The border wall Trump called unclimbable is taking a grim toll

“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 centre for the San Diego area, border wall falling victims accounted for 16 per cent of the 230 patients treated last month, a higher share than gunshot and stabbing cases, according to director of trauma Dr Vishal Bansal.

Families from Brazil wait to be processed by US Border Patrol agents after passing through a gap in the border wall in 2021.

Families from Brazil wait to be processed by US Border Patrol agents after passing through a gap in the border wall in 2021.Credit:AP

“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 US 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.

Five years later, the evidence for 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 nine metres 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 manoeuvre 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,” said Doucet. “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 US 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 725 kilometres of new fencing along the Mexico border at a cost of roughly $US11 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 nine-metre 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, many of whom require multiple, phased surgeries and long-term rehabilitation but lack insurance.

Dr Amy Liepert, the director of acute care surgery at UC San Diego Health, said the hospital is looking for help, having incurred at least $US13 million in costs from border wall patients alone. “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 falling 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 work loads,” 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 US side, but that technique has proven dangerous as well. Earlier this month a Mexican woman wearing a harness got stuck descending the wall near Douglas, Arizona, and died from asphyxiation after hanging upside down for several hours.

US 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 12 metres is considered 50 per cent 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 more than 10 metres 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 $US10,000 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 who don’t assist with climbs are instead cutting through Trump’s border wall, using ordinary power tools. US Customs and Border Protection has tallied more than 3000 breaches since 2019, records show, and along the barrier on 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.

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