SAN DIEGO — In the trauma wards of this city’s major hospitals, patients from the border have arrived every day with gruesome injuries: skull fractures, broken vertebrae and shattered limbs, their lower extremities twisted into deranged angles.
U.S. Customs and Border Protection officials say they do not tally deaths and injuries resulting from such falls. But new statistics published Friday by University of California at San Diego physicians in the journal JAMA Surgery provide one of the first attempts to measure the toll.
Since 2019, when the barrier’s height was raised to 30 feet along much of the border in California, the number of patients arriving at the UC San Diego Medical Center’s trauma ward after falling off the structure has jumped fivefold, to 375, the physicians found. Falling deaths at the barrier went from zero to 16 during that time, according to the report, citing records maintained by the San Diego county medical examiner.
“I never expected we would have to climb the wall,” said Hector Almeida, a 33-year-old dentist from Cuba, recovering this week in the trauma ward at UC San Diego Health. He fractured his left leg in a fall Monday. Smugglers led his group to the wall with a ladder and told them to climb up and slide down the other side, said Almeida, who said he saw one woman fall and break both legs, and an older man with a severe head injury.
The falling incidents are a subset of the soaring number of injuries, deaths and rescues occurring all across the southern border, where immigration arrests have reached an all-time high under President Biden. Migrants attempting to evade capture have drowned in the Rio Grande, died of exposure in South Texas and Arizona, and disappeared into the Pacific Ocean during smuggling attempts at sea.
What’s different is that the border wall is a man-made obstacle that poses a lethal danger and public health challenge where one did not exist previously.
Jay Doucet, chief of the trauma division at UC San Diego Health, said injuries along the border wall occurred before its increase in height, but the older, shorter version of the barrier, ranging from nine to 17 feet, was not lethal.
“Once you go over 20 feet, and up to 30 feet, the chance of severe injury and death are higher,” he said. “We’re seeing injuries we didn’t see before: pelvic fractures, spinal cord injuries, brain injuries and a lot of open fractures when the bone comes through the skin.”
At Scripps Mercy Hospital, the other major trauma center for the San Diego area, border wall fall victims accounted for 16 percent of the 230 patients treated last month, a higher share than gunshot and stabbing cases, according to Vishal Bansal, the director of trauma.
“I’ve never seen anything like this,” Bansal said in an interview. “This is crazy.” His trauma ward treated 139 border wall patients injured by falls last year, up from 41 in 2020.
Those injured by falls often require complex intensive care and multiple, phased surgeries, according to San Diego physicians. Lacking health insurance, many are ineligible for physical therapy and rehabilitation programs, so they remain longer in hospitals, which absorb millions in unreimbursed costs.
When the Trump administration developed a series of wall prototypes in San Diego in 2017, the most difficult to climb featured a rounded, “barrel-shaped” top. But congressional appropriations for the barrier limited development to existing barrier designs, and Trump told aides he preferred the “spiky” look of the steel bollards, which he considered more intimidating.
Thirty feet was determined to be the optimal height for new barriers, because it balanced cost concerns with U.S. Customs and Border Protection’s desire to give agents more time to respond by making it more difficult to climb, according to officials involved in the design.
Border crossings have increased sharply despite the completion of the 30-foot barrier, records show. San Diego border agents made 16,660 arrests in March, roughly four times as many as they averaged monthly before 2019.
The evidence for former Arizona governor Janet Napolitano’s quip — “show me a 50-foot wall and I’ll show you a 51-foot ladder” — is plain to see along the dusty road that edges the barrier south of San Diego.
Improvised ladders litter the brush along the base of the wall between the San Ysidro and Otay Mesa crossings. Some are fashioned from segments of metal rebar, but the more sophisticated versions use lightweight aluminum with sections that fit together like tent poles.
Smugglers hook them to the top of the wall and hurry migrants 30 feet up into the air, often with little explanation for how to get down. Many of the injuries appear to occur as migrants attempt to descend.
Videos posted to social media have shown athletic young men breezily shimmying up and gripping the bollards like fire poles to zip down the other side. But that type of skilled maneuver is beyond the abilities of many migrants, who typically attempt to climb at night to avoid detection.
“One thing I have noticed is the people who are falling are not as athletic as you think they would be to go up ladder like that,” Doucet said. “They are middle-aged, and a fair number of women, even pregnant women.”
Those who fall backward while attempting to slide down can land on their heads and necks.
Some of the deceased are recent deportees, with homes, jobs and families on the U.S. side, like Efren Medina Villegas, 56, killed in a fall last year near the Otay Mesa crossing in San Diego. “He was trying to get back to his family,” said brother-in-law, Reynaldo Medina, reached by phone.
