Health effects arising from the September 11 attacks

September 11, 2001 terrorists crashed two hijacked planes into One and Two World Trade Center. In the space of two hours, the towers collapsed and not long after that, 7 World Trade Center collapsed as well. Nearly 2,800 people died, including 343 firefighters, 23 police officers, 37 Port Authority police officers, and more than 2,200 civilians.

Hundreds of thousands of people were exposed or potentially exposed to dust, particulates, and other environmental contaminants on that day, and endured or witnessed deeply traumatic events. Fires burned and smoldered at the site for months. Many who lived, worked or attended school in the area found their lives upended and their livelihoods damaged or completely destroyed; thousands were temporarily displaced.

"We are very encouraged that the results from our monitoring of air quality and drinking water conditions in both New York and near the Pentagon show that the public in these areas is not being exposed to excessive levels of asbestos or other harmful substances," EPA Administrator Christie Whitman said. A Given the scope of the tragedy from last week, I am glad to reassure the people of New York and Washington, D.C. that their air is safe to breath and their water is safe to drink," she added.

Two days after the collapse of the World Trade Center, Mayor Rudy Giuliani said, "The air is safe as far as we can tell, with respect to chemical and biological agents." Giuliani, in attempting to deflate New York Daily News journalist Juan Gonzalez' reportage of the 9/11 air issue, claimed that "the problems created… are not health-threatening."In the first month after the attacks, the mayor said, "The air quality is safe and acceptable."

Under the gray, noxious air, trusting residents returned to their homes in Lower Manhattan, unsuspecting children returned to their schools, and hundreds of thousands of downtown workers trudged to their desks. In the following year, the EPA gave more than 50 public assurances concerning the toxic exposure. At least another 15 came from New York City officials.

Former Environmental Protection Agency boss Christie Whitman says she urged Ground Zero workers to wear respirators, but then-Mayor Rudy Giuliani blocked her efforts. She also said city officials didn't want EPA workers wearing haz-mat suits because they "didn't want this image of a city falling apart."

A memo from the federal Environmental Protection Agency to an associate commissioner at the city health department -- dated October 5, 2001 -- told the tale. "This site ... poses threats to workers related to potential exposure to hazardous substances," the head of EPA's Response and Prevention Branch wrote. The memo went on to list the hazardous substances, which included asbestos, refrigerants, hazardous wastes, ethylene and "products of combustion emitted from the long-burning fires."

Today New York City officials and a range of medical experts are now convinced that the dust and toxic materials in the air around the site were a menace. Up to 70 percent of first responders are ill as a result of 9/11 contamination. If a similar rate of illness holds true for those who lived and worked near the Twin Towers, the number of seriously ill New Yorkers could climb to 300,000.

City officials estimate that health care costs related to the air at ground zero have already run into the hundreds of millions of dollars, and no one knows whether other illnesses, like cancers, will emerge.

In the hours and days following the attacks, rescue workers, volunteers, contractors, and others from across the country descended on Ground Zero to search for potential survivors. In late September, that search came to an end and efforts turned to an unprecedented recovery, cleanup, and restoration of New York City’s infrastructure. Tens of thousands of responders and others worked at the World Trade Center, the Fresh Kills landfill, and related sites. The work took ten months and involved employees from dozens of City, State and federal agencies and the tireless efforts of responders, laborers, contractors, volunteers, and community organizations.

Along with the death and devastation immediately wrought by the attacks, there was concern from the outset that the collapse of the Twin Towers could have consequences for the health of responders, clean-up workers, residents, office workers, school children, and others. By the evening of September 11th, the City’s Departments of Health and Environmental Protection began to assess environmental conditions and what protections would be necessary.

While the full scope of 9/11-related problems is unknown, a growing body of evidence suggests that significant health conditions have emerged that are associated with the disaster, in particular for those exposed during the collapse of the towers and those who participated substantially in rescue, recovery, and clean-up operations.

The terrorist attack on the World Trade Center (WTC) on September 11, 2001, resulted in exposure to potentially harmful debris and environmental contaminants and potential psychological effects related to traumatic events. The collapse of the two WTC towers after they were struck by airplanes released pulverized steel, glass, cement, and other debris into the immediate environment. The fires started by the crashes of the two airplanes, which each carried approximately 90,000 L of jet fuel, released smoke and fumes, including polycyclic aromatic hydrocarbons, volatile organic compounds, lead, dioxin, and furans , creating a mixed cloud of dust, smoke, and debris. The collapse of each tower and neighboring buildings released into the immediate environment a highly alkaline mix of mostly large particles (i.e., 98.0% of particles >10 µm) of concrete, glass, plastic, paper, and other building materials and the pulverized contents of the WTC buildings . The fires in the 16-acre pile of rubble burned for approximately 3 months, during which time many persons returned to work in lower Manhattan .

Many occupants of the WTC towers and other nearby buildings witnessed one or more of the events of the attack and were caught in the dense clouds of dust, smoke, and debris created by the collapse of each of the WTC towers. These building occupants also were among those most likely to lose friends, co-workers, and family members in the attack. As a result, building survivors were at high risk for injury, respiratory complications, and psychological distress. Previous studies have reported both respiratory problems and psychological effects from the attacks of September 11, in other populations affected by the attacks.

