‘A silent killer’: How Hong Kong’s elderly face deadly heat inside cramped cage homes

2026-03-08 - 01:06

After climbing three flights of stairs in a building in Hong Kong’s bustling Mong Kok district, HKFP found an open metal gate and a wooden door adorned with Spring Festival decorations. The air was stale, thick with humidity from a shared bathroom and dust from the building’s ongoing renovation. There was no breeze entering the flat’s only windows, and temperatures outside were running high for February – a month that used to bring cold weather. Leung Chung-leung, 74, in his cage home in Mong Kok. Photo: Raquel Carvalho. Inside a windowless wooden compartment, which barely fits a single mattress and its occupant, was Leung Chung-leung, wearing a red t-shirt, checked shorts, and rubber slippers. The 74-year-old has lived in this rental space – known as a coffin home – for nearly a decade. He pays HK$2,500 per month for rent, plus about HK$300 every three months for water and electricity. Leung was pushed into the cheapest available accommodation in the city after first losing his job as a cook due to an accident that left him with a permanent leg injury, and later being evicted from a subdivided flat. His raspy voice grew animated when he talked about the summer months. “It’s hard, it gets very hot,” he told HKFP. Throughout the year, in the evenings, Leung relies on an old fan perched on a small table beside his bed. Some nights, he also needs to leave his bedroom door open to catch whatever cool air drifts in from the shared air conditioning unit in the corridor, which operates only between 6 pm and 7 am. When the temperatures soar, he said, he spends more time in a nearby public park than inside his tiny bedroom, where he keeps a television, a plastic kettle, Tupperware containers, and packs of cigarettes scattered on a shelf above his small bed. Sometimes he needs to take three showers a day. “There isn’t much else I can do,” Leung said. Leung Cheung-leung (right), peeking from his bedspace unit. Photo: Raquel Carvalho. In Hong Kong, elderly residents like Leung are bearing the brunt of rising temperatures. Some live in subdivided units carved up from bigger flats. Others are trapped in cage homes, communal rooms partitioned by metal mesh or wooden boards, where residents sleep in coffin-like bunks. HKFP visited 11 inadequate housing units occupied by elderly residents in recent weeks. Most were cage homes, measuring between 15 and 18 square feet, with limited ventilation and few resources to keep residents cool. Residents of cage homes usually need to share a bathroom with 12 or more people. Photo: Raquel Carvalho. After record-high temperatures gripped the city this winter, experts and advocacy groups call for “real action” to tackle extreme heat, as the city’s most vulnerable residents face a silent life-threatening crisis. For generations, Hong Kongers have mostly welcomed the Lunar New Year wrapped in warm layers. But last month, the city registered its hottest Lunar New Year’s Eve since records began in 1884, with the mercury hitting 27.9 degrees Celsius – two degrees above normal. According to the Hong Kong Observatory (HKO), the city also experienced the warmest winter on record over the past three months. While some perceive soaring temperatures as just an inconvenience, others are facing real danger. Most deaths during heatwaves “occur in people over 60 with heart disease, lung disease, diabetes, or on certain medications,” said David Bishai, health economist and director of the School of Public Health at the University of Hong Kong (HKU). Professor David Bishai. File photo: University of Hong Kong. “People who live alone and who don’t have or don’t use AC are vulnerable too,” Bishai noted. Bishai reckons the city’s growing elderly population needs further attention. “It is really the older group that is falling through the cracks and not benefiting from a territory-wide heat health action plan,” he noted. Hong Kong has become one of the world’s most rapidly ageing societies, with more than 20 per cent of its population now 65 or older. It is expected that the proportion will rise to one-third by 2036. In the first quarter of 2024, more than 580,000 individuals aged 65 or above were living in poverty – a 42.9 per cent rise since 2019, according to Oxfam Hong Kong. And, as of the third quarter of last year, government data showed that 247,700 older residents lived alone – a 43 per cent increase compared with 2020. Many elderly residents do not realise how rising temperatures affect their health, said Eva Yeung, senior manager of the community resilience service from the Hong Kong Red Cross. Photo: Lea Mok/HKFP. “Because the heat comes gradually, they may dehydrate slowly while living in environments