Cape Town: 24 hours on the street: A photovoice project with homeless people living on the streets of the Central Business District during the COVID-19 pandemic
Alberto Caoci (MPH Student, UCT)
Editorial note: This is a project by a Masters in Public Health student exploring the lived experiences of people who are homeless and living on the streets of Cape Town's central business district during the Covid-19 pandemic. The project uses a photovoice methodology to explore and capture people's experiences.
A study from 2020 about homeless people in Cape Town has pointed out that the city has a very high level of chronic homelessness (1). “Chronic homelessness” describes people who have experienced homelessness consistently for at least a year while struggling with other health conditions such as a severe mental illness, substance abuse, or physical disability (1). Hopkins and colleagues (2020) also highlighted that in 2020, approximately 14,000 people lived on Cape Town’s streets, of which about 60% resided in the central business district (CBD) (1). The COVID-19 pandemic and the economic consequences of the national regulations to curb the spread of the virus have undoubtedly increased these numbers (2). However, if experiencing homelessness means not having stable, safe and adequate housing, nor the means and ability to obtain it, this experience cannot fully be captured without knowing the effects beyond the lack of physical shelter (3).
The photographic project - Cape Town: 24 hours on the street
Cape Town: 24 hours on the street is a photographic project which uses a photovoice participatory action-research methodology. The project aim is to support the initiatives of the non-governmental organisation (NGO) The Service Dining Rooms in order to promote the general health of people living on the streets of Cape Town’s central business district (CBD) during the COVID-19 pandemic. It is underpinned by the Human Right-Based Approach (HRBA). In general, the HRBA provides a framework to incorporate and share ownership of the public health development process with relevant stakeholders, including non-state actors (8). The HRBA gives attention to ways of empowering individuals and communities, particularly the vulnerable and marginalised, to understand and claim their Right to Health(8). Among the core principles and standards of the HRBA, such as accountability, equality, non-discrimination and participation(8), the project is mainly focused on the latter. Participation goes well beyond consultation or a technical addition to project design and includes explicit strategies to empower citizens so that the state and society recognise their expectations (3). The HRBA also considers the contributions of civil society, social movements, and NGOs as a critical force to support the Right to Health claims of society’s most vulnerable people (8).
Nine people living on Cape Town’s streets were invited to be part of the project, to take photographs for 24 hours of their life, discuss their content mainly to investigate their health priorities during the COVID-19 pandemic and promote personal and community change. Among the project results, it is worth highlighting the two exhibitions of the photographs taken by the project’s participants:
1. Consulate of Italy in Cape Town and Cape Institute of Architecture, Urban Regeneration, Inclusion and Innovation, 23 March 2022, and
2. Cape Town. Living on the street, The Service Dining Rooms, 7-9 April 2022) and the video presentation of the project – Cape Town Living On The Street.
Giving voice to the pictures
Thematic analysis of interviews with participants, during which they provided comments on photographs they took during the COVID-19 pandemic, has highlighted that structural violence impacts their health and well-being. Lack of shelter, food, and security are the main issues highlighted by the participants in the project, with COVID-19 only being pointed out as a secondary issue. This supports the argument that any prevention or health promotion program is limited, if not destined to fail, when the economic and social determinants of health are not adequately addressed (9–12).
Social networks and the principle of reciprocity have been crucial to improving the health and well-being of people living on the street during the pandemic, as sharing food and supporting other people’s security needs have shown.
"We live together! If I have money, I can go and buy it. Then we even cook for someone who does not have money. Because tomorrow you do not have money, they have money, so you do not worry" (Bongani)
The principle of reciprocity is beneficial for the survival of groups with scarce material resources (13) and should be preserved and implemented in order to support street people’s strategy to address food insecurity and safety issues.
Soup kitchens have been critical facilities for delivering food and aid for the first needs of people who live on the streets during the pandemic and lockdown. The food quality served in the soup kitchen is relevant in the clients’ opinions, not only for its nutrients but also because of its associated meaning of taking care of others.
"We are lucky to have the Dining. You see in one picture of the hill, that is to show me, that is my road to heaven every day because that is the will I woke up… to get food.
I got lung disease, my lungs are slowly collapsing, so every day it is harder and harder for me to get here, but I know I come here because it keeps me alive here.
These people are a blessing to all of us on the street… the food is eatable, anywhere else you go, the food does not have taste; they just give you everything… man, it is terrible. That is life. That’s how people are. My mother always told me never to give someone something that you do would not put in your own mouth" (Dennis)
Networks among NGOs and Public Facilities have also been critical for improving health services’ availability, accessibility, acceptability and quality for vulnerable people during the pandemic.
