Opinion: A surge in border wall deaths and injuries has stressed San Diego County’s trauma system

Border Patrol agent Justin Castrejon speaks in front of newly replaced border wall sections Thursday, Sept. 24, 2020, near Tecate, Calif.

Liepert, M.D., is medical director of Acute Care Surgery at UC San Diego Health. She lives in San Diego.

An unseen public health crisis is happening along the southern border of San Diego and Imperial counties, potentially impacting all community members. It has affected — and will continue to significantly affect — major local health-care providers and has slowed access to hospital beds and trauma care.

Nora Vargas, Pedro Rios and Dr. Amy E. Liepert write about a surge in deaths and injuries from immigrants scaling and falling off a taller border wall.

In 2019, the U.S.-Mexico border wall was raised from its previous height (a range of 8 to 17 feet) to 30 feet along the San Diego and El Centro sectors. The height increase was touted as making the barrier “unclimbable,” but that has not stopped people from attempting to do so with significant consequences: The San Diego County Trauma System experienced a five-time increase in high-severity injured immigrants admitted from the three years ending in 2018 to the three years ending in 2021.

In the case of UC San Diego Health, for example, there were 67 cases from 2016 through 2018 and 375 from 2019 through 2021. As part of our research conducted at UC San Diego Health, this data was published Friday in JAMA Surgery.


Raising the height of the U.S.-Mexico border wall to 30 feet is also associated with increased deaths in California: zero from 2016-2018, and 16 from 2019-2021. Immigrants falling from the higher border wall often have severe injuries that require care that can only be provided at a designated trauma center.

Trauma centers accredited by the American College of Surgeons (ACS) are critical life-saving systems for the most severely injured patients facing a high likelihood of death or disability. Patients include victims of high-speed motor vehicle crashes, gunshot wounds, stabbings — and falls from heights greater than 12 feet. These patients are immediately evaluated at designated centers by trauma surgeons with special training in recognizing and treating complex, multi-system injuries. These experts are board-certified in both surgery and critical care, and are supported by highly trained nurses, technicians and other specialists.

San Diego County is home to one of the oldest and best County Level Trauma Systems in the country, with five adult and one pediatric trauma centers providing coordinated care since 1985. In a trauma situation, patients receive rapid access to critical, time-sensitive services, such as surgery, blood transfusions, advanced imaging, and care from neurosurgeons, orthopedic surgeons and other specialists. Additional ongoing hospital care is often required, such as treating infections, addressing complications of massive injuries and transitioning to recovery and rehabilitation.

This increased influx of severely injured immigrants has produced new and massive costs to local hospitals and personnel, including at UC San Diego Medical Center-Hillcrest, the ACS-accredited Level 1 Trauma Center that serves Downtown San Diego and South Bay to the border. This trauma center also provides primary trauma referral services to the El Centro region, the city of Calexico and the surrounding area, and Imperial County.

This border crisis has further burdened an already-overstressed health-care system struggling to emerge from the COVID-19 pandemic. Additional capacity and associated costs were not accounted for in the federally appropriated funds to reinforce and heighten the border barrier system. Hospital costs for injured immigrants at UC San Diego Health alone are estimated to be approximately $13 million between 2019-2021.

This is a humanitarian problem and a local public health crisis that has worsened trauma center bed capacity and staff shortages, and further taxed even the most dedicated health-care professionals. Many victims of falls from the border wall suffer significant brain and facial injuries or complex fractures of the extremities or spine. Many require ICU care and multiple operations. A lack of health insurance and residency status means most of these patients are ineligible for rehabilitation facilities or post-discharge physical therapy, leading to prolonged hospital stays and further restricting hospital access.

Local, county, state and federal agencies must address this capacity issue and its broad repercussions. We must increase immigrants’ knowledge of the grave dangers they face trying to scale a 30-foot barrier, find financial support and relief for stressed medical systems, and increase bed and facility capacity in our trauma centers.

We must do more to support our local health care systems. We must better address this surge in traumatic injuries and deaths, while ensuring that adequate health care is available to all who need it. Future policy decisions along the U.S.-Mexico border wall should include assessment of the effects of new barriers, including humanitarian consequences, and overloading local health-care systems.