that are too crowded or too small or too stuffy,” she said. “When they realise it, it may be already too late to alert a health practitioner.” Hot nights In Hong Kong, consistently ranked as one of the least affordable places in the world to own a home or even rent a flat, adaptation to rising temperatures is not equal. Coco Au, 71, a retiree living off disability assistance subsidies, lives in one of 14 coffin homes, partitioned from a flat in Mong Kok, known as one of the world’s densest places. Coco Au, 71, in her cage home. Au moved to a cage home in Mong Kok after her husband passed away about 10 years ago. Photo: Raquel Carvalho. She moved to the bedspace unit about a decade ago after her husband passed away. Au’s cubicle does not even allow for the door to fully open. Wedged between the wall and her single bed, covered with colourful cushions and teddy bears, two small tables hold a rice cooker, an ashtray made out of a can, scissors, a pen, and a paper cup of tea. When the temperatures are mild, Au said, residents often open the flat’s only window, which is just a few metres away from her bedroom. But even that is far from ideal. “There are rats and cockroaches,” she said, caught between amusement and disgust. “It cannot be avoided.” Au has an old air-conditioning unit in her bedroom, but she avoids turning it on for fear of high electricity bills. She, too, pays HK$2,500 in monthly rent plus about HK$300 for utilities when temperatures rise. “Sometimes, I have to open the AC. Otherwise, I cannot stand the heat. But I try not to,” she said in Cantonese. Au’s room, where a paper calendar, clothes, and dozens of red plastic bags dangle above her narrow bed, is so cramped that a doctor has told her go for walks as much as possible, she said, showing how impossible it is to stretch her slim legs inside her cubicle. Much like the lack of space, the high temperatures have also taken a toll on her declining health. “There are nights when I cannot fall asleep,” she said. “It’s very hot, and it’s getting worse every summer.” Coco Au’s cage home. Photo: Raquel Carvalho. A survey released last year by two local groups, CarbonCare InnoLab and the Kwai Chung Subdivided Units Kai Fong Association, found that more than 70 per cent of residents living in “inadequate housing” like subdivided flats experienced fatigue from extreme heat, with many developing symptoms such as headaches, dizziness, and heart palpitations. Meanwhile, about 90 per cent of respondents said the heat had impacted their mental health, leaving them stressed and irritable. The survey also found summer nights in subdivided flats could feel as hot as 44 degrees Celsius in July. Researchers say that Hong Kong’s unique vertical architecture, high density, and growing elderly population present a lethal combination during heatwaves. “Heat definitely can kill more people in the high-density areas,” said Ren Chao, a climate design scholar at the University of Hong Kong. While both hot days and nights have soared in number in recent years, hot nights have increased at a faster rate, she explained. Research conducted by the Chinese University of Hong Kong’s Institute of Future Cities and HKU in 2020 concluded that five consecutive “hot nights” and “very hot days” increase the mortality risk by 6.66 per cent and 3.99 per cent, respectively. (A “hot night” is defined by the HKO as a day when the temperature does not dip below 28 degrees Celsius, while a very hot day is when the temperature reaches 33 degrees Celsius or above.) Sze Lai-shan, deputy director of SoCO, agreed. “It’s becoming hotter, and even when the landlord installs air conditioning, it may not be sufficient.” Sze Lai-shan, deputy director of the Society for Community Organisation (SoCO). File photo: Kyle Lam/HKFP. According to the government’s census, 10 per cent of some 215,000 residents living in inadequate housing are aged 65 and older. However, their share might be higher among tenants of cage homes. Sze estimates that the elderly comprise up to 30 per cent of people residing in cage homes. In recent years, she has watched the heat take a quiet toll, with more residents facing health conditions triggered or worsened by temperatures that seem to climb a little higher each season. “It happens not just to the elderly but also to some middle-aged people. Some develop fevers, coughs, and other issues, which force them to see a doctor,” she said. Alternative solutions Chow Ngan-ying, 73, lives in a cage home in Mong Kok, cluttered with scarves and floral tops hanging at the foot of her bed, small plastic boxes filled with coins, and a portable black fan stacked against the left wall. Two analogue clocks and a plastic lion toy sit on a small table. The bed has no mattress, just three thin blankets. Chow