By Dr. Brian Elmore

On March 27, at least 40 migrants were killed in a fiery inferno that engulfed the detention center where they were being held. At least 28 more were sent to local hospitals. These migrants, fleeing crippling poverty and brutal violence in their home countries, traversed thousands of miles on foot and by train and bus. They would have traversed jungle and desert, avoiding gangs and corrupt government officials along the way. 

Dr. Brian Elmore

Their journey ended a stone’s throw from their destination, the United States.  

In medical school, we are taught about the natural pathologies of disease – the slow and insidious spread of cancer, the swelling of limbs and shortness of breath that heralds a progression of heart failure, the waves of an EKG that signify a dying heart. 

I have the privilege of treating migrant patients on both sides of the border. In El Paso, I treat migrants in an Emergency Department a few blocks from the border. In Juarez, I started and run a clinic for migrants with Hope Border Institute, a local NGO. 

The pathologies of the border that I have witnessed are anything but natural. The death and disfigurement of my migrant patients, as well as those killed in the fire, are wholly political, consequences of deliberate decisions generations of policy-makers have made. The border wall, a scar that divides our two communities, is the perfect manifestation of this political pathology. 

In El Paso, I treat patients with mangled extremities, shattered bones and broken backs who have fallen from the wall in a desperate attempt to cross to safety. These injuries are devastating, and will often leave the patient debilitated for life. 

Others will be stranded for hours in the sand and mud, exposed to the unrelenting sun or the piercing cold of the Chihuahuan Desert. 

I’ll never forget one of my first border wall fall patients, a young woman discovered by Border Patrol on a rainy day, moaning in pain at the base of the wall. Her clothes, a dark hoodie and sweatpants, were drenched and covered in sand that mingled with the blood that had drenched through her pants. 

We removed her wet clothes to reveal jeans and a Yankees jersey, the uniform of someone desperate to seem American. We carefully preserved the items stitched into her clothes – a handful of dollar bills, a crucifix, short notes from loved ones. We took trauma shears to her jeans, revealing the jagged knife blade of an exposed bone. 

That is the cost that we have chosen to impose on seeking a better life in America. The pathology is political. 

For those who have crossed the border wall unscathed, the dangers are not over. For those who have the money, a car may be waiting for them on the other side. The driver, often a local teenager, will be anxious and jittery. When spotted by Border Patrol, he will bolt and a chase will ensue. The driver, loaded with a car of human freight, will often lose control of the vehicle.

Border Patrol’s deadly pursuit policy has left dozens of deaths in their wake, including those of bystanders and U.S. citizens. The pathology is political. 

An additional barrier awaits after the border wall. In El Paso, Interstate 10 and Highway 375 wind along the border, paralleling the wall. In a perverse game of Frogger, migrants must dodge traffic traveling in excess of 70 mph to cross this additional crucible. 

Several months ago, a mother and daughter from Central America were crossing the border highway when they were hit by a vehicle. I went in to examine the mother for admission to the ICU after she had been notified desperate attempts to save her daughter had failed. 

She stared blankly ahead, dazed. “Bury her in Virginia,” she told me. Their final destination. I don’t know if the daughter ever reached it. The pathology is political. 

It is not surprising why these migrants and refugees would risk life and limb to make it across that border. In a sadistic abuse of public health policy, Title 42 has blocked access to legal asylum for thousands of migrants by this administration and the last. 

For those turned back and forced to wait at the border, the consequences can be dire. Mexican border communities can be some of the most dangerous in the world. Migrants are vulnerable to abuse, violence and extortion by both gangs and government officials. Human Rights First has documented over 10,000 episodes of violence against migrants forced back by Title 42, including rape and murder. The pathology is political.  

The deaths in Ciudad Juarez should not be surprising. It is a progression of the disease, a reflection of the conscious decisions of our policy-makers to fortify and make dangerous the border and to eliminate any pathways to cross legally and safely. 

It is a reflection of our indifference to human life that generations of our leaders have inculcated in us, of our inhumanity to humans who look different than us and our fleeing crippling poverty and brutal violence. The pathology is rooted in each of us who, through our indifference, have allowed it to spread and to metastasize. We have ignored the disease as it has turned our southern border into a macabre zone of death and disfigurement. 

These migrants did not have to die in the fire. If the pathology is political, the solution is too. 

I don’t want to have to treat anymore migrant patients in my emergency room with mangled extremities and exposed bone, victims of our border policies. 

If Title 42 crippled most opportunities for legal asylum, the Biden administration’s proposed transit ban would deal the final blow to our asylum system. There will be more deaths, more fires, more families forced to climb the wall and dodge traffic on our border highways, more patients in my emergency room clinging to life. 

We must use the fire to reflect on the death and destruction our policies have created, on the human cost of a broken immigration system that we have ignored for too long. 

Brian Elmore is an emergency medicine resident in El Paso.