Its a good photo and it can tell many stories, can be interpreted many ways.

The thing that always gets me about this type of work is the possible exploitation that can take place. Avedon, another splendid photographer, often produced work in this same genre. My own personal opinion, but I just have a gut rejection of photographers making money off other people's misery or perceived misery. Have no idea whether that's the case with this one or not, but I think it can easily become demeaning to the subjects, whether intentionally demeaning or not.