(AP Photo/Giovanna Dell'Orto)

Between the Concertina Wire and the Cartel

As a border physician, I see firsthand the violence of Operation Lone Star, which has made America a key partner in a dangerous triad targeting refugees.


“Can you take us in your car to the next gate?” the group of migrants asked. I was in Ciudad Juárez, along the U.S.-Mexico border, with another doctor and members of my organization, Hope Border Institute. It was early May, and we were driving along the banks of the Rio Grande, providing whatever humanitarian aid and medical care we could to migrants stopped by the concertina wire put up by the Texas National Guard.

This group of migrants, three young children and several adults, were desperate. They looked exhausted and dehydrated. Their windswept faces looked at us for a response. We looked around uncomfortably. Every bit of me wanted to give these desperate families a ride, but the reality was that it wasn’t safe—for us or for them. They said they had been walking along the concertina wire for four days. They were out of water, and now they were out of money. The day before, they said they’d been robbed of all of their money and material possessions by cartel members. Now, the National Guard was telling them they would have to continue walking for miles to find a point to be processed. The soldiers, clad in desert camouflage and touting assault rifles, looked on as we talked to the migrants.

Brian Elmore treats a migrant in Juárez. (Courtesy/Heidi Ostertag, Worldwide Documentaries )

Between here and the port of entry where they would be processed—wherever it was—another cartel operated. The migrants said they didn’t have anything else to give and were afraid of what the next cartel would do to them. But by picking them up, our group and theirs would both become targets. So we gave them water, food, and the limited medical aid we could provide, and we drove off. A fear gnawed in my stomach as I watched them trudge on along the dusty banks of the Rio Grande, the soldiers looking on.

The National Guard members standing on the other side of the concertina wire were brought to the border by Governor Abbot’s sweeping anti-immigration operation dubbed ‘‘Operation Lone Star.” This operation represents an escalation of policies of deterrence by state officials. It has been an experiment in new ways to maim and mangle migrants and has exacerbated pre-existing patterns contributing to migrant deaths. 

As part of Operation Lone Star, the Texas National Guard has deployed over 100 miles of concertina wire along the banks of the Rio Grande. I’ve treated children whose flesh has been torn by the razor wire. Further down the river, the National Guard has also deployed floating buoys marked by serrated metal blades. Increasingly aggressive vehicular pursuits of migrants by Department of Public Safety officers have killed both Americans and migrants. 

It’s left to border organizations like mine, the Hope Border Institute, to deal with the human costs of failed border policies. “Prevention through deterrence,” America’s strategy to make the border as dangerous to cross as possible, has spawned increasingly macabre policies including family separation, Title 42, the heightening of the border wall, and now Governor Greg Abbott’s Operation Lone Star. These measures have created a growing public-health crisis along the border. 

In 2022, the U.S.-Mexico border was the most dangerous migratory land route in the world, according to the International Organization for Migration. Increasingly desperate migrants are forced to cross in the desert where many will succumb to heat injuries and dehydration. Others will attempt to scale the wall, and many will inevitably fall. Those that survive will often have debilitating injuries. As an emergency medicine physician in El Paso, I treat the traumatic injuries of migrants who could no longer wait. As the co-founder and medical director for Clínica Hope, I treat migrants in Juárez who have yet to cross. 

In response to this growing public health crisis, Clínica Hope was co-founded with Hope Border Institute in 2022 to provide shelter-based medical care to migrants stuck in Juárez. As policies have changed, so has our response—which is why we were cruising along the concertina wire. 

The next group we came across was in dire straits as well. Dozens of migrants huddled under the little shade offered by the meager brush lining the Rio. In the midday heat, the groups slowly stirred. They were apprehensive at first but then began to make their way to our vehicles. Other members of our group started distributing water as I started seeing patients.

We tried to convince the Venezuelan to come with us to a hospital, where he could be evaluated and treated. “I can’t,” he said.

Stories of violence and brutality spilled out as the weary migrants were eager to take the opportunity to share their traumas with sympathetic Americans who were not pointing weapons at them. Their bodies bore witness to the traumatic injuries they claim were done to them. The reality of their desperation was made clear to me by their torn and bruised flesh. The Texas National Guard, Mexican immigration officials, and cartel members were now all working together in this perverse game of deterrence, the goal being to inflict as much suffering as possible on these migrants. In my two years of treating migrants in Juárez, I had never witnessed such desperation. Hemmed in by the cartel, concertina wire, and both U.S. and Mexican security forces, these migrants were completely vulnerable to the depredations of each of these predators.

Texas soldiers have fired non-lethal projectiles at border crossers, as reported by Border Report, and migrants report beatings by Mexican immigration officials and by cartel members.

A Venezuelan migrant approached me, his left arm bandaged in a disintegrating sling. He appeared to be in his thirties, dusty and battered from his journey. His chest was heaving in pain. He was on La Bestia, the train that carries migrants to the north of the country, when it was stopped by Mexican immigration officials outside of Juárez. The migrants scattered and the immigration police gave chase, beating anybody they could get their hands on, he said. This beating had left the migrant with a fractured arm, on which a Mexican physician had haphazardly slapped a splint. 

On making it to the Rio Grande, he told me he was pushed back by National Guard soldiers as he attempted to scamper up the banks of the American side, after which he said he was pelted by rubber bullets. His entire left chest seemed detached from his sternum and clavicle. The left-side of his ribs heaved independently from the rest of his chest. He needed to be evaluated in a hospital and likely would need urgent surgery.

The Texas Military Department did not respond to a Texas Observer request for comment about use of non-lethal projectiles and physical violence.

We tried to convince the Venezuelan to come with us to a hospital, where he could be evaluated and treated. “I can’t,” he said. He didn’t want to miss an opportunity to cross the concertina wire and present himself to the authorities for processing for asylum. I treated a few more injuries, including of children whose flesh was torn by the Texas razor wire. Then, we reluctantly left the seriously injured migrant, exchanging contact information in case he changed his mind.

The next day, his pain had become unbearable and he reached out to us, asking to be taken to a hospital. Crystal Massey, the humanitarian director for Hope Border Institute, sprung into action, coordinating with our Mexican colleagues to pick him up and transport him to a hospital. Our Mexican partners arrived with an ambulance to extract the patient to safety. They told us that an armed cartel member stopped the ambulance as it approached the concertina wire. All of this occurred as the National Guard watched on, only a few yards away on Texas soil.

It occurred to me, in this twilight zone between borders, the most basic right to life had ceased to exist. These human beings, desperately seeking safety and a new future, were completely vulnerable to the cartel and the security forces of both nations. They all were working together to brutalize men, women, and children. Each of these groups acts with impunity and with the same objective: to extract their pound of flesh and make dangerous this border. 

In mid-May, the body of a Honduran migrant was found along the river in Juárez, near where we’d seen patients. As reported by the newspaper El Heraldo de Juárez, his face had been sunken in from the attack that left him dead. A migrant who was with him said the beating was the work of U.S. authorities.