It took one family years to escape their leaking, mouldy state house for a warm, dry home. Social issues reporter Michael Neilson reports on a happy ending for the Pye family in Napier - but a long wait ahead for thousands of other children who end up in hospital through living in the same conditions.
The first five years of Unique Pye's life were spent in a Kāinga Ora home that leaked nearly every time it rained, causing perpetual dampness and mould through the family home.
Unique developed chronic lung disease and asthma which her doctor said was "if not caused by her housing [conditions] at least they are contributing to her deterioration".
"Not to jeopardise her medical wellbeing she needs to be provided with a dry and mould-free living space," a medical note viewed by the Herald read.
Last year, her first year at school, she missed nearly an entire term due to illness.
After a prolonged battle with their government landlord, Kāinga Ora (formerly Housing NZ), Unique's mother, Vannessa, was able to secure Unique and her three siblings a warm and dry alternative home in Hastings nearby.
Pye said just a month after moving into their Hastings home her children - Unique, 6, and three boys Alizae, 4, Casey, 2 and Carter, 6 months - were all starting to breathe clearly.
"It is so much better, and it is so nice not to be always worrying about their health."
Kāinga Ora has denied their previous home was contributing to Unique's poor health. The Government agency has refused the Herald a request for an interview.
Meanwhile, a Herald analysis of 2018 Census data shows that the Pye whānau's situation is far from uncommon.
In 2018, people living in Kāinga Ora properties were more than twice as likely to report their homes being "always damp" as those living in private rentals, and more than 15 times compared with homes owned or held in a family trust by the household.
Kāinga Ora houses were also nearly twice as likely to have tenants to report a section of mould over a piece of A4 paper in size "always", compared with the private rental market, and more than eight times more likely compared with homes owned or held in a family trust by the household.
Mould flourishes in cold and damp homes, especially those poorly built, lacking insulation and adequate heating or with water leaking into or pooling around the house.
Homes that aren't ventilated by having their windows opened regularly were also mould-prone.
Medical experts have told the Herald that with rising demand for social housing they are seeing increasing numbers of desperate people seeking medical attention for preventable respiratory diseases related to poor housing.
For years Pye said she fought to have her landlord, Kāinga Ora, repair the leaks, which as well as clogging her four young children's lungs were even sparking small electrical fires.
When Kāinga Ora did agree to replace the roof in January, a contractor accidentally drilled through a pipe in the ceiling, sending water pouring through the two-bedroom house.
Kāinga Ora initially said the damage to the house was "not serious" and the family would be back "as soon as possible".
"The house is in liveable condition and we would certainly get other suitable accommodation for our customer and her whānau were that not the case," Hawke's Bay area manager Andrew Cairns said at the time.
Pye disputed this, and eventually got her way.
She and her children never returned to the Maraenui house, and ended up spending three weeks in emergency accommodation in a motel while a new home was sought.
Eventually a three-bedroom home was found in Mahora, Hastings.
Pye told the Herald they were all feeling "really good".
"It's warm, it's dry, it's not new but it has new carpet and new paint, and no leaks.
"I love it. I feel so much better not having to constantly worry about how the house might be affecting my children's health."
However, Pye was still not satisfied with the way Kāinga Ora had treated her complaints about their old home.
After the latest leak during the roof repair, initially Kāinga Ora had offered her and three children - including a toddler and a 4-month-old - space in a hostel.
Luckily, Pye was able to stay with family.
"I'm not happy with how Kāinga Ora dealt with me. They weren't worried at all until I went to the paper."
Pye said despite their ordeal, not having to worry constantly about her children's health and battle Kāinga Ora had given her more time for her family, and even some for herself.
She'd started working part-time, and even taken up gardening, but had recently been told most of their backyard was going to be taken up with another Kāinga Ora property.
"There will be barely any room after that," she said.
"But it is much better, and now I just want to make this feel like our home."
Hawke's Bay is among the areas worst affected by New Zealand's housing crisis, and Napier has, per capita, the country's highest demand for social housing.
"We have houses going for extraordinary prices, unaffordable rental prices, overcrowding with people sleeping in cars and garages, and a dearth of social housing supply, along with the floods," Denis O'Reilly, chairman of Waiohiki Community Charitable Trust which is involved in social housing, said recently.
There were 1600 Hawke's Bay households on the social housing register as of last December - an increase of 1000 per cent from five years ago.
Nationally there were 22,501 households on the register in December, up from 3476 in December 2015.
Ministry of Social Development general manager housing Karen Hocking said the causes of the increasing demand for public housing were "complex", but included a shortage of affordable accommodation throughout New Zealand.
