EL PASO, Texas – It wasn’t until Alma Zavala was on top of the 30-foot steel border fence that she realized how far she had to fall.
“I hugged the wall,” she said. “My hands were bleeding from the rough edges. The guide screamed, ‘Let go! Let go!’ I fell down and felt my bones break.”
Zavala, a young mother from Mexico, lay on a bed at an El Paso shelter Wednesday in a room with four other migrants who survived terrifying falls from a nearly three-story barrier. Between them, they had undergone eight operations in the past month. Zavala’s right leg was attached with an external fixator that looked like scaffolding.
New public health data confirms what border trauma surgeons have suspected since the U.S. government began raising the height of the Southwest border wall to curb migration: The 30-foot-tall fence causes more injuries and is far deadlier than any barrier before it.
Doctors say the falls and deaths are a public health crisis for border communities at a time when the Biden administration and the state of Texas are investing in new border fences amid record fears of migrants.
County hospitals in El Paso and San Diego are seeing patients with fall-related paraplegia at a rate of one per day by 2023, according to their chief trauma surgeons. Injuries range from complex fractures to the lower extremities, including broken ankles, foot and leg bones, to life-changing spinal and skull injuries.
Borderline cases carry “a mortality rate higher than that of COVID in the general population,” said Dr. Susan McLean, medical director of the surgical intensive care unit at University Medical Center in El Paso. “And it’s something that happens up and down the border.”
The Biden administration announced in October that it would waive more than two dozen environmental protection laws to build 20 miles of new border fence in South Texas this year, breaking a presidential campaign promise to halt the construction of new barriers. The fence proposed for Starr County has been described as shorter and “movable.”
But the Department of Homeland Security is already replacing an 18-foot fence with the 30-foot version near San Diego. DHS did not immediately respond to USA TODAY’s requests for comment on whether the agency considers public health outcomes when designing the style or height of border barriers.
In a statement earlier this year about the rise in migrant deaths at the border, Customs and Border Protection said, “Crossing the border illegally is inherently dangerous. CBP urges migrants to seek legal pathways into the United States and not to place their lives in the hands of traffickers whose priority is profit.”
Texas is also poised to expand its border security measures. In addition to the accordion wire and buoy barriers in the Rio Grande built under Gov. Greg Abbott’s Operation Lone Star, the Texas House last week approved a $1.54 billion proposal from the Senate to fund the construction of an additional 50 miles of border fencing.
“Texas will continue to use all tools and strategies to deter and repel illegal crossings between ports of entry as President Biden’s dangerous open border policies encourage migrants from over 150 countries to enter the country illegally,” Abbott spokesman Andrew Mahaleris said in a statement email responses to questions about migrant deaths.
‘This wall cannot be climbed’
When DHS began building a 30-foot fence in Southern California in 2019, then-President Donald Trump described the barrier as impassable: “This wall can’t be climbed,” he said during a tour of Otay Mesa.
Border Patrol officials are rarely so starry-eyed. CBP prefers to use the language “border barrier system” in the agency’s communications to refer to fencing, lighting, cameras, technology and roadways — elements that Border Patrol agents say slow, but don’t stop, migrants from crossing the border illegally and trying to evade apprehension.
The injured women at the shelter, each with a badly broken foot, ankle or leg, climbed over the 30-foot fence the same way: using makeshift rope ladders of braided cord and plastic tubing, the kind favored by smugglers in the El Paso area.
They said they did not realize they would be forced to climb the wall; or that it was so high, or that there would be no way down on the American side. They also did not believe they would be eligible for a visa and never considered presenting at a port of entry.
Once there, in the hands of dangerous traffickers, there was no turning back.
“They don’t treat you like a queen,” Zavala said. “You have to climb.”
She thought of her little son, his delicate health and the money she had to pay for his frequent medical treatment. She let go and landed face down, her foot twisting unnaturally. She said she only felt cold at first and began crawling north on all fours.
Boundary wall fall trauma
From 2000 to 2019 — when construction began on the 30-foot-tall fence in California — El Paso’s University Medical Center recorded a single death from a fall on a border wall, McLean said.
Last year alone at UMC, nine patients died after a fall in the boundary wall. Another 326 people were treated for injuries, with a fatality rate of 2.8%, she said.
The University of California, San Diego Health medical center has documented a similar rate of border wall fall-related trauma: 345 patients this year, January through October, said Dr. Jay Doucet, chief of trauma. The human and economic costs continue to rise, he said.
“October was the worst month we’ve seen: 70 major trauma victims,” he said. “That’s more than two a day.”
There is no comprehensive count of border wall fall-related damage, Doucet said.
Trauma surgeons — especially at university-run hospitals in counties along the U.S.-Mexico border — have been collecting data independently to better understand a public health problem they say trumps politics.
The increase in border wall fall-related trauma increased in San Diego and El Paso after 2020, coinciding with the expansion of the taller 30-foot fence and an increase in migration. Border Patrol migrant encounters rose from 400,000 in fiscal year 2020 during the pandemic to more than 2.4 million in fiscal year 2023.
“We noticed right from 2020 that the numbers had gone up,” McLean said.
“It qualifies as a public health issue,” she said. “It’s a large population and it’s a preventable problem with serious consequences.”
McLean and emergency room doctors have developed some best practices, she said, including regularly ordering CT scans of the spine, since migrants often have spinal cord injuries they may not be aware of yet.
The height of the wall can be deadly. Vicki Gaubeca, associate director of US immigration and border policy for Human Rights Watch, argues that it is by design.
“The rationale is that at 30 feet, your body naturally experiences vertigo, and that makes it easier to fall off the wall,” she said. “We’re talking about the equivalent of a three-story building. It almost seems like they built it that high on purpose.”
Many migrants arrive at the border in poor condition after arduous overland journeys, and their health complicates their path to recovery, Doucet said.
“Their infection rate is higher and their immunity is poor,” he said. “They stay in the hospital much longer; their surgeries are more difficult. Their long-term healing is in doubt. They don’t come back for clinic appointments. They don’t get rehab; often they have to take out their own staples. .”
All of this means local residents are also waiting longer for care, he said.
There are not enough orthopedic surgeons at the hospital to meet the increased need in San Diego. Patients with spinal fractures, whether local or migrant, are waiting up to five days for surgery now, instead of 2.5 days before 2019, he said.
“When the wall was built, comments were made that the wall could not be climbed,” Doucet said. “No one predicted the number of injuries that would occur. The number of injuries seems to be increasing regardless of administration.”
‘If you fight for your life’
Zavala could spend weeks at the shelter while she waits to be cured.
The pain in the lower leg throbs and shoots up to the hip, she said. She was scheduled to undergo another operation. But she said she knew she was lucky: the other men in her group stayed with her in the desert until Border Patrol agents found them and put her in an ambulance.
Immigrant attorney Crystal Sandoval, director of cross-border strategies at Las Americas Immigrant Advocacy Center in El Paso, has worked with hundreds of migrants and refugees at the El Paso-Juárez border and has seen them face even the most dangerous obstacles — regardless of consequence.
“The wall is definitely not a deterrent,” she said.
“If you’re fighting for your life, if you’re fighting not to starve to death, for the future of your children and your family, I don’t think a wall or anything is going to stop you,” she said. “It’s like saying you’re going to forget hope.”