Ngan-ying, 73, in her cage home. She works as a cleaner at a shopping mall during the day and as a street cleaner at night. Photo: Raquel Carvalho. Chow, a women with short hair and a wide smile, has to deal with high temperatures both at home and at work. She juggles two jobs: eight hours cleaning a shopping mall during the day, then another six and a half hours as a street cleaner in the evening. “The mall job is easier because I can get AC there,” she said. How about at home? “I am so tired that I don’t have problems sleeping even when it’s very hot,” she said, with a laugh. Outdoor workers in Hong Kong – including street cleaners, sanitation staff, and construction workers – are increasingly vulnerable to extreme temperatures, with previous surveys showing that many had experienced symptoms of heat exhaustion or heatstroke. In 2023, the city’s Labour Department introduced a three-tier Heat Stress at Work Warning, along with specific guidelines for employers, but these recommendations remain non-binding. Getting ready for another night shift, Chow donned a bright green T-shirt with reflective strips over a black long-sleeve top and a mask across her face. “I just prefer not to spend much time at home,” she said. Advocates not only call for stronger protections for outdoor workers but also say much more needs to be done inside the homes of the most vulnerable residents, where stifling heat prevents many from resting. Chow Ngan-ying’s cage home. Photo: Raquel Carvalho. Hong Kong passed a landmark bill last year regulating the city’s subdivided flats, setting minimum standards that landlords must meet by 2030. Under the new regime, which kicked in last week, each unit must measure at least 86 square feet and have a ceiling height of 2.3 metres, a dedicated toilet, and at least one window. In 2021, Xia Baolong, head of the Hong Kong and Macau Affairs Office, urged the city to “bid farewell to subdivided flats and cage homes” by 2049. But Hong Kong’s new legislation stops short of addressing the city’s infamous cage homes. Rather than being folded into the new Basic Housing Units regime, they will continue to be regulated separately. Different NGOs have been helping residents to cope with extreme heat. Residents of cage homes usually do not have access to a fully-equipped kitchen. Photo: Raquel Carvalho. Oxfam Hong Kong is running a project to support grassroots residents in subdivided units, where electricity meters are often shared, leading to higher costs when using air conditioning. “Some residents do not have enough space to install an air conditioner, while others are worried about the financial burden of switching it on,” said Terry Leung, director of Oxfam’s Hong Kong, Macau, Taiwan Programme. To address this, Oxfam “started working with a technology start-up to provide special coatings and window films that reflect solar radiation and absorb heat, helping to lower indoor temperatures,” he added. Terry Leung of Oxfam Hong Kong. File photo: Oxfam Hong Kong. Yeung said that the Red Cross had deployed a team of volunteers to help declutter and clean the homes of older residents who cannot manage on their own, and distributed dehumidifiers, fans, and other appliances to replace older models that generate excessive heat. Advocates have called on the government to help tenants shoulder the rising cost of electricity bills and embed cooling measures into landlord-required standards. Authorities work with power companies to provide subsidies for low-income households and subdivided flat tenants. When the Observatory issues a “very hot weather” warning, the government opens 19 community halls and centres across all 18 districts as temporary heat shelters, while reserving space in eight additional facilities for daytime relief. Between 10.30 pm and 8 am, shelters have provided bedding for those who need to escape high temperatures. After analysing the 19 heat shelters, Ren and her team concluded that the number was insufficient in most high-risk areas. Yeung agreed, saying that more cooling centres are needed near the places where the most vulnerable communities reside. A survey conducted by Greenpeace Hong Kong and homelessness charity ImpactHK last year showed that while 65 per cent of respondents had not used heat shelters because of their inconvenient locations, a third were not even aware of the facilities’ existence. Silent killer Ren urged the government to introduce additional measures to lower temperatures in the city, including more green spaces downtown and ventilation corridors to avoid heat-trapping concentrations of concrete. Professor Ren Chao. File photo: University of Hong Kong. A spokeswoman for the Environment and Ecology Bureau told HKFP that “the government attaches great importance to combating the