Decade of tracking homeless deaths in SF sheds light on imperfect system

Note to Readers: This story is part of a package investigating the deaths of homeless residents in San Francisco for the past decade.

See related story: When street life turns from ‘comfort zone’ to casualty

Database: Homeless deaths, 2005-2015

Interactive map: View homeless deaths by location in 2015

A man sleeping outside of a South of Market apartment parking garage was fatally struck by an SUV. A transgender woman never woke up on New Year’s Eve Day after falling asleep on a bench in the Castro. A young man succumbed to an overdose on a sidewalk in the Tenderloin.

These are among the 41 deaths of homeless residents recorded in San Francisco between Dec. 1, 2014 and Dec. 1, 2015.

The potentially deadly outcome of homelessness is often overlooked amid today’s tense political and cultural debate over how best to address the issue, which was heightened in recent weeks by sweeps of tents along Division Street.

But the fact remains that homeless residents suffer from severe health issues at earlier ages and hundreds have died on San Francisco’s streets, their lives cut short, in the past decade.

The San Francisco Examiner obtained details of the homeless deaths on record at the Medical Examiner’s Office and the Public Health Department since July 2005 through the Freedom of Information Act.

A project that sought to memorialize homeless deaths on the streets was blocked by City Hall in recent years, but a review of homeless deaths by a small group of city officials is bringing renewed attention to the mortality of San Francisco’s homeless residents in ways that could change services and rethink approaches to housing.

That could benefit those like 63-year-old Tawfik Ebousassoune, who has lived in San Francisco since 1986 and been homeless for the past five years.

“I do my best to care for myself – mentally and physically,” he said on a recent Tuesday of his life on the street. “I made it to 63.”

When asked how being homeless could impact his lifespan, he said, “I don’t think like that. I am a survivor.” He then motioned up to the sunny sky and said, “That’s up to Him.”

He added, “Some people have everything and they die tomorrow.”


In the past 11 years, between July 1, 2005 and December 1, 2015, San Francisco has recorded the deaths of 415 homeless residents, ranging from a high of 86 in 2006 to a low of 15 in 2009.

That information is tracked by the Medical Examiner’s Office using Homeless Death Forms. The office has filled out the forms since 2005, as a result of a local law that took effect that summer requiring The City keep track of homeless deaths. The forms are completed for those without a fixed address.

There were 41 homeless deaths from Dec. 1, 2014, to Dec. 1, 2015, according to the forms, with nine in December 2014 alone. Around the same time, there were 6,686 homeless in San Francisco, of which 3,505 were living on the streets, with the remainder in shelters, hospitals or jail, according to The City’s 2015 homeless count.

To improve the accuracy of the death reporting, city officials, as part of the review, have started to broaden the reporting scope, including to capture those who may be only temporary housed in Single Room Occupancy hotels or who have U.S. Postal Office boxes but are homeless.

The single leading cause of homeless deaths during the 12-month period was drug related incidents, which were linked to 16 fatalities. There were four homicides, one suicide and eight natural deaths.

Five of the natural deaths were of people between 49 and 56, indicating how living on the streets shortens lifespans. Two were fatally hit by vehicles, one drowned and six cases listed no specific cause of death.

The average age of those who died was 56. Ten were female.

By race, 22 were white, 11 black, five White Hispanic, one Pacific Islander and two were listed as “other.”

HomelessDeathMap (web)

Click the map above to see an interactive data map of San Francisco’s homeless deaths from Dec. 1, 2014, to Dec. 1, 2015. Data is via the San Francisco Medical Examiner’s Office.


San Francisco’s homeless czar Sam Dodge is among those currently reviewing the homeless deaths. “Homelessness can be fatal,” Dodge said. “I’ve always struggled with everyone remembering the humanity in homelessness.”

Dodge said the ongoing quarterly review of the deaths began last spring to “see how we can change our system and tailor our services to try and intervene and save people’s lives.”

“They are all tragic,” Dodge said of the deaths. “Each one of these is a sign of how we could do better.”

