Water, Sanitation, and Hygiene (WaSH) insecurity in unhoused communities of Los Angeles, California

Lourdes Johanna Avelar Portillo, Georgia L. Kayser, Charlene Ko, Angelica Vasquez, Jimena Gonzalez, Diego Jose Avelar, Nayib Alvarenga, Meredith Franklin, Yao Yi Chiang

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Access to water and sanitation is a basic human right; however, in many parts of the world, communities experience water, sanitation, and hygiene (WaSH) insecurity. While WaSH insecurity is prevalent in many low and middle-income countries, it is also a problem in high-income countries, like the United States, as is evident in vulnerable populations, including people experiencing homelessness. Limited knowledge exists about the coping strategies unhoused people use to access WaSH services. This study, therefore, examines WaSH access among unhoused communities in Los Angeles, California, a city with the second-highest count of unhoused people across the nation. Methods: We conducted a cross-sectional study using a snowball sampling technique with 263 unhoused people living in Skid Row, Los Angeles. We calculated frequencies and used multivariable models to describe (1) how unhoused communities cope and gain access to WaSH services in different places, and (2) what individual-level factors contribute to unhoused people’s ability to access WaSH services. Results: Our findings reveal that access to WaSH services for unhoused communities in Los Angeles is most difficult at night. Reduced access to overnight sanitation resulted in 19% of the sample population using buckets inside their tents and 28% openly defecating in public spaces. Bottled water and public taps are the primary drinking water source, but 6% of the sample reported obtaining water from fire hydrants, and 50% of the population stores water for night use. Unhoused people also had limited access to water and soap for hand hygiene throughout the day, with 17% of the sample relying on hand sanitizer to clean their hands. Shower and laundry access were among the most limited services available, and reduced people’s ability to maintain body hygiene practices and limited employment opportunities. Our regression models suggest that WaSH access is not homogenous among the unhoused. Community differences exist; the odds of having difficulty accessing sanitation services is two times greater for those living outside of Skid Row (Adj OR: 2.52; 95% CI: 1.08–6.37) and three times greater for people who have been unhoused for more than six years compared to people who have been unhoused for less than a year (Adj OR: 3.26; 95% CI: 1.36–8.07). Conclusion: Overall, this study suggests a need for more permanent, 24-h access to WaSH services for unhoused communities living in Skid Row, including toilets, drinking water, water and soap for hand hygiene, showers, and laundry services.

Original languageEnglish (US)
Article number108
JournalInternational journal for equity in health
Issue number1
StatePublished - Dec 2023

Bibliographical note

Funding Information:
This study was supported by the University of Southern California. Fieldwork and data collection was supported by the University of Southern California Undergraduate Research Associates Program, the USC Graduate School Research and Writing Grant, and the Gold Family Fellowship. During final data analysis and revisions, this research was supported by the Fogarty International Center of the National Institutes of Health under Award Number D43TW009343 and the University of California Global Health Institute. Funding was also provided by NIEHS K01ES031697 to Dr. Kayser that helped bring this research to publication.

Publisher Copyright:
© 2023, The Author(s).


  • Access disparities
  • Homelessness
  • Los Angeles
  • Unhoused communities
  • Urban populations
  • WaSH
  • WaSH access
  • Water insecurity

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural


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