challenges posed by extreme heat,” pointing to a series of initiatives “underway to enhance the city’s resilience through urban planning, building design, energy efficiency, and greening efforts.” She said authorities are creating “cool spots” for pedestrians, while reviewing the Hong Kong Planning Standards and Guidelines to incorporate wider climate adaptation and mitigation considerations. About 1.48 million trees and 30.2 million shrubs and herbaceous plants have also been planted across the city over the past five years. However, experts fear that Hong Kong might be lacking a comprehensive strategy to mitigate the heat crisis. In recent years, from Dhaka to Melbourne, cities around the world have appointed chief heat officers, tasked with raising awareness, coordinating emergency responses, and building long-term defences against the dangers of soaring temperatures. “In Hong Kong, our government is very experienced with typhoon preparation, event management, resilience, and recovery,” Ren said. However, “so far, there is no real action” when it comes to addressing extreme heat. A government campaign advising workers about heat stroke. Photo: Earth.org. Ren called heatwaves “a silent killer.” Because health data usually takes about two years to become available, she said, “we cannot see the immediate health impact.” Finance Secretary Paul Chan’s 2026-27 budget speech last month mentioned green initiatives, mostly focusing on waste reduction, recycling plans, and support for green industries. However, it left out specific climate adaptation measures to tackle extreme heat. In a statement reacting to the budget, the NGO Greenpeace slammed the lack of “people-centred climate initiatives” and “zero support” for vulnerable groups, including the homeless, residents living in subdivided flats, and outdoor workers. Chow Ngan-ying working as a street cleaner at night. Photo: Raquel Carvalho. Friends of the Earth, another environmental organisation, called on the government to “mandate heat adaptation plans for public housing estates and schools.” Although Hong Kong has tried to respond to rising temperatures through shelters, improved heat-warning systems, infrastructure updates, and long-term climate policies, advocates and specialists argue that more coordinated adaptation measures are needed as climate change worsens. Ren said that even though research has established a correlation between soaring temperatures and health risks, it is not easy to draft a policy or implement a design that effectively mitigates the problem. “We need interdisciplinary collaborations to understand the changing climate at the district level and also understand this kind of high-density urban context and its population,” she said. “It’s not just about temperature. We need to put it into context, like the temperature plus humidity, temperature plus air pollution, and also considering the social demographic disparity and ageing population issues.” A resident walks in a park when the city is struck by hot weather on May 23, 2025. Photo: Kyle Lam/HKFP. While the “government should have a clear policy strategy and allocate enough resources” to deal with climate change, Ren noted that the private sector, residents, and non-profits also need to do their fair share. Health economist Bishai said that municipal heat health action plans could help citizens, government agencies, and non-profits know what they should do in the event of a heatwave. “Paris was able to lower its heatwave mortality by 90 per cent by having and using a plan like this,” he said. In the French capital, “there is a team of thousands of volunteers who have a list of people who are vulnerable because of housing and health conditions. During heatwaves, they call and check [in] on them,” Bishai said. “Some NGOs are doing this in Hong Kong, but it is not systematic.” Eva Yeung of the Hong Kong Red Cross. File photo: Hong Kong Red Cross. Yeung agreed that more collaboration is needed. Describing extreme heat as a “core issue,” she urged stakeholders with “power and resources” to unite around it. Addressing the problem requires combining “data, science, and technology” to protect the most vulnerable communities, she said. Leung, the 74-year-old living in a coffin home in Mong Kok, believes the record-breaking Lunar New Year’s warmth is likely to be a prelude to a sweltering summer. Asked if he is concerned, the man laughed loudly. “Of course, I am,” he said, sitting on his bed, hands resting on his swollen knees. “I cannot bear the heat.” Raquel Carvalho is a recipient of a climate adaptation grant by the Brazilian Association of Investigative Journalism and the think tank Instituto Talanoa. This article was reported with the support of the grant and is being co-published with The Diplomat.