One May afternoon, the temperature was already approaching 99 degrees fahrenheit when the first call came. The calls kept coming, and they wouldn’t stop. In the span of several hours, the fire department of Sunland Park, a small community in New Mexico nestled between El Paso and the border wall, was overwhelmed with heat injury calls. All around town, calls were coming in about migrants collapsing in the midday heat. As Fire Chief Daniel Medrano recounted, his department sprung into action, splitting up his small crew to respond to the emergencies. Only a single paramedic was on duty that day—the rest of the crew were certified as EMT basics, not able to do much more than chest compressions. He only had two fire engines and a single ambulance available.
Crews responded to a call involving two migrants suffering from heat exhaustion, stable enough to be transported to the hospital. Amid the chaos, another call came in about a critically ill migrant who was found unresponsive and without a pulse. The lone firefighter that responded to this patient frantically performed chest compressions for 20 minutes until a paramedic arrived at the scene. As they were pronouncing the patient dead, yet another call: nearby construction crews had found another woman collapsed at the edge of town, where Sunland Park empties into the vast Chihuahuan Desert. Her husband was beside her, in better shape but hysterical. The construction workers carried her body, burning with the heat of the desert, onto a driveway in the shade of a house and called for help. By the time Chief Medrano arrived on scene, she was unconscious.
Her breathing came in short, ragged gasps, her chest rising and falling erratically. A firefighter slid a thin tube down her nose into her airway to help her breathe. He placed a mask over her face, pumping air into her lungs. Another unfurled a white body bag. Together, they maneuvered her inside the bag and began packing it with pounds of ice. Suddenly, dark and thick vomit erupted from her mouth. Chief Medrano had the sinking realization that no more ambulances were available for transport. They were less than 20 minutes from the nearest hospital, but they would have to wait for a helicopter.
An hour later, I was walking into my shift in the emergency department as the dull thump-thump of a departing helicopter cut through the summer heat. Two ambulances, a firetruck, and several Border Patrol vehicles were crowding the ambulance bays. A cool whoosh of air greeted me as the bay doors parted. The ER was buzzing more than normal. All the rooms in the trauma zone were full, nurses with blood-splattered gloves were racing to triage patients as Border Patrol agents and police officers lingered outside of rooms.
I had barely stepped into the department when Dr. Adams, the day doctor I was taking over for, got up from his seat. “Follow me,” he said. “I want to do this one bedside.”
He led me into a trauma bay where an intubated female patient lay on a gurney covered in ice and wet towels. She was intubated, blood oozing from her mouth. “She was found down in Sunland Park,” he said. “She had just crossed the border. Intubated on scene. Her temperature was 107 on scene, she was unresponsive.”
As he explained the care she had received so far, I opened her eyelids and shined a light in them. No response. “She’s off sedation, completely unresponsive,” Dr. Adams said. Her temperature was still high, at 103 degrees, and her heart rate was through the roof.
I turned my attention to her belongings placed next to her bed. For critical patients, it is often necessary to completely undress them to expose any hidden injuries. In this process, it is common to find the few belongings a migrant patient brought with them. In this final stage of the journey, the coyote would have told them to drop everything that they had carried with them for the thousands of miles up to this point—to only bring what they could carry on their body. And at this moment, when everything unessential is left in the desert, it is often only faith that remains—as was the case for this patient.
There was a book of prayers. A necklace with an icon of the Virgin Mary. A charm bracelet with crosses, the Virgin Mary again, and little airplanes. A card with the icon of Saint Toribio, who is known as the patron saint of migrants and is said to appear to those crossing the desert in distress. I wonder if he appeared to her.
The patient was quickly transferred to the ICU soon after my shift started. I followed her progress for several days, until there was nothing left to follow. She died, having never regained consciousness. Her husband, released from custody, was able to be by her side when she passed away. She was my first heat death in what would become a particularly deadly summer.
The death of my patient that day underscores the increasingly deadly risk that migrants take in crossing the southern border near El Paso. Last year, the Border Patrol documented a record 149 migrant deaths in the El Paso sector, which includes southern New Mexico and Far West Texas. This year’s toll has already surpassed last year’s, according to Border Report. Many of these deaths come from the unrelenting heat.
As a border physician, I have encountered all of the macabre ways in which border policies lay waste to migrant bodies: heat injuries, wall falls, drownings, motor vehicle accidents after reckless pursuits by overzealous officers. All of these deaths are avoidable, perpetuated by the cruelty of our policies. But the heat deaths in particular seem so senseless. For the migrants who cross the border wall outside of Sunland Park, the desert in many places only stretches a few hundred yards before blending into the residential neighborhoods of Sunland Park. El Paso, with its highways and hospitals, is only a short drive away. They’re reached the promised land, but they’re struck down in sight of help. “They barely got their feet wet”, Chief Medrano says of the migrants who cross the wall into Sunland Park. “And then they drown.”
On Mount Cristo Rey, where a 29-foot cross towers over the borderlands, nine migrants were found dead last year. For me and many other El Pasoans, it is a popular spot for hiking, biking, and running. Along the border, a site of recreation can conceal a graveyard.
