WASH Policy responses for homeless populations during the COVID-19 pandemic: a global review with emphasis on Brazil

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Abstract
Conceptual framework illustrating the structural gap between emergency WASH interventions implemented during the COVID-19 pandemic and long-term policy solutions required to ensure equitable access for homeless populations. Our findings highlight the prevalence of ephemeral, palliative interventions - such as mobile sanitation and temporary sheltering - which, while mitigating immediate health risks, perpetuate a cycle of exclusion. Consequently, we argue for the radical structural integration of WASH services into permanent housing and social protection frameworks, shifting the focus from crisis management to rights-based policy. Homeless populations worldwide face sanitary vulnerability due to limited access to safe WASH. The COVID-19 pandemic exposed this failure, rendering mitigation measures unfeasible and transforming a chronic crisis into a public health emergency. We critically analyze WASH and health policies implemented during the pandemic, focusing on international and Brazilian contexts. Drawing on an integrative review and documentary analysis of 94 sources, evidence was categorized across four analytical axes: Immediate Access, Equity and Inclusion, Sustainability and Political Integration, and Social Context. Findings reveal an ‘inequality of attention,’ referring to the unequal extent to which vulnerable populations are institutionally recognized, prioritized, and incorporated into coordinated responses, despite legal rights. Most literature focused on Social Context, considering WASH a social determinant of health rather than a technical service. This indicates that, for homeless populations, WASH cannot be reduced to service provision; it is shaped by urban exclusion, dependence on public spaces, and policy prioritization. Sustainability and Political Integration revealed decentralized emergency measures relying on existing legal frameworks but lacking central coordination and consistent implementation. We conclude that the pandemic exposed limited institutional resilience. Future WASH policies must be integrated into housing strategies, ensuring dignified, equitable, and sustainable access as a fundamental human right.
Funding Information
  • Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (001)

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