Photographic exhibitions
The project’s goals are to raise public awareness on the infringement of the Right to Health on homeless people and to contribute to changing the process of dehumanisation that affects them in Cape Town. Those are pretty ambitious goals, considering the multitudes of homeless people still living on the streets of Cape Town and the social prejudices that affect them, which often do not consider the differences related to backgrounds, life trajectories, length of stay on the street, survival strategies adopted, and social dynamics of the inhabited territory itself. However, during the exhibitions, visitors have shown interest in the photographs, participants’ narratives, and sometimes engaged with them thoughtfully. As pointed out by Wang (1999), the interest is not mainly in the beauty of images but in their power to represent what those who shoot them cannot otherwise communicate (14).
The choice of giving a tool such as disposable cameras to express participants’ points of view on health priorities during the COVID-19 pandemic has indeed solicited their willingness to take pictures as a creative act that has a social and political value.
"The ambition (of the exhibition) was very beautiful. And I loved to be part of that. The reason I did that is to let people know about homeless people. And people must wake up and see what is going on around them.
I really love my pictures. I wanted just to show the world that is going on in Cape Town" (Queeny).
"It was great. I didn’t expect to see a lot of people. It was like a gallery day. I saw a couple of people who were happy, and they even liked my photos. I like this one; I like this one! So, I was very happy that people loved my photos.
It is very good content to conscientise people, so they know what is happening in the streets. Because many people just pass. They do not really know what transpired on the streets. Some people tend to judge homeless people because some are drug-addicted and alcoholic. But from the pictures, they can see people sleeping, cooking, and so on. So that we are also human.
I am happy because people appreciated what I did. I feel special" (Bongani).
It is, therefore, crucial to implement programs that may support the social integration of people living on the street into a more extensive sense of community and consider their different backgrounds and social trajectories.
I like to think about the photographs and the stories around them, as well as food and other exchanged goods and services among homeless people, as gift-giving. The French anthropologist Marcel Mauss viewed reciprocity and gift-giving as binding people together in a social relationship that goes beyond the material value of the object involved or the service offered (15). The givers (the project participants in this instance) do not merely give an object (photographs) but also part of themselves, creating a social bond with an obligation to reciprocate on the part of the recipient(s) (13). Probably the best way to stay within the gift ring with the project participants would be to pay attention to what they want to communicate.
References
1. Hopkins, B. J., Reaper, J., Vos, S. & Brough, G. The cost of homelessness Cape Town. U-Turn 1–32 (2020).
2. Schotte, S. & Zizzamia, R. WIDER Working Paper 2021/56-The livelihood impacts of COVID-19 in urban South Africa: a view from below. (2021) doi:10.35188/UNU-WIDER/2021/994-5.
3. WHO. Key facts: Human rights and health. https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health (2022).
4. OHCHR. International Covenant on Civil and Political Rights. Unite Nations, Human rights office. https://www.ohchr.org/en/instruments-mechanisms/instruments/international-covenant-civil-and-political-rights (1966).
5. OHCHR. International Covenant on Economic, Social and Cultural Rights. Unite Nations, Human rights office. https://www.ohchr.org/en/instruments-mechanisms/instruments/international-covenant-economic-social-and-cultural-rights (1966).
6. OHCHR. Spatial segregation and the right to adequate housing - Report of the Special Rapporteur on adequate housing as a component of the right to an adequate standard of living, and on the right to non-discrimination in this context, Balakrishnan Rajagopal. UN Human Rights. https://www.ohchr.org/en/documents/thematic-reports/ahrc4948-spatial-segregation-and-right-adequate-housing-report-special (2019).
7. UN. Universal Declaration of Human Rights. United Nations (1948).
8. London, L. What Is a Human-Rights Based Approach to Health and Does It Matter? Health Hum. Rights 10, 65 (2008).
9. Farmer, P. Pathologies of Power: Health, Human Rights, and the New War on the Poor. (University of California Press, 2005).
10. Farmer, P. On Suffering and Structural Violence: A View from Below. Race/Ethnicity Multidiscip. Glob. Context. 3, 11–28 (2009).
11. Farmer, P. Infection and Inequalities: The Modern Plagues. (1999).
12. Friedman, I. & Ntuli, A. “Poverty, Human Rights and Health,”. 1–12 (2001).
13. Godbout, J. T. & Caille, A. C. The World of the Gift. (McGill-Queen’s University Press, 1998).
14. Wang, C. Photovoice: A Participatory Action Research Strategy Applied to Women’s Health. J. Women’s Heal. 8, 185–192 (1999).
15. Mauss, M. The Gift. The form and reason for exchange in archaic societies . (Routledge, 2002).
Author Biography