As deaths from heat injuries seem to have increased, crossings have declined. Border Patrol apprehensions in the El Paso area were 30 percent lower this July—the most recent month available—than last July. This could be because El Paso is witnessing the convergence of two deadly trends: climate change and border militarization. In 2023, El Paso experienced 44 consecutive days of over 100 degree heat, shattering a decades-old record. June of 2024 was the hottest June recorded in El Paso, and the second hottest month in El Paso’s recorded history, only surpassed by July of last year. The Sunland Park Fire Department has measured ground temperatures as high as 156 degrees. At 162 degrees, human skin is destroyed.
As the heat rises, it has become harder to safely cross the border. Since late 2022, Texas National Guard soldiers deployed under Operation Lone Star have installed miles of concertina wire along the Rio Grande in an attempt to prevent migrants from crossing the river to seek asylum. Without any other option, migrants are forced into more dangerous areas to cross, often under the control of criminal organizations in Mexico. In 2024, an executive order by President Biden curtailed the right to seek asylum along the border.
Desperation breeds dangerous crossings. Under the scorching heat of a warming earth, decisions to cross in the desert can be fatal, even if the journey to shade is a few hundred yards. Desperation also breeds innovation.
A few weeks after my migrant patient’s death from heat exposure, I was sitting in the office of Sunland Park’s Fire Chief Medrano to discuss his department’s response. The body-bag ice bath that the woman had arrived in at the hospital was one of Medrano’s innovations.
On a whiteboard behind him was a tally of migrant deaths his department had responded to over the summer—28 as of late July. Next to this tally was the number of ice baths his department had used to treat migrants suffering from heat injuries this year.
Last year, when heat deaths first soared, Chief Medrano was frustrated. “This isn’t working”, he remembers, recalling the then-standard treatment of placing ice-packs under patients’ arm-pits and groin. The ice-packs would rapidly melt. “We were taking them off, and they were freaking hot. Looking outside of the box, what can we do?” he said. He found a solution after stumbling upon a paper from a fire department in Arizona detailing the use of body bags for whole-body immersion in the field, expediting the treatment the patient would receive in the hospital.
Medrano starkly remembers the first migrant patient he treated with this new technique. She presented similarly to my patient; unresponsive and hyperthermic. Her temperature was 107.7 in the field. By the time she was being loaded onto an ambulance, her temperature was down to 104. In the emergency department, she started opening her eyes. By the next day, she was talking again. While the ice bath didn’t save my patient, it’s likely that it gave her husband enough time to be by her side when she died. Chief Medrano has already had to purchase two more orders of body bags to keep up with the amount of heat injuries this summer.
A Sunland Park firefighter named Luis Marquez took me into the desert to show where they had performed rescues and found bodies. As we drove along the Rio Grande, he recounted stories of pulling the dead bodies of migrants from the river. Marquez pointed towards bushes and ravines, the stories of patients found there etched into his memory.
It is in this environment that ordinary citizens have organized to leave water in the desert for parched migrants. For years, groups like No Mas Muertes in Arizona have been leaving water for migrants in the Sonoran desert. Similar efforts in the deserts around El Paso have begun recently, driven by the soaring death rates. Faith leaders have also rallied their flocks in a mission to leave water in the desert. “Whatever our position on immigration, I don’t think anybody can agree that the death of people is a fitting response, a solution,” El Paso Catholic Diocese Bishop Mark Seitz told Border Report. Seitz recently led a group on a water drop on Cristo Rey.
Seitz and his compatriots may be putting themselves in a precarious position. In 2018, a member of No Más Muertes was charged with multiple felonies for providing humanitarian aid for migrants in the desert, including leaving water. These charges were ultimately dismissed. However, these water drops occur in the context of a new effort by Attorney General Ken Paxton to criminalize humanitarian aid from migrants. Paxton’s effort to shut down Annunciation House, a Catholic-affiliated migrant shelter in El Paso, was recently thrown out by a lower court. Paxton has announced he’s appealing. Another Catholic-affiliated shelter in the Rio Grande Valley has been similarly targeted.
I recently led a group of volunteers up Cristo Rey. Each of us filled our bags up with bottles of water and began the trek up the mountain. It is one of the most beautiful areas of the borderlands, cut through by deep ravines and brown mottled cliffs. The faithful will stop at the various crosses that interrupt the trail, marking the Stations of the Cross. The crosses bring to mind a cemetery. Along the way, we left water in shaded and conspicuous stops, replacing them in our bags with empty bottles to carry back down. We met small groups of migrants, skittish but grateful for the water that we handed over to them. A Border Patrol helicopter circled in the sky above, lazily surveilling us.
From the top of the mountain, in the shadow of the statue, you have views of the entire Paso del Norte region. The scar that runs through the landscape, the border wall, ends abruptly in the mountainous terrain behind Cristo Rey. From the top of the mountain, you can look down and almost imagine that no border exists.
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