Kāinga Ora refused an interview request from the Herald, but in a statement Cairns said of Pye's new placement: "We're pleased we've found Vannessa and whānau a new home in a location with which they're happy.
"We'll continue to support them."
Kāinga Ora refused to answer questions relating to health concerns raised by Pye, including if they had seen her doctor's note confirming Unique's respiratory issues were being worsened in the home.
Cairns said Pye was moved was because she now had three children and her previous home only had two bedrooms.
The home had a new roof installed in January, and was in a liveable condition, he said.
"The previous home is undergoing our normal between-tenancy refurbishment work and will be available for a suitably sized family in the near future."
Kāinga Ora also refused to answer questions about the way Pye said she was treated.
Dr Maryann Heather, a GP at South Seas Healthcare Clinic in Ōtara, Auckland, said the clinic was treating dozens of people each day with housing-related respiratory illnesses.
"Asthma, rheumatic fever, bronchiolitis - a lot of them long-term issues, and all because of the way they are living.
"Poor housing is the biggest issue for our people's health at the moment."
She said a wraparound service is offered through the clinic, with social workers following up after GP visits to advise and advocate for healthier housing.
"We find rentals that are damp, full of mould, with mice and cockroaches. People come in with these housing-related illnesses and we can treat them, but then are sending them back into the same places that made them sick in the first place."
A 2019 study found that over the past 20 years hospitalisations have steadily risen for these preventable illnesses, which are linked to cold and damp housing.
Hospitalisations for bronchiolitis, which causes shortness of breath in children, have doubled since 2000. Of greater concern are admissions for a condition called bronchiectasis, which have tripled over the same period.
Since Covid-19, with job losses and hours being slashed all hitting those on the breadline the hardest, Heather said those figures would likely now be even worse.
"We are seeing two to three families moving in together to cut costs, people living in garages and sleepouts with no carpet and no heaters. It is a real concern, particularly for children."
On the housing quality side, housing advocates say mandatory insulation, ventilation and heating rules should see significant improvements in health outcomes.
But it could be more than a decade before they make any impact on child hospitalisation rates.
Families in cold rental properties can also get help through the Healthy Homes Initiative, which assesses whether they need new curtains, bedding or insulation and part-funds the renovations.
Initially available only to families whose children had rheumatic fever, it was expanded in 2016 to families with preschool children who had a housing-related condition.
However, Heather said while good ideas, in practice these processes all took a lot time and administration, which for families living in poverty added another layer of stress.
University of Otago associate professor Nevil Pierse said Kiwis make about 28,000 visits to the hospital each year as a result of living in cold and damp houses.
Children who went to hospital for these so-called housing-related illnesses returned for further treatment almost four times more often than those hospitalised for other conditions.
And while the illnesses – including asthma, pneumonia and bronchiolitis – were preventable, many children were dying.
"In the next 15 years, those kids are 10 times more likely to die than kids hospitalised from other causes," said Pierse, who is deputy director of He Kainga Oranga/Housing and Health Research Programme.
The Healthy Homes Initiative, while only active for a few years, had already seen hospitalisation rates drop - and this was expected to continue, he said.
Children had been referred to the programme more than 15,000 times between 2013 and 2018 which had led to 1533 fewer child hospitalisations, 9443 fewer doctors' visits and 8784 fewer medicines issued.
Pierse said it was not surprising people were reporting Kāinga Ora homes as having greater issues than the private market, but he expected this to improve greatly as the agency worked through its retrofitting and programme and building new stock.
"They have about 68,000 homes, a lot built a long time ago to pretty poor standards, and they have a huge programme ahead of them but they really need to get cracking because in the meantime it is affecting peoples' lives."
Kāinga Ora general manager national services Nick Maling said all older stock had been retrofitted with ground and ceiling insulation, at least one heater, thermal curtains, carpet in living areas and extraction fans.
Further work was being done to ensure all homes complied with the Healthy Homes Guarantees Act by July 1, 2023.
They also had a wider retrofit programme under way to take these improvements further, spending $500 million over the next two years on 1500 homes including full insulation, double glazing, improved airtightness, ventilation, and new heating.
Meanwhile, for four years now all new builds were thermally designed, meaning they were fully insulated, double-glazed and have thermally sealed fittings around doors and windows, thermal curtains, carpet in the living area and bedrooms, extraction sources in the kitchen and bathroom and electric heaters.
Kāinga Ora has around 67,000 homes with a further 3200 under construction - making up about 6 per cent of residential rentals in New Zealand.