The 21-year-old was five months pregnant. Her back ached and her feet throbbed from three weeks on the road. She had hoped she wouldn’t have to push her toddler’s stroller today as the sun rose and the temperature soared and her family’s water ran out.

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But now that hope was gone.

“There are no buses,” she said. “So it looks like we’ll have to keep walking.”

On the 20th day of the caravan’s journey north from Central America, signs of its physical toll were everywhere — in the bright white bandages that stand out against dust-caked clothes, in the chorus of coughs that fill their camps at night, in their limping gaits and bloodshot eyes as they set out each morning.

In recent days, at least two women in the caravan have been rushed to hospitals to give birth.

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As the caravan has wound its way north, it has drawn the ire of President Trump and the anxiety of federal officials in Mexico, many of whom do not want to be seen as helping migrants reach the United States in the final days before the American midterm elections.

But without buses — blocked by the Mexican federal government Wednesday night — how far the caravan goes may come down to how healthy it remains.

Even the strongest on the caravan are starting to complain.

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“Dear God, my whole body hurts,” said Humberto Osorio Argueta, a tall 22-year-old from Honduras with biceps bulging from his tank top but painful blisters on his feet.

Despite the disappointment over the buses, Thursday morning was better than most.

The previous day, as they waited to hear about transportation, roughly 4,200 members of the caravan had rested in an unfinished bus station on the outskirts of Juchitan that city officials had turned into a temporary shelter.

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They had arrived Tuesday afternoon with fresh injuries after crossing more than 30 miles of a stretch of Oaxaca state known as La Ventosa, for the hot winds that whip cars from side to side on the highway.

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On Tuesday, state health-care workers treated at least 138 members of the caravan, mostly for respiratory illnesses from dust and the dramatic change in temperature from days walking in 100-degree heat to nights spent sleeping on the cold ground outside, said Benito Noyola, from Oaxaca’s System for Integral Family Development.

Since the caravan entered the state Saturday, Oaxacan health workers had treated 1,125 people.

Tuesday, another one arrived in the form of a young woman whose right eye was red and weeping.

“Yesterday something just hit my eye, boom!” said Cinthi Fajardo, an 18-year-old who said she had left home in Santa Barbara, Honduras, because she couldn’t find a job.

“It burns whenever I open it,” she said. “Today has been the worst day so far.”

After Fajardo was Grey Elizabeth Perez, a 22-year-old from Honduras who was 32 weeks pregnant and worried that the long walks were hurting her baby.

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Vinisa Pineda Martinez, a health worker in bright blue scrubs, took Perez inside a mobile health unit and asked her to lay down. Then she put gel on her stomach, turned on a sonogram machine and showed Perez her baby.

It was a boy, she said.

“I thought so, since I could feel him kicking,” Perez replied, Pineda later recalled.

The health workers said their efforts were part charity and part protection against problems the caravan could bring to Oaxaca.

During a previous two-day stop in Tapanatepec, bathrooms had been scarce and some migrants had relieved themselves near the river flowing through town. Migrants had then bathed and washed their clothes in the water, which at times smelled like sewage.

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At the bus station in Juchitan, hundreds of migrants slept side by side on cardboard or thin blankets under massive tents. Others slept in the unfinished rooms, which included a ticket office and a waiting area for buses that would never come.

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The close quarters and difficult conditions contributed to the respiratory infections that were swirling among the migrants, according to health-care workers.

Under one tent, Lucia Vigil Bardales gave her daughter, Meylin, sips from two bottles of medicine doctors had prescribed the 18-month-old for a fever and cough. Like many in the caravan, they had fled poverty and crime in Honduras.

Just as the girl with enormous eyes and nothing on but a diaper and a bracelet was starting to get better, however, her mother had begun to feel sick.

“It was so hot and windy,” she said, “and then cold at night.”

The three weeks on the road were proving particularly difficult for the disabled.

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Axel Palacios Molina, 14, said he had been protesting against Nicaraguan President Daniel Ortega in July when he was shot in the leg and partially paralyzed. His family had fled in September and eventually joined the caravan.

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For days he had walked from town to town on crutches that rubbed his underarms raw.

“He couldn’t take it anymore,” said his mother, Idania Molina Roche. “His feet were so swollen.”

Then, in the southern Mexican town of Tonala, the mayor had given him a wheelchair, Palacios said.

Mauricio Gonzalez was not so lucky. The 39-year-old had been thrown from the back of a truck in a car accident as a boy, leaving his left leg twisted and immobile. He had tried to reach the United States seven times on his crutches, but the farthest he got was in 2015, when he was caught at the border by Mexican authorities and deported to El Salvador.

He normally walked about 2½ hours each morning on his crutches before catching a ride, he said. And at night, he balanced on one crutch while unfolding a plastic tarp on the ground to sleep.

Caleb Isaac Flores, 7, had fallen while trying to climb a tree in Tapachula a week earlier, breaking both arms. Doctors had given him two casts, but his father had taken one off a few days ago.

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“I couldn’t eat. They had to feed me,” he said, his sentences interrupted by a violent cough. The boy was asthmatic, but his inhaler had run out and none of the Mexican doctors had a new one, said his mother, Sandra Veralice, 24. The Salvadoran family had fled gang violence.

So had Amanda Breve Jimenez, 73. Of her 10 children, four had been killed by gangs or criminals in La Ceiba, Honduras, she said. A fifth had recently received been threatened by a gang, forcing Breve, her daughter and her two grandchildren to flee.

Walking each day had opened a varicose vein on her ankle, which was now swollen and wrapped in gauze.

Her five other children had already fled Honduras, one to Mexico and four to the United States, where Breve was hoping to receive asylum.

On Thursday morning, as migrants began to pack up their meager belongings and prepare for another day on the road, Breve was gone — offered a ride the night before.

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Axel — named after the singer his mother had once, but no longer, loved — was hoping for the same. His family wheeled him over to a truck belonging to the state’s human rights agency, which was giving the neediest migrants rides to the next town. But the back of the truck was already full.

“You’ll have to wait,” an official told Axel’s family. “Please stay calm.”

That was more assurance than Roxana Orellana’s husband, Kevin Flores, received when the 26-year-old asked about a ride for his pregnant wife and two children.

He returned to find Orellana sitting on the curb, next to the two strollers they would now have to push.