The hospitals of Ciudad Juárez bear the brunt of the deadly shootouts that rival criminal organizations unleash against one another throughout the city. "The authorities are failing us," an emergency room doctor at the Instituto Mexicano del Seguro Social told me. "When more soldiers arrived in March, the city did calm down for a month or two, but now the violence is as bad as ever. It's as if the gangs had decided to wait and see what the army would do and then realized that they could carry on their business with total impunity."
As we spoke, two soldiers and a municipal guard escorted a man with gunshot wounds across the aisle and into a separate room. "We need security because otherwise the gangsters would finish off their victims," the doctor said.
A surgeon working at the nearby Red Cross described to me how in November 2008 a commando of six men wearing black masks stormed into the ward, ordered everyone on the ground, and mowed down an 18-year-old who had been wheeled in 30 minutes earlier with a serious gunshot wound. The surgeon remembered bitterly how the killers had had the insolence to say "adiós y buenas noches" before leaving.
As a result of this incident, the Red Cross now swiftly transfers all victims of violence to the General Hospital, where security is tighter. But even there professional killers occasionally succeed in eluding the soldiers and the police. A nurse told me that in September 2008 she witnessed hospital staff handing over a youth who had been shot in the face to "a group of men who looked like assassins," despite his desperate cries for help. When the nurse asked a doctor what was going on he answered brusquely: "Their paperwork was in order." The body of the young man surfaced a few days later in the desert outside the city.
Ciudad Juárez acquired the dubious reputation of wild border town during the Prohibition years, and has long been a major transshipment point for drugs entering the United States, but bloody struggles among rival cartels here are a relatively new phenomenon that stems from recent domestic and international developments.
During the 1990s the city became a magnet for poor Mexicans, who came by the tens of thousands seeking jobs in a series of newly established U.S. assembly plants known as maquiladoras. Rapid population growth in turn led to the rise of sprawling slums that the municipal government was unable to regulate or police. These rough neighborhoods became the ideal base for criminal organizations smuggling drugs across the U.S. border.
Meanwhile, the decline of Mexico's Partido Revolucionario Istitucional, which culminated in its loss of the presidency in 2000 after seven decades of uninterrupted one-party rule, shook the clientelistic networks that the historical crime syndicates had established with the authorities. Riding the wave of Mexico's democratic transition, new and more violent criminal organizations penetrated government institutions and challenged the old mafias, competing with them for political influence and for the control of key drug trafficking routes.
Internationally, the gradual dismantlement of the main Colombian cartels after the death of Medellín kingpin Pablo Escobar in 1993, coupled with a U.S. crackdown on smuggling routes across the Caribbean, strengthened the geostrategic leverage of the Mexican cartels. With more and more cocaine transiting through their territories, these organizations stopped charging transshipment fees and instead began to demand a share of the cargo, which they then resold in the United States for a greater profit. This strategy has allowed the Mexican cartels to emerge as wholesale distributors and capture the cocaine market in the United States.
"Ciudad Juárez is a very important plaza," told me the director of one of the city's hospitals. "Whoever controls the drug trade here also controls it in New York and Chicago. These wars will continue, until one of the cartels can establish its supremacy over this city and the routes around it."
Maryam Ishani contributed to this report.