The Trump administration built 450 miles of new fencing along the Mexico border at a cost of about $11 billion, mostly replacing older, smaller barriers with three-story steel bollards anchored in concrete. Biden halted construction after taking office, but his administration has developed plans to close open gaps, mostly in Arizona.
Republicans have hammered Biden’s decision to halt construction, campaigning ahead of November’s midterm elections with calls to complete the structure.
Ronald Vitiello, former chief of the Border Patrol, said the large number of migrant releases into the United States occurring under Biden has created an incentive and driven ever-riskier attempts to cross. “More traffic equals more misery and death, from all causes,” he said.
In locations where gaps remain in the barrier, injuries and deaths appear to be less frequent. But in border areas with new, continuous segments of 30-foot fencing, such as the deserts west of El Paso, across eastern Arizona, and along California’s Imperial Valley, falling incidents have soared.
UC San Diego Health has converted a postpartum wing into a makeshift recovery ward for border wall patients, with many requiring multiple, phased surgeries and long-term rehabilitation, but lacking insurance.
Amy Liepert, the director of acute care surgery at UC San Diego Health, said the hospital is looking for help, having incurred at least $13 million in costs from border wall patients. “We need policies that fund the care that’s being delivered, in order to make sure we’re providing access for our other populations that need trauma care,” Liepert said.
Liepert said the volume of fall victims from the border wall is straining San Diego’s entire trauma system. “It means trauma surgeons, medical teams, the ICU, therapists and others all have grossly increased workloads,” she said.
Almeida, the dentist from Cuba who broke his leg, said he was knocked off the top of the wall when others in his group rushed to climb a single ladder as Mexican police approached from the south. He was able to partly grab the bollards and slow his fall, sparing a worse injury.
Some smugglers use ropes and harnesses to lower clients safely onto the U.S. side, but that technique has proved dangerous, as well. Earlier this month a Mexican woman wearing a harness got stuck descending the wall near Douglas, Ariz., and died from asphyxiation after hanging upside down for several hours.
U.S. Customs and Border Protection officials say they are amplifying their safety warnings and intensifying efforts to target smugglers. “There are not strong enough words to describe the actions of these smugglers, who are personally responsible for the deaths and injuries they cause to very vulnerable populations,” Patricia McGurk-Daniel, deputy chief of the Border Patrol’s San Diego sector, said in an interview.
She and other Border Patrol officials say the barrier remains an essential border security tool but not an unclimbable one. “Infrastructure alone was never intended to be a stopgap for everything,” McGurk-Daniel said. “We need a multitiered approach that includes technology, boots on the ground and comprehensive immigration reform.”
In trauma medicine, a fall from a height of 40 feet is considered 50 percent lethal, meaning only half of patients survive their injuries, according to Doucet. Bansal described it as “akin to being hit by a car at a moderate rate of speed.”
The San Diego medical examiner reports describe unspeakable injuries. Amet Garcia Mendez, a 31-year-old from Mexico, fell 35 feet to the ground last March, where he was found dead by agents. He died of cranial and chest fractures, with multiple perforated organs, an autopsy showed.
Marifer Jimon Rojas, a 19-year-old from Mexico, died in 2020 from a broken neck and multiple fractures to the skull and sternum. In 2019, an expectant mother fell from the wall, broke her pelvis and lost her unborn son, weeks before her due date.
“It’s absolutely tragic, and it’s not deterring anyone — it’s only harming people,” said Jules Kramer, co-director of the Minority Humanitarian Foundation, a nonprofit in San Diego that has cared for several migrants injured in falls.
Last year, Kramer and her colleague Mark Lane aided an 18-year-old girl who fell from the wall and suffered five broken vertebrae and a leg fracture. They raised nearly $10,000 to medevac the teen to a hospital close to her relatives in Northern California.
She survived and regained the ability to walk, according to her attorney, Priscilla Higuera. “You couple this bigger, taller wall with Title 42 and ‘Remain in Mexico,’ and it’s a recipe for disaster,” said Higuera, referring to pandemic-era border restrictions and the Trump-era program, reinstated by federal courts, that returns some asylum seekers to Mexico.
Higuera said she has multiple clients who suffered injuries after falling, some of whom are discharged from trauma wards and deported or sent to immigration detention.
Smugglers saw through Trump’s border wall using ordinary power tools when they aren’t climbing it. U.S. Customs and Border Protection has tallied more than 3,000 breaches since 2019, records show, and along the barrier Thursday a welding crew was busy fixing a badly damaged span. Nearly every steel bollard had been sawed through and patched with a metal sleeve. Some had been cut through four times.