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Ralph McRaw, who lives on the streets of East Village, counts himself as lucky.
The 68-year-old says it’s not common for him to have to relieve himself in an alley or on a tree – as so many other homeless San Diegans do given the few restrooms in the area – because his body “works pretty well.” He can often make it to a nearby grocery store or hold it when he goes to St. Vincent de Paul, since there’s normally a line.
Having access to public restrooms is an issue San Diego’s homeless population grapples with every day, and it’s an issue that’s knocked on the doors of San Diego’s public officials for decades. Still, access to public restrooms is lacking, and it’s contributing to public health threats that have sickened many.
Since 2000, four grand jury reports have warned that the city’s inadequate public restroom infrastructure could become a public health threat. That’s what happened in 2017 and 2018 when Hepatitis A swept through the city, sickening 582 people and killing 20. Downtown’s homeless camps were ground zero of the outbreak.
In August, the county declared an outbreak of shigella in central San Diego, another preventable disease linked to contact with human feces. There have been 38 confirmed and three probable cases, all among people experiencing homelessness, as of Friday.
In response, the city installed portable restrooms at three sites last week, including outside the Old Central Library downtown, with an estimated monthly cost of about $30,000 per site, according to a city statement.
Advocates say poor toilet accessibility and sanitation come down to a lack of political will to proactively address the problem and opposition from community members who associate bathrooms with problems.
“Because we haven’t solved the homelessness issue in any major way, people are concerned these are going to become hangouts for homeless people, gangs or drug deals, and saying ‘I don’t want one near me because I don’t want this overflowing where I live,’” said Mike Stepner, former city architect and professor of architecture and urban design at the NewSchool, a private for-profit college in San Diego.
Mayor Todd Gloria’s office said in a statement that the emphasis for addressing homelessness should be on more permanent housing, not restrooms.
“The goal here isn’t to add as many permanent public bathrooms as possible,” the statement said. “The goal is to help get unsheltered residents off the streets and into safe, sanitary shelter and permanent housing.”
But advocates and researchers argue the city’s public restroom shortage is not a problem that only affects unsheltered people.
“The public restroom for the pedestrian is just as important as the public rest stop on an interstate highway, and we need to think about them that way,” said Kathryn Anthony, distinguished professor at the University of Illinois’s School of Architecture.
The city has a lot to lose by not addressing this issue, too, as it spends nearly $1 million a year cleaning human feces and other biohazards off the street, according to an NBC7 investigation . The City Council on Nov. 9 approved an additional $3.8 million — on top of about $3 million that was already allocated for the span of five years — for additional sidewalk cleaning in response to the shigella outbreak.
“It’s very expensive to deal with some of these problems,” said Jennifer Felner, assistant professor of public health at San Diego State. “I’d argue it’s likely much more expensive to clean up once we have an infectious disease outbreak that’s killing people, but people are scared of prevention often in general because it costs money.”
The municipal reaction to shigella and the Hepatitis A outbreak read very similarly: Lots of handwashing stations, sidewalk cleaning, installing more portable restrooms and increased sanitation of existing facilities.
The epicenter of San Diego’s homeless population is in downtown, where the Downtown San Diego Partnership’s October count identified 1,026 unsheltered individuals.
Downtown San Diego is currently home to 26 permanent and portable public restrooms, one of which is temporarily closed. That’s two more than before the Hepatitis A crisis, and one of those was installed on Nov. 15 amid the shigella outbreak. Most of those restrooms close nightly, with the exception of five, according to a city map of facilities .
The city stopped closing public restrooms at night after the Hepatitis A epidemic, but that changed with the COVID-19 pandemic when facilities were temporarily closed. Some have not returned to 24/7 service since.
Great inequities exist among open restrooms. Along the waterfront in Downtown, one can visit the infamously expensive $2 million alphabet-themed restroom with a line of tourists out the door, or go just half a mile north along the bay to a dark, littered facility with doorless stalls. Bathrooms across Balboa Park – save for those in the main area near the museums – are often soapless and cluttered with stray toilet paper.
“I just went to the restroom in Golden Hill and it’s horrid,” said local bathroom and parks advocate René Smith. “Why? Because it’s out of sight and out of mind.”
In Mission Bay, showers installed for swimmers have become a draw for unsheltered folks, but police have contained groups sleeping in their cars and tents to limited parts of the coastline.
“I’ve tried other areas, but there’s a bathroom here,” said Jake Adams, who’s nine-months homeless due to severe identity theft. “It’s cold, but there’s a shower.”
The city has tried to open more restrooms downtown in the past decade, but few of those attempts have been successful long-term.
A set of restrooms launched in 2015 along with the opening of Fault Line Park in East Village was part of a public-private partnership with Pinnacle Bayside Development. They were initially closed just two months after they opened despite receiving $1.6 million in public funds, and can currently only be accessed by tracking down the park’s security guard.
The city also installed two Portland Loos – prefabricated, single-stall metal restrooms – in East Village and near Petco Park in 2014, but one was yanked from the ground after just 13 months due to complaints of increased crime. Neither remain in downtown.
The installation of the loos cost nearly double the anticipated amount: about half a million dollars up from around $200,000. Former City Councilmember Marti Emerald, who advocated for the Portland Loos, said they were bound to fail when the chosen locations lacked existing plumbing infrastructure, an issue she says could have easily been avoided.
