As injuries on border wall pile up, migrants face another barrier: emergency medical care

It was 9:55 p.m. when Mandy made the first call to 9-1-1. Peering between a few inches of space between the steel beams of the U.S.-Mexico border fence, she could see a man in his 30’s, cradling his broken arm. 

“His arm was just kind of dangling,” said Mandy, a local activist who provides food and water to migrants awaiting immigration processing between the two parallel fences that make up the U.S-Mexico border wall near San Ysidro. 

But it would take about 45 minutes, plus Mandy calling 9-1-1 once more and fielding another call from Border Patrol, for emergency personnel to reach the patient. By that time, Mandy and another volunteer had identified three more migrants who suffered possible broken bones after crossing into the United States.

“Border Patrol has driven by a couple times but has not stopped. We have also called EMS a couple times,” the volunteer told the dispatcher. Meanwhile, a woman with a broken back was “wailing in pain,” she said. 

inewsource is only using Mandy’s first name because she says she has been threatened by anti-immigration extremists before. 

That scene from February is just one example of what some volunteers describe as a circuitous, challenging process – full of barriers both physical and perceived – for obtaining emergency medical care for migrants in an unofficial holding area along the border.

Working through the 30-foot beams of the border fence, volunteers say they are often the first ones to provide critical medical assessments of newly-arrived migrants who, in many cases, incur traumatic injuries from scaling and falling from the fence on their way into the U.S.  

“They can’t leave. We can’t get in to help them. And that’s the worst part of that specific area, is we’re pretty much only able to help them with what we can do through the fence,” Mandy told inewsource. 

Shoddy cell service, restricted areas,  unpaved roads and unmarked locations add to the confusion of identifying and locating patients, and ultimately can lead to more delays. 

And delays in care likely lead to worse health outcomes, said Arielle Schecter, a family medicine resident at UC San Diego who volunteers at the border in her personal time. 

“We know from many decades of data that time is essential in recognizing health emergencies or crises and then getting that person to the appropriate level of care,” Schecter said.

“So if there is a delay in activating emergency medical services … then it’s not a stretch of the imagination to surmise that the person is likely not going to get to an appropriate level of care in a timely fashion.”

inewsource talked to a handful of volunteers, including Mandy, who have spent months providing aid at the border. Some said that medical care has at times been delayed by Border Patrol agents who have exclusive control over the gate that opens to the holding area and who gains access. 

Other volunteers say Border Patrol’s response has improved more recently, after multiple complaints from advocacy groups and months of volunteers operating an aid tent on the border. Still, they say medical issues among migrants requiring immediate attention would go unnoticed or have further delays without volunteers. 

Over the past year, tens of thousands of migrants have ended up here – in unofficial holding areas along the San Diego border where they wait hours, at times days, between the fences or in the open desert to be documented by authorities in order to start an asylum claim. 

In San Ysidro, migrants wait between the two 30-foot fences of the border, for many, after having climbed and fallen from the southernmost fence dividing Tijuana from San Diego. They have little food, water or shelter from the elements, much less access to medical care.

Migrants desperate to reach the U.S. where they can initiate an asylum claim are pursuing more dangerous pathways to entry, including scaling the 30-foot border fence. Access through ports of entry remains mostly limited to migrants with appointments made through the CBP One app.

U.S. Customs and Border Protection, which oversees Border Patrol, denies that the migrants are in federal custody, a position which has been challenged by advocates and now questioned by a federal district court judge in a lawsuit over conditions at the holding areas. That case could decide whether CBP is responsible for caring for migrant children there.

Between May and December, San Diego Fire-Rescue received about 3,500 medical calls for service to the border area west of the San Ysidro Port of Entry, where migrants wait in a holding area known as “Whiskey 8.”  

In addition to broken bones related to falls from the fence, volunteers have seen pregnancy issues, respiratory infections, gastrointestinal distress, head lacerations, brain injuries, flare-ups of chronic conditions, fainting, and children with fevers, diarrhea and vomiting. 

In October, one woman died while waiting to be processed between the border fences. In December, a 13-year-old boy died near another holding area in Jacumba. 

‘You could hear her cry in pain’ 

In a region as tightly restricted and surveilled as the U.S.-Mexico border, timely, coordinated responses for migrants with urgent medical needs has, at least in the case from February, eluded authorities.

That night, while Mandy said she was waiting for help at the border fence, medics and Border Patrol were meeting at a crossroads about a mile away. 

In this area, medics rely on Border Patrol to direct them to the exact location and provide access to the patient, according to Mónica Muñoz, a public information officer for San Diego Fire-Rescue. 