Ebousassoune, the self-described “survivor” who has lived in San Francisco’s streets for the past five years, said despite the some $1,000 a month he receives from social security benefits and qualifying for Section 8 housing a few years ago, housing options are out of reach.

“Of course I want housing. Of course you feel better when you have housing,” Ebousassoune said. Specifically, he misses the privacy.

These days the Moroccan native sleeps outside of a parking garage in the Middle Polk neighborhood and occupies a portion of each day writing in a journal in French, being a devotee of French literature.

While he regularly enjoys a $1 cigar and $2 vodka, he says he doesn’t lose control. “I know how to drink,” he said. “I’ve never been in jail in my life.”


Dr. Barry Zevin is the medical director of the Homeless Outreach Team and has provided healthcare for the homeless for the past 25 years.

“I review these homeless deaths and then I work with living people. Everyday it’s on my mind, ‘Is this person going to be the next one I read about in one of these reports?’” said Zevin, who is working with Dodge on the review.

“So much of what we have to learn is in the intimate details of each case,” Zevin added.
Chronic alcoholism is a large culprit, Zevin said, and he intends to recommend ways The City can better address this addiction.

He offers some prescription solutions to alcoholism, like naltrexone and for heroin users Suboxone, both which he thinks should be more widely distributed.

Zevin stressed the importance of focusing more on preventive efforts to keep persons from becoming chronically homeless in the first place.

Homeless death counts in the late 1990s exceeded 100 annually. There are several factors for the lower totals in recent years, Zevin said, including methodology of the count and reduction in heroin-related deaths using the overdose reversal medicine naloxone.

There’s another reason the number has dropped: The City has since built thousands of supportive housing units.

“We have taken the sickest people and provided them with supportive housing,” Zevin said. “This is quite calculated. We sit and have these discussions when we decide who is going to get the housing slot.”

Those suffering from major heart disease, cirrhosis of the liver, severe mental illnesses or AIDS take priority.

“They are at very high risk of dying in the next year or two and we’ve got to get them indoors,” Zevin said. “We do have less people who die literally homeless. How much extra life we’ve given people by housing them, I don’t think the research exists very well for that.”


San Francisco would have had a daily reminder of the homeless who died on the streets if music producer and former psychiatric worker Ian Brennan had gotten his way.

To counter vilification of the homeless and apathy, Brennan proposed in 2008 installing body-shaped memorial sidewalk plaques where homeless died. But that effort was, he said, “in some ways sabotaged by bureaucracy” even though the Board of Supervisors voted to support it at the time.

In a city that has experienced dramatic gentrification since the beginning of the technology boom and following the end of the recession, such a project may seem more relevant than ever today as a new wave of residents are often viewed as being intolerant of the homeless.

Recent high-profile altercations between tech workers and San Francisco’s homeless are widely documented online. In 2013, then-tech AngelHack CEO Greg Gopman took to Facebook to disparage the homeless on Market Street.

“Why the heart of our city has to be overrun by crazy, homeless, drug dealers, dropouts, and trash I have no clue,” he wrote at the time. He referred to the homeless as “the lower part of society” suggesting they should stay out of view. “There is nothing positive from having them so close to us.”

Gopman faced public outcry, and later admitted the error of his ways. He launched an effort to address homelessness, but his plan soon faded away.

Tech start up founder Justin Keller struck a similar tone in an open letter to Mayor Ed Lee last February.

“I shouldn’t have to see the pain, struggle, and despair of homeless people to and from my way to work every day,” he wrote. He added, “The wealthy working people have earned their right to live in the city. They went out, got an education, work hard, and earned it.”

Brennan, who still would like to see the homeless memorial project move forward, said the first time someone stepped over a homeless person on the street marked a cultural shift in the attitude toward the most disenfranchised members of society.

He said he was disheartened to realize that people were more outraged by the idea of the proposed memorial plaques than the reality of the struggles people face on the streets.

Brennan said, “They should be appalled by the death.”

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