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Pedestrians pass a homeless man begging in front of the Design Exchange on Bay Street in downtown Toronto on Dec. 16, 2013. In the span of one year, starting in October, 2015, London, Ont., recorded 19 deaths. In Toronto, 25 people who circulate through its shelter system die every year on average.Peter Power/The Globe and Mail

For six years, Monica Lindenfield was homeless. She used to scan the city for shelter away from bright lights to avoid encounters with local police. When the weather was good, cardboard at the back of vacant lots served as a bed. But dawn signalled the worst: She would begin to jones for a catalogue of drugs that were readily available on the streets of London, Ont.

"When I was on the street it was like an everyday battle," she said. "I would be feeling [terrible] until I got what I needed into me so I could feel better. It was a whole lifestyle: You live to use, you use to live."

With few friends to keep her safe, she eyed most people with suspicion.

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"You have to invent yourself. I was known as this tough bitch that you don't [mess] with. I've never been in a fight in my life. It was something I had to put forward because if I didn't, I'd get taken advantage of, stolen from – beaten up even," said Ms. Lindenfield, who is now 44.

On an annual basis in London alone, there are 2,600 people searching for emergency shelter, according to Abe Oudshoorn, chair of the London Homeless Coalition. (Nationally, there are about 35,000 Canadians on the streets every night.) Among other things, the coalition is responsible for keeping a death toll of homeless people in the city; in the span of one year, starting in October, 2015, it recorded 19 deaths. By way of comparison, according to the City of Toronto, 25 people who circulate through its shelter system die every year on average – even though Toronto's population is more than seven times the size of London's.

"Homelessness itself is a palliative condition," Mr. Oudshoorn said.

Agencies working with the homeless seek confirmation of death from kin, police, coroners and hospitals, and the information is then relayed to the coalition with the deceased's name and date of birth, he said. The city also stores the information in a database for further use. Mr. Oudshoorn said compiling such data has been going on for about three years, but this is the first time the coalition has publicly released the number of dead.

Ms. Lindenfield suspects the real number is much higher.

"It got to the point where I couldn't go to funerals any more," she said of her time on the streets. "I knew a lot of them. I look around now and I don't see three-quarters of the faces I used to see."

Mr. Oudshoorn said the causes of death in London are manifold, including chronic disease, substance abuse, violence and suicide.

People end up in emergency rooms for their basic health needs, he added. "They have limited access to that primary care, so they go to emergency, which is not set up for long-term management of chronic conditions."

One issue that is compounding the precarious lifestyles of homeless people in London is the city's crystal meth problem.

"There's a significant decline of health as a result of crystal meth use," said Brian Lester, the interim managing director at London CAReS, a city-affiliated service dedicated to mitigating rates of homelessness. "I think you could categorize it as a process of slow death."

Ms. Lindenfield was in the throes of a crystal meth addiction when she was homeless, a drug she characterizes as the worst she's ever used.

"It was hell," she said. "What it did to my body. It's affected my brain, the way I think. Using became as casual as shaking hands."

London is trying to "move away from managing homelessness to ending it" by securing stable housing for people, Mr. Lester said. "Over the next few years, we are going to move away from the status quo of people living long-term in shelter systems to essentially community-based housing in neighbourhoods of their choice with accommodations of their choice." The city is about three or four years into the process, he added.

While Ms. Lindenfield agrees that housing is an important component of ending homelessness, wiping drugs off the streets may be equally – if not more – crucial.

In addition, she said, "having nurses and psychologists in the shelters for anybody who needs to talk or wants help – somewhere they can go to get help getting their life together rather than being brushed off into the gutter."

She is a testament to the fact that people who have experienced homelessness can turn their lives around. She has kicked her drug habits, has a proper home and a partner and is practising art.

"I'm connecting socially again. I just started doing yoga in the fall," she said. "I want to find other women I can be friends with and do normal women stuff."