But at that meeting point, instead of directing medics to the holding area, Border Patrol told medics there was no patient who needed medical care at the time, according to an incident report from Fire-Rescue. 

Despite calls between Border Patrol and Fire-Rescue and Border Patrol and Mandy, agents couldn’t locate the patients Mandy had called about. Muñoz said in one of those calls, an agent was confused about another migrant with an ankle injury.  

Meanwhile, Mandy said agents drove past her at the border while she tried to flag them down. At one point, she saw the lights of an emergency unit stopped in the distance. She thought help was on the way, but 20 and then 30 minutes passed without help arriving, she said. 

“The woman (was) getting progressively worse. You could hear her cry in pain,” Mandy said.

CBP did not respond to specific questions about this incident, but said in a statement that “officers and agents prioritize the health and safety of all those they encounter by providing appropriate medical care and humanitarian assistance as needed and by routinely coordinating with emergency medical services to assist individuals in need.” 

Muñoz, with Fire-Rescue, said the incident was an outlier and that it’s normally easier for medics to locate patients, though they “are at the whim of the information and assistance provided by CBP agents at the scenes.” 

“The environment at the border is unique and challenging, but we’ve successfully treated and transported thousands and thousands of patients from the areas for many, many years,” Muñoz said. 

Since 2019, serious injuries among migrants who attempt to scale the border fence to get into the U.S. increased fivefold after the fence was raised to 30 feet under former President Donald Trump. Local trauma doctors have documented an extraordinary impact on ERs, now inundated with patients with critical, traumatic injuries. 

Last year broke a new record for the number of patients with border fall injuries treated at local hospitals, and volunteers have already noticed a marked increase in how often they come across injured migrants in just the first few months of this year. 

Last month, 10 were transported to the hospital in a single day after falling from the wall and on a separate day, one woman fell to her death from the top of the northernmost fence after calling out for help and as federal agents and local authorities struggled to reach her. 

‘It’s not a good system’ 

One overcast morning in March, a Colombian woman approached the border fence where, on the opposite side, volunteers were waiting near a tent stocked full of emergency medical supplies.  

Her hands trembled as an aid worker asked in Spanish: “Did you fall?” 

Often the first contact migrants have after crossing, volunteers do their best to assess them for medical needs through the border fence, but identifying those with medical needs and getting them care is difficult.

“I’ve listened to people’s hearts and lungs with my stethoscope through the wall,” Schecter said. With the added challenge brought by nightfall and language barriers, “it’s very hard to provide meaningful even first aid assessments of what’s going on,” she added. 

Some volunteers say the current situation is an improvement from previous months. 

Nearly a year ago, the Southern Border Communities Coalition, among other advocacy groups, filed a complaint with Homeland Security’s Office for Civil Rights and Civil Liberties alleging federal agents were outright failing to provide medical care for migrants in the outdoor holding areas. 

The complaint described a woman who was in pain after a miscarriage, a 79-year-old woman who fell from the wall and a man who suddenly collapsed, saying it took hours to days for agents to summon medical care after volunteers brought the injured to their attention. 

Lilian Serrano, director of the Southern Border Communities Coalition, said now agents are asking migrants about injuries when they arrive to process them – something that didn’t happen before. 

But other obstacles remain. 

One recent morning in February, Adriana Jasso, who leads the U.S.-Mexico Border Program for the American Friends Service Committee, said she called two different Border Patrol numbers eight times before someone picked up. She was calling about a man who was unable to walk after falling from the fence. 

“It’s not a good system,” Jasso said. “There are many obstacles and many challenges (and) added complications.” 

On another occasion, Schecter said she alerted an agent to a migrant who had a severe headache, weakness and a history of strokes.

She told the agent that the woman needed emergency medical care, and while the agent agreed to call medics, the woman’s family would not be allowed to join her in the hospital, Schecter said. 

“I do stay up at night thinking about how horrible that is,” Schecter said. 

From a health care perspective, Schecter said it was also “confusing.” Family members of migrants may be better able to translate for loved ones in hospitals and outcomes for patients who have family support are in general improved. 

Schecter said she’s seen migrant parents who have declined medical care in a hospital because they don’t want to be separated from their children. 

In response to a question about this policy, a CBP spokesperson said the agency “seeks to maintain the unity of families where legally and operationally feasible.”

San Diego Fire-Rescue typically does not allow family members to ride in ambulances, except occasionally “as a last resort,” they may let someone ride in the front seat, the chief said. 

Instead, medics encourage family members to find their own transportation to the hospital.