The Human Cost of Border Enforcement: Trauma and a Public Health Crisis
In late spring 2024, Dr. Brian Elmore was working in a mobile clinic, providing medical treatment to migrants in Ciudad Juárez, Mexico, just south of the U.S.-Mexico border wall. One patient, a Venezuelan man, described to Elmore how Mexican immigration officials broke his arm, and that pepper balls fired by Texas National Guardsmen caused chest injuries. The man had fashioned a splint for his arm, but his chest injury required surgery. Yet, a criminal group controlling the area prevented his transport to a hospital, while the Texas guardsmen observed from the U.S. Side of the Rio Grande. This incident exemplifies a growing public health crisis at the border, driven by increasingly harsh enforcement policies.
A Disparity in Care
Dr. Elmore, an emergency medicine physician who trained in El Paso, Texas, witnessed a stark contrast in healthcare access. While patients in El Paso’s level 1 trauma center received comprehensive emergency care, migrants in Juárez faced limited or no access to medical attention. This disparity prompted him to co-found the Hope Border Institute in 2022, aiming to address the medical needs of migrants in Juárez.
Escalating Injuries and a Public Health Crisis
Trauma doctors began to describe a surge in severe injuries as a public health crisis. Migrants were suffering from falls from the border wall, fractures, spinal injuries, brain damage, drownings in the Rio Grande, and deep lacerations from razor wire. The El Paso area, historically a relatively safe crossing point, became the deadliest section of the world’s deadliest land migration route between 2023 and August 2024.
The Policy of Deterrence
Medical research identified enforcement barriers as the direct cause of these injuries and deaths. The U.S. Border policy of deterrence, initially deployed in El Paso under President Bill Clinton’s Operation Hold the Line, aims to funnel migrants into the most dangerous environments to discourage crossings. Despite this strategy, desperate individuals continue to attempt the journey.
Escalation Under Recent Administrations
The situation escalated further under President Donald Trump, who promised to expand the border wall and implemented other restrictive measures. A national emergency declaration allowed for the deployment of federal troops without congressional approval. The One Big Beautiful Bill Act, passed in July 2023, allocated $170 billion to immigration enforcement, including $46.5 billion for wall construction and roughly $30 billion over four years to Immigration and Customs Enforcement (ICE).
These policies have led to clashes between federal agents and protesters, resulting in at least eight deaths, including U.S. Citizens, involving ICE in 2026. Ironically, migrant arrivals had already begun to decline before Trump’s return to office, and his stricter policies have led to an even sharper decrease in crossings and border-related injuries.
The Use of Pepper Balls
In June 2024, National Guard members on the Texas-Mexico border began using pepper ball guns against migrants gathering on the U.S. Side of the Rio Grande or attempting to breach the concertina wire. These launchers, resembling paintball guns, fire munitions causing irritation to the eyes, nose, and throat. According to a video released by Operation Lone Star, the intent is to deter migrants by firing the balls in their general direction, not directly at them. However, migrants interviewed in Mexico reported being directly hit, resulting in welts and bruises.
A Physician’s Responsibility
Dr. Elmore believes a physician’s responsibility extends beyond the exam room to address the social and political factors contributing to patient illness. He has dedicated his time to caring for migrants in Juárez and writing about the humanitarian and public health crisis he witnesses. He observed that the influx of punitive spending on border enforcement has not addressed the root causes of migration.
The Dangerous Wall
The construction of taller border walls, like the “big, beautiful” wall championed by former President Trump, has demonstrably increased the severity of injuries. Rodney Scott, former Border Patrol chief, admitted in 2019 that wall prototypes were designed to a height where individuals were more likely to lose their balance and fall. Despite this, construction continued, resulting in a significant burden on border trauma centers and costing hospitals millions of dollars.
Trauma surgeons like Jay Doucet at UC San Diego Health argue that the wall’s design was not fully considered, and its outcome was predictable. They have advocated for increased resources for hospitals and a halt to further wall construction, but have faced resistance from elected officials.
The Human Stories
Dr. Elmore’s experiences highlight the individual stories behind the statistics. He recounts the case of Juan, a Mexican man who fell from the wall, sustaining a fractured ankle and requiring multiple surgeries. Juan’s journey, driven by economic hardship, was derailed by the dangerous conditions at the border, leaving him with lasting physical and emotional scars.
Beyond Medical Care
Dr. Elmore emphasizes the need to address the upstream conditions driving migration. He encourages medical students to advocate for their patients and bear witness to the injustices they face. He believes that recognizing the political nature of the pathology is crucial to preventing suffering.