The majority of (56.6%) survivors of collapsed or damaged buildings reported one or more new or worsening respiratory symptoms after September 11, including symptoms of sinus problems, nose irritation, and postnasal irritation (38.1%); shortness of breath (35.1%); wheezing (28.5%); throat irritation (28.0%); and persistent cough (27.0%)

The 9/11 Health and Compensation Act, signed into law by President Obama in early 2011, establishes the World Trade Center (WTC) Health Program. It ensures that those affected by 9/11 continue to receive monitoring and treatment services for 9/11-related health problems through at least 2015.

The WTC Health Program consists of a Responder Program (for rescue and recovery workers, including more than 15,000 New York City firefighters) and a Survivor Program (for those who lived, worked or went to school in lower Manhattan on 9/11). People eligible can receive services, no matter where they live now in the US.

The director of the National Institute for Occupational Safety and Health (NIOSH) administers the WTC Health Program. The federal government and New York City pay for it.

In addition, the 9/11 Health and Compensation Act will re-open the September 11 Victim Compensation Fund. This allows those affected to file claims for economic losses due to illnesses or injuries caused by 9/11.

	Detective Kevin G. Hawkins died May 7, 2007 of 9-11 related illness after serving over 20 years with the Department. He worked in the 17th Precinct, the Executive Protection Unit of the Intelligence Division, and the Patrol Borough Manhattan South Task Force, as well as in the rescue, recovery and clean-up effort at the World Trade Center site. Detective Hawkins was recognized three times for excellent police duty and meritorious service. He is survived by his wife Marie and daughters Natalie and Stephanie, mother Dorothy and brother Dave.
	Detective Robert W. Williamson died May 13, 2007 of 9-11 related illness after serving 20 years with the Patrol Borough Manhattan South Anti-Crime unit. He made 203 felony arrests and was recognized 38 times in his career for excellent police duty, meritorious service and other commendations. Detective Williamson was a part of the rescue, recovery and clean-up effort at the World Trade Center site. He is survived by his wife Maureen, son Joseph and daughters Katelyn and Laura, mother Blanche and sister Jayne.
	Detective John T. Young died in February 2007 of 9-11 related illness after serving 20 years. He worked in the Midtown South Precinct and was a member of the Detective squad there, as well as in the 34th and 50th Precincts. He made 203 felony arrests and received eight recognitions for excellent police duty and two for meritorious service in his career. In addition to the rescue, recovery and clean-up effort at the World Trade Center site, Detective Young worked at the Fresh Kills Landfill in Staten Island after the Sept. 11 attacks Detective Young is survived by his wife Maura, son John and daughters Kristin and Shannon, and his parents Bob and Ann.
	Detective James Zadroga died in January 2006 of 9-11 related illness after serving nearly 11 years with the Department. He worked in the 6th Precinct, and 25th Precinct Detective squad, as well the Detective Borough Manhattan South Homicide Task Force, the Street Crime Unit and Patrol Borough Bronx Anti-Crime unit. Detective Zadroga made 136 felony arrests and received 31 recognitions for excellent police duty and seven for meritorious service. He worked in the rescue, recovery and clean-up effort at the World Trade Center site and is survived by his daughter Tyler-Ann and parents Joseph and Linda.
	Police Officer Angelo Peluso died in May 2006 of 9-11 related illness. He served for over 18 years, in the Department's 10th Precinct, the Detective Bureau Criminal Identification Unit, Photo Unit and License Division. Officer Peluso received two excellent police duty, and two meritorious service recognitions. He also was a part of the rescue, recovery and clean-up effort at the World Trade Center site. Officer Peluso is survived by his wife Kim, son Daniel and daughter Noelle, and father Angelo.
	Police Officer James J. Godbee died in December 2004 of 9-11 related illness after 18 years of service in the 28th Precinct and Manhattan Housing Borough. Officer Godbee was recognized three times in his career for meritorious service, and worked in the rescue, recovery and clean-up effort at the World Trade Center site, as well as was assigned to various posts in Lower Manhattan after the September 11, 2001 attacks. Officer Godbee is survived by his wife Michelle, daughter Imani and son Kai, parents James and Rena, brother Kevin and grandmother Dora Brown.
	Police Officer Ronald E. Weintraub died in November 2005 of 9-11 related illness after 15 years with the Department. He worked in the Midtown South Precinct and was recognized five times in his career for excellent police duty and meritorious service. Officer Weintraub also provided rescue, recovery and clean-up efforts at the World Trade Center site. He is survived by his wife Eileen, daughter Danielle and son Ryan, parents Sheila and Arnold and sister Sharon.
	Police Officer Thomas G. Brophy died in April 2005 of 9-11 related illness after 11 years of service in the 114th and 109th Precincts and Fleet Services Division. He too received recognition for excellent police duty. Officer Brophy worked in the rescue, recovery and clean-up effort at the World Trade Center as well as covered various posts in Lower Manhattan after the attacks. He is survived by his wife Rita and son Matthew, mother Janice, brother Brian, a New York State Trooper, father Tom, brother Justin and sister Erica.

credit The City of New York, EPA , The Canadian Broadcasting Company, ABC. New York Police Department