Health Effects From The 9/11 Attacks

International Space Station image taken on September 11, 2001, with the smoke plume rising from lower Manhattan and extending over Brooklyn (Expedition 3 crew).
International Space Station image taken on September 11, 2001, with the smoke plume rising from lower Manhattan and extending over Brooklyn (Expedition 3 crew).

There has been growing concern over the health effects arising from the September 11 attacks in the Financial District of Lower Manhattan. Within seconds of the collapse of the World Trade Center, building materials, electronic equipment, and furniture were pulverized and spread over the area.

In the five months following the attacks, dust from the pulverized buildings continued to fill the air of the World Trade Center site. Increasing numbers of New York residents are reporting symptoms of Ground Zero respiratory illnesses.

Various health programs have arisen to deal with the ongoing health effects of the September 11 attacks. The World Trade Center Health Program, which provides testing and treatment to 9/11 responders and survivors, consolidated many of these after the James Zadroga Act became law in January 2011.

Materials in the 9/11 cloud, and potential for creating Ground Zero illnesses:

The dust from the collapsed towers was “wildly toxic”, according to air pollution expert and University of California Davis Professor Emeritus Thomas Cahill. Much of the thousands of tons of debris resulting from the collapse of the Twin Towers was pulverized concrete, which is known to cause silicosis upon inhalation. The remainder consisted of more than 2,500 contaminants, more specifically: 50% non-fibrous material and construction debris; 40% glass and other fibers; 9.2% cellulose; and 0.8% of the extremely toxic carcinogen asbestos, as well as detectable amounts of lead, and mercury. There were also unprecedented levels of dioxins and PAHs from the fires which burned for three months. Many of the dispersed substances (asbestos, crystalline silica, lead, cadmium, polycyclic aromatic hydrocarbons) are carcinogenic; other substances can trigger kidney, heart, liver and nervous system deterioration. This was well known by the EPA at the time of collapse. A Centers for Disease Control and Prevention (CDC) and National Institute for Occupational Safety and Health (NIOSH) funded case report performed by Mt Sinai observed carbon nanotubes in dust samples and in the lungs of several 9/11 responders.

Ground Zero illnesses

This has led to debilitating illnesses among rescue and recovery workers, and the pulmonary fibrosis death of NYPD member Cesar Borja. Increasing numbers of cases are appearing in which first responders are developing serious respiratory ailments. Health effects also extended to some residents, students, and office workers of Lower Manhattan and nearby Chinatown.

World Trade Center exposure and excess cancer risk:

Smoke plume coming from the WTC site, seen on NEXRAD weather radar at 6pm on September 11th, 2001.
Smoke plume coming from the WTC site, seen on NEXRAD weather radar at 6pm on September 11th, 2001.

A study published in December 2012 in The Journal of the American Medical Association observed the possible association between exposure to the World Trade Center debris and excess cancer risk. Over 55,000 individuals enrolled in the World Trade Center Health Registry, separated by rescue and/or recovery workers and non-rescue and/or recovery workers, were observed from 2003 or 2004 to December 31, 2008. The findings showed the overall incidence of all cancers among rescue and/or recovery workers was not significantly elevated, compared to non-rescue and/or recovery workers. Despite this, the incidences for prostate cancer, thyroid cancer, and multiple myeloma were significantly elevated among the rescue and/or recovery workers, in the final year of observation.

Ground zero workers and cancer:

On November 28, 2006, the Village Voice reported that several dozen recovery personnel have developed cancer – as opposed to having contracted respiratory ailments, and that doctors have argued that some of these cancers developed as a result of the exposure to toxins at the Ground Zero site: “To date, 75 recovery workers at ground zero have been diagnosed with blood cell cancers that a half-dozen top doctors and epidemiologists have confirmed as having been likely caused by that exposure.”

Judgments and statements by leading physicians:

Dr. Larry Norton of Memorial Sloan-Kettering Hospital said “Why isn’t the whole nation mobilizing to take care of the chronic health impact of this disaster?”. Dr. Norton cited the 70 percent illness rate among first responders as “a wake up call.” Dr. Nathaniel Hupert of Weill Cornell Medical College, quoted by Jill Gardiner of the October 4, 2006, issue of the New York Sun said that premature deaths and other ailments of dogs in the area are “our canary in the coalmine.” Richard Clapp and David Ozonoff, professors of environmental health at Boston University School of Public Health; Michael Thun, director of epidemiological research at the American Cancer Society; Francine Laden, assistant professor of environmental epidemiology at Harvard School of Public Health; Jonathan Samet, chairman of the epidemiology department at Johns Hopkins Bloomberg School of Public Health; and Charles Hesdorffer, associate professor of oncology at Johns Hopkins School of Medicine argue that the cancer incidence among monitored individuals cannot be called a coincidence. They assert that the Ground Zero cloud was likely the cause of the illnesses. The American College of Preventative Medicine is concerned that malignant mesothelioma will develop among persons exposed to Ground Zero air.

2010 New York Fire Department Medical Office Study:

A study of 5,000 rescue workers published in April 2010 by Dr. David J. Prezant the chief medical officer for the Office of Medical Affairs at the New York City Fire Department found that all the workers studied had impaired lung functions with an average impairment of 10 percent. The study found the impairments presented itself in the first year of after the attack with little or no improvements in the ensuing six years. 30 to 40 percent of workers were reporting persistent symptoms and 1000 of the group studied were on “permanent respiratory disability.” