Abele Ikkusek opens the passenger door of an abandoned black pickup and crawls inside. He covers himself with a blanket, pulls his father’s parka up to his chin and lies down on the back seat.
This is where he’ll sleep tonight, in a broken-down truck leaning on a spruce stump where one of its front tires used to be. The overnight temperature will be mild by northern Labrador standards, just around -8C, but Mr. Innusak knows that winter, and nights cold enough to freeze him to death, are coming.
“Tonight will be 93 nights in here,” said Mr. Ikkusek, 57, who digs graves and sweeps up at the local hotel to earn money for food. “Sometimes my legs hurt from the cold. But I am Inuk, and I am strong.”
In Nain, a growing community of 1,200 where nearly 50 families are on a wait list for housing, there are many people like Mr. Ikkusek. Most choose to stay indoors with extended family, but squeezing into crowded homes can also be dangerous. In 2018, a tuberculosis outbreak hit Nain, killing a 14-year-old boy, forcing another 50 people into treatment and exposing a persistent housing crisis in Labrador’s remote Inuit communities.
Tuberculosis – a disease that spreads through the air when someone coughs or sneezes – is a historical problem here, inflamed in large part by overcrowded homes with poor ventilation and a lack of timely access to medical help. This corner of Labrador has the highest rate of tuberculosis in Canada – 248 cases for every 100,000 people, nearly 50 times the Canadian average.
It was an outbreak of tuberculosis in Hebron, an abandoned Moravian mission on the northern tip of Labrador, that led to Nain’s first housing crisis back in 1959. Concerned about cramped living conditions in the community, the federal government relocated most of the Inuit population to Nain. “It became a problem, and it stayed a problem,” said Joe Dicker, the AngajukKak, or mayor, of Nain. “They were promised housing, but that did not happen. They couldn’t keep up. To this day, this community still can’t house everyone properly.”
Nain’s population nearly doubled as a result of the influx of people from Hebron and nearby Nutak, as dozens of families moved into tents on the beach or other temporary housing. Many here trace their roots to that displacement and say they’re still living with the legacy of the 1959 tuberculosis outbreak.
“My grandfather died waiting for a house,” said Mary Andersen, known as Binky. “There are still a lot of people affected by the housing problem in this town. It doesn’t matter who you are, your income, whether you’re Inuk or not, young or old. This has been a historical struggle, it’s been going on for years.”
Ms. Andersen, 23, is one of many educated young Inuit who have returned to Labrador’s coastal communities after university to find there’s no place for them to live. Last summer, she moved into her mother’s three-bedroom house – a modest dwelling shared by 13 people. Unable to find another place to live and frustrated with the overcrowding, she planned to leave Nain, until her employers at the Nunatsiavut government made a home available for her and her young daughter. Many others aren’t so lucky, she said.
“They don’t want to leave, but they don’t have a choice,” she said. “Most people here without a home are couch surfers. It’s like they’re invisible homeless.”
The housing shortage causes more than just tension in families. Children are sometimes removed from homes by provincial child-protection officials because extended families are too crowded together, she said. It tears families apart, she said.
Ms. Andersen’s mother, who is the town manager for the Nain Inuit Community Government, said the community’s families are feeling the pressure of overcrowded homes that are in some cases falling apart. It’s estimated three-quarters of Nunatsiavut’s houses need major repairs.
“We take turns sleeping on the couch. I had to sleep on the floor a couple of times,” said Benigna Ittulak. “It’s very stressful, because you just don’t have space. But that’s just what you do here.”
Ms. Ittulak points to a list on her wall of dozens of local families who have waited years for housing. The community spent three years developing a new subdivision with 29 building lots, but at $250,000 just to prepare and service each site prior to construction because of Nain’s remote location, it’ll be a very long time before they can begin to address demand. A short building season and thawing permafrost only compounds the problem.
“They’ll build four homes and get 60 applicants. It’s that bad,” Ms. Ittulak said.
At the same time, abandoned homes are scattered throughout the community, sometimes taken over by homeless people with nowhere else to go. Social-housing agencies are trying to use those properties to build new housing, but many belong to deceased residents who didn’t leave legal wills behind – which complicates their purchase, Ms. Ittulak said.
The Torngat Regional Housing Association, which provides subsidized rents, says it doesn’t have nearly enough funding to meet the need for homes across Nunatsiavut, a self-governing Indigenous region. In Nain alone, there are nearly 50 families who need housing, Mr. Dicker said.
The provincial government remains responsible for social housing in Labrador, but Nunatsiavut – which signed a land-claim agreement in 2005 – has been slowly trying to take control of its housing needs and improve people’s living conditions. With the help of federal funding, it’s creating a new housing commission to deal with the problem, but it will be years before it can get on top of the shortage.
Several multiunit apartment buildings have been built by the Nunatsiavut government, but they’re not coming nearly fast enough, Ms. Andersen said. Priority is given to families, so single men such as Mr. Ikkusek are low on the list. With no homeless shelters, they’re left to fend for themselves.
Fears of another tuberculosis outbreak, meanwhile, still lurk throughout the community. Most here knew Gussie Bennett, the 14-year-old boy who died in 2018 from TB. Planeloads of people were sent to Goose Bay after the outbreak, which lasted for months and involved more than 50 confirmed cases. Medical authorities assure residents the disease is now under control – while warning them to be on the alert for any symptoms, which can appear to be a regular cold or flu at first.
Tuberculosis – caused by bacteria spread through the air – and poor housing have always been linked in northern Labrador. In a place where it’s not uncommon to have a dozen people or more living in a small, two bedroom home, overcrowding and poor ventilation continues to cause health issues.
“Tuberculosis is spread by people being together in unhealthy situations. We still have those problems,” Mr. Dicker said. “TB has always been here, but it’s just waiting for a situation that allows it to become active again.”
The Nunatsiavut, provincial and federal governments are trying to stop the cycle of tuberculosis outbreaks in Labrador’s remote communities. Ottawa has vowed to eliminate the disease by 2030, setting aside $27.5-million over five years for disease prevention, screening, diagnosis and treatment in Canada’s north.
It’s too early to say how effective that campaign has been so far, but officials say 90 per cent of Nain’s residents have now been screened for TB, a small sign of progress. TB, however, remains a serious challenge across Canada’s north, where the disease rate among Inuit is 290-times higher than for non-Indigenous people.
The 2018 outbreak brought a lot of attention and resources to Nain, including TB clinics, an X-Ray machine and disease specialists. Doctors can now diagnose and screen for tuberculosis in remote, fly-in communities much more quickly than in the past. Money is also being spent on improving nutrition and cutting down smoking rates among Inuit, which also affects immune systems’ ability to fight tuberculosis.
But without fixing the housing crisis, tuberculosis has remained a stubborn problem in the region for a very long time. While patients can now be treated without leaving their communities, except in extreme cases, there’s still a stigma around a TB diagnosis for many older Inuit people. And that only complicates things for officials trying to prevent further outbreaks.
Many here remember the medical boats the Canadian government used to send up the Labrador coast. A confirmed TB diagnosis meant Inuit were sometimes separated from their families for years, while others died in sanitariums far removed from their northern homes.
“They worried if they were diagnosed, they would have to go down south for treatment and may never be heard by their loved ones again,” said Tom Wong, chief medical officer of public health at Indigenous Services Canada. “To this day, some elderly community members have very painful memories when they think about TB.”
Some Inuit are reluctant to seek medical help if they show symptoms. While disease rates have declined, regional health officials caution TB may always be a fact of life in northern Labrador.
“I think we’ve tried to address that stigma, but we still have a long way to go,” said Sylvia Doody, director of health services for the Nunatsiavut government. “This isn’t going to happen overnight. That’s why we need a sustainable approach to eliminate TB, which we’ve never really had in Labrador.”
They know that a medical response is only part of the solution to beating tuberculosis in Labrador’s most remote communities. The disease has as much to do with social inequity among the Inuit, as well as a failure of past government interventions, as it does a lack of medical resources in the region. As long as the cramped, crowded conditions continue, TB can be very difficult to contain.
“Elimination is possible, with improved diagnosis, treatment and addressing the root causes,” said Thomas Piggott, medical officer of health for Labrador-Grenfell Health. “We can get on top of this. Just look at the progress we’ve made in the rest of Canada, where roughly 50 to 80 years ago, rates of tuberculosis were basically what they are today in Labrador.”
The housing crisis in Nain that inflamed the tuberculosis outbreak remains a daily concern for people here. Ms. Andersen and others say a temporary homeless shelter is one of their most pressing needs. That would ease some of the overcrowding in Nain’s homes and reduce the risk that TB can be spread.
In the middle of an outbreak, sleeping alone in a truck can sometimes be safer than being indoors. But for Mr. Ikkusek, a warm place to sleep is all he wants. He’s been homeless for three years, ever since the house he was living in burned down. He’s slept on couches, in trucks, in tents and in whatever makeshift shelter he can build ever since. Sometimes Mr. Ikkusek calls the police on himself, just to have a safe place to sleep. And he’s getting worn out.
“I just want a house over my head. I’m tired of sleeping outside,” he said. “But there’s no houses for people like me here.”
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