“These little $70,000 loos wound up ballooning into a project that was well over half a million dollars because they had to jackhammer into streets and well up plumbing,” Emerald said in a phone interview.
In Oregon, where the Portland Loos originated, the facilities have received praise as a safe and inexpensive way to expand restroom access. But the San Diego project has had a very different story, and some say their failure locally is holding up the city from embracing the potential of prefabricated facilities.
Community opposition played a role in the struggles. Although advocates for the project, including homeless advocacy group Think Dignity, were initially able to gain public support, that quickly faded once the facilities became a magnet for homeless residents and crime.
A big part of the opposition came from business owners who complained the loos created poor optics and scared off customers, according to complaints sent to the city.
“The city has heard from business owners and other neighbors who have witnessed incidents of violence, drug use and vandalism at both permanent and portable public restrooms,” reads part of a statement from Mayor Gloria’s office regarding Portland Loos. “As a result, lighting and 24-hour security are requirements for the installation of portable restrooms, and those requirements can create additional logistical challenges in identifying appropriate locations for these facilities.”
San Diego Police Department data obtained by NBC7 in 2017 shows crime near Park Boulevard and Market Street increased 20 percent after the loo was installed, and was subject to the same kinds of complaints that led to the removal of the facility near Petco Park.
“We seem to be trapped in a criminalization mindset around these problems,” said Megan Welsh, associate professor in SDSU’s School of Public Affairs. “So that means when we have put in public facilities, particularly in downtown, immediately they become a focal point for criminal complaints.”
Restroom experts say there are lots of ways to get around the issues of crime and security often associated with public restrooms, looking to other cities who have figured this issue out.
“I think it takes an attendant to make sure (public restrooms) don’t become used for other purposes,” Stepner said, emphasizing that an attendant is different from a security guard. “That’s the European model.”
In Portland, the city hires unsheltered folks to handle restroom upkeep, and features paid advertising on the facilities to help cover the costs, Emerald said.
It is also possible to implement safety measures in public bathrooms through the way they’re designed.
Anthony from the University of Illinois points to two public restrooms at La Jolla Shores as an example. All the doors open directly to the outside where the sinks are, the roof has slits to air out the space and they’re among the first unisex public facilities. They’re also open 24/7.
“You don’t have that gang area in the middle where illicit behavior can occur,” Anthony said.
This conversation also requires the city to consider ways to improve its existing facilities, Think Dignity Executive Director Mitchelle Woodson said.
“We have a currently built infrastructure, and I think the city and the county should invest in improving the existing public bathrooms in our parks and libraries by increasing hours of operation and employing staff,” Woodson said.
There’s also a network of restrooms already available downtown through private businesses, but many limit their use to customers or employees to keep out trouble and save on maintenance costs.
Some bathroom advocates see promise in public-private partnerships that would expand access through local businesses, but say it would require an incentive system and is not a complete solution.
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“The one thing that worries me about pursuing access through a public-private partnership is I don’t want to see the onus fall on private business,” Felner from SDSU said. “I want our government to take initiative and see this opportunity and create the infrastructure we need to get bathroom access.”
Every new restroom added downtown since the Hepatitis A outbreak has been portable, which means they are less expensive than permanent facilities but can still cost a pretty penny.
Requirements for on-site security, lighting and the competitive nature of securing units put the cost per site around $30,000 a month during the shigella outbreak, according to a city statement. Finding appropriate sites that are near homeless camps but don’t block the right of way is also a struggle.
Before the city expanded restroom hours in response to Hepatitis A, unsheltered folks who needed to use the restroom at night were mostly out of luck. But the move created problems for the Parks and Recreation Department, which was ordered to expand service but given no additional funding to do so.
“We didn’t really get any funding increase to support those expanded hours and also we saw an increase in vandalism because when you have bathrooms open after dark, people go into the dark spaces and they’ll use them, causing the destruction to be more prevalent than they were before they were open overnight,” said Andy Field, department director.
Parks and Recreation, which operates all restrooms located at public parks and beaches and contracts with the city to maintain numerous non-park facilities, also has a staffing issue. With hundreds of vacancies and a lack of funds, upkeeping restrooms has become a difficult task.
But this is by no means a single-agency issue. The city’s planning department, parks and recreation, the City Council, the county and Port of San Diego are just a few of the municipal actors in the world of local restrooms, and consensus is lacking over which is the most important.
City Councilman Sean Elo-Rivera, who represents City Heights, the College Area and Mount Hope, sees this as both a roadblock and an opportunity.
“It’s technically complicated because there are a lot of different jurisdictions at play, so that means lots of lawyers and lots of rules, and personally complicated because you’re adding to the number of people involved in coming to a decision,” he said. “But there’s tons of opportunity there as well because if we think of this as a community-wide issue that needs to be addressed, that means that we all should have a stake in solving the problem.”
The web of bureaucracy associated with toilets is an issue Welsh, the SDSU researcher, ran into while compiling a comprehensive list of local facilities for a research project. She said this makes expanding accessibility a “politically challenging problem.”
“It becomes very easy to pass the buck, unfortunately, and to say that it is someone else’s responsibility,” Welsh said.
Lisa Halverstadt contributed reporting to this story.
Clarification: This story was updated to reflect more detailed information about the monthly cost of portable restrooms per site.
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