Katherine “Kat” Yanez stepped out of her tent, took a long drag from her cigarette, and scanned the faces outside a row of tents for signs that someone was overdosing on heroin.

A longtime heroin user herself, Yanez has learned to spot the symptoms: the slackened jaw, pale lips and drooping eyelids. Twice in the past month, she has saved a homeless companion in this camp from death with a shot of naloxone, a drug that reverses the effects of heroin. She keeps a rescue kit in her backpack.

“It’s just a matter of time before someone dies out here,” said Yanez, 33, as she stopped to help a young man slumped over in the midday heat.

Yanez lives at the heart of a sprawling homeless settlement that has formed and grown quickly this summer in the shadows of the Little Earth housing project near the intersection of Hiawatha and Cedar avenues in south Minneapolis.

Their numbers have multiplied in recent weeks, reaching about 60 men, women and children this week, turning this narrow stretch of grass into one of the largest and most visible homeless camps ever seen in Minnesota.

The camp dwellers, who are mostly American Indians, say they feel safer watching over each other in a large group than living scattered on the streets; they are determined to remain despite repeated attempts by the state to clear them out.

The growing tent city has alarmed county health officials and American Indian leaders, who say the lack of hygiene facilities and frequent reuse of needles have made the area ripe for infections and disease outbreaks. The camp has several known cases of a drug-resistant infection known as MRSA, or methicillin-resistant Staphylococcus aureus, which can lead to sepsis, pneumonia, bloodstream infections and death. There are also reports of hepatitis C, sexually transmitted illnesses, and scabies.

The area surrounding the encampment is rife with hundreds of used needles, garbage and human waste, despite stepped-up efforts by campers to keep the area clean. There is just one portable toilet, and many campers bathe in the open near their tents by pouring jugs of water over their bodies.

“This is a public health emergency,” James Cross, founder of Natives Against Heroin (NAH), said as he handed out clean needles and water at the site on a recent afternoon. “Nearly everyone here is sick — some of them seriously — and no one is getting treated.”

Despite the health risks, the growing number of people who arrive each week insist that the tent camp is much better than the alternatives: spending nights in crowded shelters or sleeping alone under bridges.

Like homeless camps that have sprung up on the West Coast, the site has become a haven from the violence and isolation of living on the streets. The tents line a 12-foot-high highway sound wall, which acts as a barrier to thieves and other predators. Elder women, known here as “aunties,” keep an eye on the children, while men patrol the area at night for unwelcome visitors and overdose victims. Several times a day, self-appointed crews of campers walk through the site and pick up trash and used needles.

Rousted twice

By dusk, the site can be almost as quiet as a forest campground. On a humid night last week, the only sounds were children giggling and the steady drone of passing cars.

“We can be killed any day out on the streets,” said Vanessa Howard, 36, gesturing toward the neighborhoods beyond the sound wall. “But standing together as one, we can watch over and protect each other. We have more of a shot at staying alive.”

Even so, tensions with authorities are rising. The camp is situated on property owned by the Minnesota Department of Transportation (MnDOT), which has ordered the campers to leave twice in the past month. On both occasions, people packed their belongings into backpacks and shopping carts and moved to nearby East Phillips Park, then quietly returned after the authorities left. After the last removal, elders called a campwide meeting and insisted that dwellers do a better job picking up their trash and reducing their drug use.

Minneapolis police have no plans to remove people from the camp, a spokesman said, and instead have focused on helping camp dwellers get food, water and social services. Police have also increased patrols around the encampment to deter crime and drug use but also to deepen relationships with the camp dwellers. “We have a humanitarian obligation to make sure that environment is as safe as we can possibly make it,” said Sgt. Grant Snyder, who visits the site daily. “Because the reality is, these folks have nowhere else to go.”

A spokeswoman for MnDOT could not be reached Monday for comment.

Dr. Antony Stately, chief executive of the Native American Community Clinic (NACC) nearby on E. Franklin Avenue, said any attempt to remove the campers will only worsen the health problems by forcing people with serious addictions and infections to scatter, making it more difficult to reach them with medical help and social services.

“They’ll just move on and we’ll lose a great opportunity to deliver a meaningful intervention,” Stately said.

300 needles

For now, the visibility of the campsite has made it easier for people to get help. At least once a week a medical outreach team with the Kola (the Lakota word for “friend”) Project, a nearby drop-in clinic, walks through the site dispensing clean needles, medical supplies and advice to the growing number of tent dwellers.

On Monday, a trio of health workers stopped at the campsite of a man who looked confused and was sweating profusely. “I don’t want to die,” he said, as they approached. The man, Todd Weldon, 48, said he believed that he had MRSA and held out his arms, which were covered with red blisters.

“These are Third World conditions,” said Dr. Ken McMillan, a physician for Kola, as he examined campers.

Travis Earth-Werner, a case manager of Kola’s street outreach team, said the early symptoms of MRSA, including shaking and sweating, can resemble drug withdrawal. He said he’s concerned that some people at the camp are injecting more heroin to combat what they think are withdrawal symptoms, when they actually have MRSA and other serious infections.

The fear of eviction is ever-present at the site, and some camp dwellers say it’s aggravated the health risks by making people afraid to contact authorities when health emergencies occur. Instead of dialing 911 and calling attention to themselves, people in the camp have been reviving overdose victims by injecting them with naloxone.

“I keep saying, you gotta ‘slow your roll,’ ” Yanez said, meaning they should pace their drug intake. “If people don’t control themselves, then we’re going to get bumped [evicted], and no one here wants to get bumped.”

Kariece Wilson, 26, whom camp dwellers have nicknamed “Queen,” said she became sick with a bloodborne infection from a used needle. Now she’s determined to prevent others from suffering the same fate. Each day, Wilson scours the area looking for used needles, which she carefully places in hazardous waste containers. In the two weeks since arriving here, Wilson has collected more than 300 used needles.

“The problem is, no one can force you to quit using,” said Wilson, whose right arm is lined with needle marks. ”You have to want it for yourself. And I’m not sure how many people here want it.”