• Accidental Falls
• epidemiology
• Healthcare disparities

At the US–Mexico border, a wall of up to 30 feet in height embodies restrictive US immigration policies and attempts to deter unauthorized border crossings. Injuries caused by falls from that wall likewise embody the danger generated where these policies converge with the desperate conditions that drive many to migrate. Trauma centers have seen a 10-fold increase in admissions for border wall falls since 2017, adding traumatic injury to established risks of migration such as heat and cold exposure.1 2 Here, Lagan et al examine the struggles that survivors of these falls and their clinical teams face: communicating about complex clinical needs across language barriers and establishing follow-up care for a transient, under-resourced population.3

Lagan et al identified patients from 38 countries who were in turn discharged to more than 30 states. Clear, detailed, discharge processes that incorporate patients’ language, literacy, and health literacy may promote understanding. As patients disperse after discharge, establishing a network of follow-up destinations with shared record keeping could improve continuity of care. These findings also raise broader challenges, as many migrants struggle to get needed healthcare, ranging from new acute and chronic problems, to communicable disease contracted in border camps or en route, to psychological trauma related to conditions before or during migration.4

Providing intelligible, patient-centered care regardless of language is an essential component of equity and justice but remains challenging at the border and across the country. Bilingual providers are scarce,5 and patients with limited English proficiency may have elevated mortality, longer length of stay, and lower utilization of postacute care and rehabilitation.6 7 As this article illustrates, the challenge extends beyond Spanish language services, to the 22 primary languages. Interpreter resources, defined clinical protocols, and clinician and patient patience are all necessary to bridge this gap in care.

Fundamentally, these are preventable injuries. Current international policy and political circumstances along with US immigration policy and border conditions drive migration and put migrants at risk for harm during unauthorized border crossings. Interventions at all levels are necessary and indicated to reduce harm. In tracking, treating, and telling the stories of these injuries, trauma clinicians can contribute to addressing the root causes of harm, as well as the acute consequences of injury.