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It was a quiet Wednesday night in the Tijuana city morgue: only eight murder victims were on ice, including two young Mexican women shot through the back of the head and dumped on waste ground.

These are the latest victims of the United States’ seemingly insatiable demand for cocaine, heroin and methamphetamine, which has sparked the bloodiest drugs war in the Americas and cost more than 4,000 lives in the past 18 months.

The war has pitted the Mexican government, with American help, against a ruthless drugs cartel led by a Mexican female mastermind who has a degree in business administration. The victims in the mortuary may have been smugglers who ran into a rival faction. Their stories are unknown: undertakers do not have time to find their relatives. “They’ll find us,” said one.

Morgue staff are so frantic that they have asked ambulance drivers with fresh corpses to cruise around for an hour or even return the deceased to the city hospital.

Gangsters get little sympathy from medical staff - not since the spring, when an armed gang attacked an operating theatre to snatch a wounded thug from police custody.

Doctors do, however, teach six-year-olds the most basic survival skill in Tijuana: how to bandage a gunshot wound. Many children are taught the best places to hide in school, preparing them for when the bad men arrive to kidnap the better-dressed tots for ransom.

The doctors comfort a traumatised housewife knocked over by a supermarket trolley that had rolled down a hill, its contents not groceries but a body. They patch up police besieged by a gang in their own police station. They collect the human heads arranged in pyramids by the roadside.

Doctors are also a hot target for kidnappers: about 40 have been kidnapped in Tijuana this year. They struggle to keep a semblance of civil order in a city which is being torn apart by a vicious drug cartel. It is known as the Arellano Felix cartel, or CAF, after its kingpins, a well-educated family that arrived in Tijuana in the 1980s.

Their escalating violence has turned this once prosperous border town, which feels safe and friendly during the day, into a shooting gallery at night.

In one recent fight, a CAF lieutenant called El Cholo (Street Boy) arranged a 3am meeting with El Muletas (Crutches), a rival CAF enforcer who had kidnapped one of his men. Insults escalated into gunfire, a battle and 13 dead.

The cartel has dominated Tijuana for a decade or more. It is an organisation forged by a policeman, Miguel Angel Felix, who honed his financial skills as a director of the government-owned Somex bank. Its mules and minions deliver up to a quarter of the United States’ drugs by boat, by lorry or through tunnels deep under the border. Now the CAF is under attack from all sides, resulting in a body count not known since the Colombian drug wars of the 1980s, which paved the way for the rise of the Mexican cartels.

Mexican police estimate that the CAF has lost half its 2,000 “foot soldiers” since October, when Felipe Calderon, the new president, signed the Merida initiative with the American government, designed to combat cross-border crime.

Over the next three years Calderon will receive nearly £1 billion in helicopters and technical aid: he has launched the first serious crackdown on the cartels for a generation.

He took crime investigations away from often corrupt police and handed operations to the army. The cartels are not going quietly: 15,000 gangsters have been arrested but 4,200 people have died and the death rate is accelerating. More than 200 people have been shot dead in Tijuana this year, a 50% rise on last year’s murder rate.

The CAF is under attack from four directions: General Aponte Polito, known to his men as Take No Prisoners Polito, and US antidrug agencies are a strong threat; but the most brutal attacks come from within its own ranks and rival gangs.

“The Arellano Felix cartel is splintering and this is resulting in the bloodshed we’re seeing,” said Alan Poleszak, of the American Drug Enforcement Administration.

Ten years ago the CAF was run by Miguel Angel’s seven nephews, with four nieces firmly in the background: after arrests and violent deaths, there are only two family players left. According to Mexican police, it is now led by Enedina Arellano Felix, a 46-year-old with a business degree - and probably the most powerful female criminal in the world.

They believe she has US citizenship and, like many middle-class Tijuanians seeking to escape the violence, spends much of her time in La Jolla, a California beach town. She partially inspired the rising drug lord played by Catherine Zeta-Jones in the film Traffic.

Today she “advises” her younger bother Eduardo. “She is a very smart woman and could save the cartel,” said Cesar Villalon, an executive on Zeta, a Tijuana-based investigative magazine, where journalists work behind bulletproof glass.

“The cartel has become far more brutal. Civilians used to be off limits but now it kills wives and children and tortures in new ways. Beheadings are recent, too. They walked into a disco and dropped three heads in the middle of the floor to prove the cartel still rules.”

Thanks to the Merida initiative, many murderous thugs will die and some cartels will be destroyed. But, critics say, while Americans are prepared to pay for drugs, the gangsters who supply them will never be defeated.

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