staff member must be trained to use naloxone, also known by the brand name Narcan. The agency said it has trained more than 14,000 shelter employees and more than 17,150 clients on how to administer the life-saving nasal spray.

DHS staff administered naloxone 1,107 times last calendar year and reversed 928 overdoses, the agency added. Emergency medical services staff used naloxone another 139 times on DHS clients. At several shelter locations, residents can receive a prescription for buprenorphine, an opiod replacement medication used to treat addiction, immediately following an overdose.

“Protecting the health and safety of New Yorkers in need as they get back on their feet is our number one priority," a DHS spokesperson said. "As the nation’s challenges with opioid use have reached epidemic proportions, we are proud be part of our city’s broader efforts to reimagine how we support and serve New Yorkers experiencing substance use challenges, including through the recent implementation of the first-in-the-nation safe injection sites in NYC. "

But overdoses have spiked over the past two years, with substance use problems exacerbated by COVID isolation, stress and dysfunction, according to Bronx Councilmember Diana Ayala, chair of the general welfare committee and the former chair of the mental health committee. Ayala said the pandemic interrupted people’s ability to visit treatment centers and interfered with their recovery.

“There was a disconnect,” Ayala said. “There’s a huge lesson to be learned that those centers that treat substance use disorder are a lifeline.” 

The deaths report covers a time period that overlapped with the city’s use of hotels to prevent the spread of COVID-19. The report does not delve into the impact of the hotels, but some advocates and providers say the private rooms may have prevented even more deaths by limiting coronavirus exposure and potentially leading to fewer overdoses. 

During an April 2021 conference on preventing deaths among homeless New Yorkers, researchers from the organization Project Renewal reported that staff “saw fewer OD incidents since hotelling began”—the result of a less stressful environment allowing for more stability. 

A handful of deaths did occur inside the hotels, however, according to a September 2021 response by the Office of the Chief Medical Examiner to a City Limits Freedom of Information Law request. At least 11 people died last fiscal year at more than 50 addresses corresponding with the hotels rented by the city, according to the OCME data. Six were the result of drug overdose, the records show. The other deaths were attributed to heart disease, chronic alcohol use and a “gastroesophageal rupture.” The data does not include people who died in hospitals after being removed from the hotels.

The 2021 report is likely an undercount of New York City’s true homeless death toll. The data does not include homeless New Yorkers who died in nursing homes, young people served by the Department of Youth and Community Development (DYCD) or many others without permanent addresses.

But the report provides additional context about two problems facing Mayor Eric Adams as he settles into office: a citywide rise in violent crime and a failure to move people from public spaces into permanent housing. 

The data shows that 22 homeless New Yorkers were killed by another person last year, compared to 16 in the 2020 fiscal year and 10 in 2019. They included Lukasz Ruszczyk, a Polish immigrant staying under the train tracks in Ridgewood and Glendale who was killed during a fight in May 2021, and Claudine Roberts, a woman who was stabbed to death on a subway in February 2021.

The report also reveals a dramatic rise in the number of homeless New Yorkers who died as a result of extreme weather: 16 people perished because of “exposure to excessive natural cold” compared to four in 2020. Two died due to “excessive natural heat” last year, though the report does not include the number of heat deaths in previous years.

The weather-related deaths occurred as the city struggles to move thousands of people from public spaces and into suitable transitional shelters and permanent apartments.

Simone and other advocates cautioned that Adams’ plan to drive homeless New Yorkers off the subways could expose more people to the dangers of extreme weather above ground. 

Adams said his plan includes opening new drop-in centers, supportive housing apartments and nearly 500 SafeHaven and stabilization beds, which provide more privacy and feature fewer restrictions than congregate shelters. But those longer-term initiatives were not yet reflected in the first week of the “Subway Safety” plan. Between Feb. 21 and 27, police ejected 455 people from trains and arrested 143 others, but outreach workers only managed to place 22 people into shelters, the Mayor’s Office said.

Adams inherited a homelessness and affordable housing crisis that has plagued New York City for nearly two decades. Under the direction of his predecessor, Mayor Bill de Blasio, the city managed to reduce the shelter population by about 15,000 people. At the same time, city agencies cracked down on people staying outdoors. During the pandemic, DHS, NYPD and the Department of Sanitation ramped up so-called “sweeps” in defiance of Centers for Disease Control and Prevention guidance. Advocates have warned that the crackdown only makes street homeless New Yorkers wary of city agencies and less likely to move to shelters, which can be the only clear path to permanent housing.

“Every one of these deaths is a tragedy that was likely preventable,” said Peter Malvan, a homeless rights advocate with the Safety Net Project. “Housing is a basic human need, and housing is what homeless New Yorkers need—not constant harassment by city agencies.”