糖心vlog

A former, veteran Border Patrol agent told me recently, 鈥淏order walls alone never stop anybody. People desperate to cross will go over, under, or around.鈥� Migrants arriving at the US-Mexican border have likely invested their life savings, often taking out rapacious loans, in order to finance their journey north. Many migrants have trekked through the treacherous Darien Gap between Colombia and Panama, and all have endured the risk of corruption, sexual assault, extortion, and murder that menaces migrant travel through Guatemala and Mexico. After all this they reach the US border and are met with the wall鈥檚 steel bollards or, in some parts of Texas, a twirl of barbed wire. None turn around and go home. They go over, under, or around.

Many decide to go over. Inevitably, of the thousands who make this choice every year, some will fall and some will be injured, and some attempting to climb over the 30 foot sections will die. The article by Tenorio and colleagues¹ in this issue describes falls from the border wall near San Diego, between October 2023 and January 2024.² This article contributes important new evidence regarding the dangers of the wall, including the risk of head injury among children.³ We do not know the number who attempt to climb over the wall, which makes it difficult to assess the relative rate of falls. This study also underscores the importance of establishing prompt, high-quality emergency medical systems at the border, even at Open-Air Detention Sites (OADS), where, until a recent court order, Customs and Border Protection (CBP) did not assume responsibility for the provision of food, water, or medical care.

We need the rule of law at the border as we do everywhere else in the US. While the wall itself does not stop migrant crossings, it does, nevertheless, have its uses for border security. It certainly has political utility, emerging first as a rhetorical metaphor but subsequently reified as steel and cement. Most border security professionals support physical barriers at the border, but concentrated in strategic locations. This is because the primary deterrent function of obstacles at the border is diversion, which uses risk and hardship to shift migrant flows to locations more easily patrolled or surveilled. In urban areas, the wall can also buy time for Border Patrol agents to apprehend migrants before they can blend into local communities.

The border wall is merely one of many deterrent tactics that uses the potential for physical harm to achieve its objective. The higher the wall, the more dangerous is the attempt to scale it. The more expansive the wall鈥檚 reach, the greater the diversion to more remote, and usually more dangerous, border crossings. Indeed, the US-Mexican border has become the deadliest migration land route in the world,⁴ claiming almost 900 lives in 2022,⁵ a figure all recognize as a significant undercount. And a count is all it is. Recently, efforts have turned to the arts, including photography, literature, and song, to more fully express the human suffering the counts imply, to portray the faces in the numbers.⁶ These initiatives recognize that humanitarian norms cannot only be argued, they must also be felt.

The danger in using harm as a deterrent is that it has no inherent limits. The more desperate US border policies become, the more they may rely on the prospect of harm as a deterrent. The family separation policy (referred to as the 鈥淶ero Tolerance鈥� policy), implemented quietly in 2017 and loudly in 2018, moved parents into criminal proceedings while placing their children in shelters established for unaccompanied children.⁷ This policy was met by a crescendo of public outrage that transcended political affiliation and culminated in the policy鈥檚 final, if unrepentant, rescission some 6 weeks after its public disclosure. This experience exemplified just how easily unbridled deterrence policies can bleed into cruelty. At its core, the family separation policy used cruelty to children as an instrument of US immigration policy. Yet, the American public finds immigration a more troubling issue now than it did in 2018 and may show a greater tolerance for a Zero Tolerance policy the next time it is proposed. I have often heard humanitarian concerns at the border met by the refrain, 鈥淚f they don鈥檛 like our border policies, they shouldn鈥檛 come.鈥� This position, while understandable at some level, could also justify virtually any border policy regardless of their inherent cruelty or humanitarian impact.

By far, the most consequential deterrent to unauthorized migration is eliminating the hope of making it into the US, either through evasion or release. For many years, even during the implementation of the Migrant Protection Protocols (known as the 鈥淩emain in Mexico鈥� policy), a large portion of families and virtually all unaccompanied children have been released into the US pending immigration proceedings. Unaccompanied children are routinely transferred from CBP custody to the Department of Health and Human Services, which arranges release to a relative or sponsor in the US. For families, CBP relies heavily on flying them back to their home countries. However, Venezuela, Cuba, Nicaragua, among other countries, will not generally accept removal flights from the US. Moreover, apprehensions can surpass the capacity of flights available to countries that do allow removal flights. Given CBP鈥檚 legally and logistically constrained holding capacity for families, there may be few alternatives to release. Even when Immigration and Customs Enforcement (ICE) ran several family detention centers, their holding capacity could not keep pace with the number of family apprehensions routinely occurring at the border.

For some, this reality has generated an impulse to impose ever more desperate strategies of deterrence. The desperation of migrants has been well documented. But beware that fear and the dark passions of exclusion do not generate 鈥渄esperate deterrence鈥� policies at the border. Indeed, there is the very real potential for a rapidly accelerating, escalatory ladder of adversarial desperation between migrants and US policymakers. Undoubtedly, there will be legal challenges to overly aggressive deterrent policies. However, in the end, the humane limits of deterrent border policies will lie primarily in the boundaries of acceptance, of the decency, of the American people, boundaries that will ultimately find expression in the epidemiology of broken bodies at the wall and loss of life along the rivers and deserts that have long defined the contours of refuge at our Southern border.

Published: October 4, 2024. doi:10.1001/jamanetworkopen.2024.37160

Open Access: This is an open access article distributed under the terms of the CC-BY License. 漏 2024 Wise PH. 糖心vlog Open.

Corresponding Author: Paul H. Wise, MD, MPH, Richard E. Behrman Professor of Child Health and Society, Professor of Pediatrics, Professor of Health Policy, Senior Fellow, Freeman Spogli Institute for International Studies Stanford University, 616 Crothers Way, Stanford, CA 94305 (pwise@stanford.edu).

Conflict of Interest Disclosures: Dr Wise reported personal fees for service with US Federal Court as a juvenile care monitor outside the submitted work.

Disclaimer: Since July 2019, the author has served as the Juvenile Care Monitor for the US Federal Court overseeing the treatment of migrant children in U.S. detention. The views presented in this commentary are not based on his court position nor are they derived from privileged or confidential sources.