When President Donald Trump’s commissioner of Customs and Border Protection toured a stretch of the new 30-foot high border wall here in August 2020, he told the local newspaper that its steel beams were “impressive.”

“It really does, I think, physically represent exactly what we’ve been trying to do since Day One,” Commissioner Mark Morgan told the El Paso Times. “That is to give Border Patrol increased operational capacity to do what they need to do to protect the country.”

Flash forward nearly two years and, as of Friday morning, illegal border crossings are at an all-time high and Border Patrol agents and local paramedics have responded to 229 injuries since October 2021, including some fatalities, as migrants scale the Mexican side of the steel barrier and then fall 30 feet onto U.S. soil.

On a ride-along with Border Patrol agents, NBC News saw the aftermath of one of the most recent injuries, a teenage girl who agents say fell from the top of the wall and was found alone at the bottom. She struggled to catch her breath and writhed in pain as paramedics secured her to a stretcher and loaded her into an ambulance.

“This little girl was exploited by a smuggler,” Agent Valeria Morales said. “She was forced to scale the border barrier and she fell.”

Morales said it’s a common scene: Smugglers build ladders that can scale the fence and force migrants to the top, often telling them they can scale the fence on the way down. But many lack the upper body strength to do it or are not able to hold on to the hot steel posts.

Broken ankles, broken legs, and even brain and spinal injuries are common, Morales said.

In the Border Patrol’s El Paso sector, which includes the entire border between Mexico and New Mexico, the Trump administration built 133 miles of bollard-style fencing in Texas and New Mexico. It replaced a portion of the earlier barrier, made of two layers of mesh netting, which is easier to cut through. Some stretches of mesh netting remain, and Morales and her fellow agents often wonder why smugglers force migrants to scale the wall rather than cut through the mesh. They say it speaks to the inhumane way smugglers view migrants.

In addition to the human toll, the Border Patrol must dedicate time and personnel to respond to emergencies at the border wall.

In one highly circulated video from 2021, smugglers were seen dropping two young sisters over the wall in El Paso onto the ground. Both girls survived unharmed.

Customs and Border Protection did not respond to a request for comment or provide overall numbers on border wall injuries across the 2,000-mile southwest border.