Op-Ed: Fractures, trauma, amputations: What medics see when they rescue migrants at the border

Red Cross paramedics transport a Honduran woman to the hospital after she had an asthma attack in the U.S. border city of Piedras Negras, state of Coahuila, Mexico on Feb. 6.
(Julio Cesar Aguilar / AFP / Getty Images)

We found her in a ditch a few steps away from the rusted border fence on the east side of Nogales, Ariz., an inch-and-a-half laceration on her swollen forehead. She came from Guerrero, one of the most violent states in Mexico, and could not remember how she landed on the rugged surface after her grip on the top of the barrier failed and she fell.

Six firefighters carried her to the ambulance, which took her to a helicopter bound for the regional trauma center in Tucson. Captain Lopez recorded the incident in the logbook when we returned to the firehouse: “1107 Medic 2, Engine 2: Dead End Freeport — Jumper/Head Injury.” This was two lines below an entry logged earlier that morning, for a teenage boy who had come down with a 102-degree fever while locked in a cell at the Border Patrol station after agents apprehended him in the desert: “0951 Medic 2: 1500 West La Quinta Rd — High Fever.”

Emergency responders are the first on the scene in any life-threatening situation: car accidents, drug overdoses, heart attacks, shootings. In the southern United States, the list of routine trauma scenarios includes border-related injuries.


For more than a year, while I was volunteering as an EMT and paramedic in Arizona, I witnessed ambulances pick up wounded border crossers so frequently that some of my peers were casually referring to the cement ledge abutting the fence as “the ankle alley.”

Such reinforcements don’t contribute to national security. Instead, they erode the foundations of public safety in communities on both sides of the border.

From EMTs to emergency room doctors, medical professionals see firsthand how, as the design of the barrier changes, so do the patterns of injury: While the previous, shorter fence, built in the 1990s and made of sharp corrugated sheet metal, amputated the fingers of those who tried to scale it, the current 20-foot-tall bollard barrier causes orthopedic fractures and multi-system trauma.

Emergency responders also see that, no matter its design, the fence does not deter unauthorized migrants. Even more often than ambulances are dispatched to “the ankle alley,” they are sent to help those choosing the dangerous journey across what the Border Patrol calls “hostile terrain,” where enforcement is outsourced to the extreme environment.

Migrants rescued in the desert are often severely dehydrated and face a life with permanent kidney damage. Lucky ones, nevertheless: In the last two decades, more than 7,000 people have died crossing the increasingly militarized Southwest border region, some of them from head trauma suffered when they fell off the fence in Nogales.

The border fence, now enhanced by spools of concertina wire, is a key component of “tactical infrastructure,” a term Customs and Border Protection uses to refer to the assemblage of materials and technologies that regulate movement in the name of national security. CBP doesn’t have metrics to assess whether fencing contributes to their border enforcement operations, as the Government Accountability Office noted in a report released last year.


The ineffectiveness of current fences has nothing to do with their size or their length. Barriers along the border have doubled in height since the 1990s and now cover nearly 700 miles, or about one-third of the length of the U.S. Southwest border. But they have failed to stop unauthorized migrants or illegal drugs.

Still, as we can see from the ongoing debate on border security among lawmakers, there are no plans to abandon this brutal and ineffective enforcement strategy.

The stubborn focus on barriers is shortsighted, and it obscures how the deployment of tactical infrastructure harms and threatens the safety of communities that straddle the international boundary, such as Nogales. The same emergency responders who splint broken legs and give IV fluids to wounded border crossers depend on partnerships with fire departments in Mexico. Wildfires and flash floods, air pollution and toxic spills spread from one country to another without regard for borders. Walls don’t stop them.

Arizona is downhill, downwind and downstream from the Mexican state of Sonora. Towns on both sides have their public utilities and transportation systems intermeshed. In Nogales, Ariz., and Nogales, Sonora — together known as Ambos Nogales — an arroyo and a sewage pipeline cross the border through a drainage tunnel underneath the port of entry, where residents line up for passport control steps away from railcars carrying sulphuric acid. Aware of this intertwining, emergency managers and first responders have developed binational partnerships.

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The U.S. Forest Service and Mexico’s National Forestry Commission jointly fight wildfires within 10 miles of the border. Sister cities have mutual aid agreements, which allow them to share resources in cases of emergency on either side. While Americans push fire hoses through the gaps in the fence, supplying their peers in Mexico with water, Mexican volunteers come to the U.S. side to provide manpower in large structure fires and search-and-rescue operations. Such cooperation is more than a century old. It precedes the fence that divides the communities.


Building barriers undermines these achievements and imperils border residents. To speed up the construction of the wall after Sept. 11, 2001, the Department of Homeland Security was authorized to waive more than 30 environmental and other federal laws, including regulations preserving clean air and clean water. Tactical infrastructure, deployed at any human, social or ecological cost, exacerbates the potentially disastrous consequences of natural phenomena.

We saw it happen a decade ago, when the CBP installed a 5-foot concrete barrier inside the drainage tunnel under Nogales. The barrier formed a bottleneck. With heavy rain, water pressure kept rising, until about 1,000 feet of the tunnel collapsed and inundated the city. Mexican authorities declared the area a disaster zone, citing damage to hundreds of homes, while the CBP recovered two bodies, suspecting the drowned were unauthorized migrants. Despite calls for investigations and reparations, the U.S. government’s only concession was an offer to lower the barrier by a foot and a half.

Such reinforcements don’t contribute to national security. Instead, they erode the foundations of public safety in communities on both sides of the border. As U.S. soldiers added more concertina wire to the fence in Nogales earlier this month, an EMT told me he dreads the day he may be called to help someone entangled in its razor-sharp coils.

Ieva Jusionyte is an assistant professor of anthropology and social studies at Harvard University and the author of “Threshold: Emergency Responders on the U.S.-Mexico Border.” She has volunteered as an emergency medical technician, paramedic and firefighter in Florida, Arizona and Massachusetts.

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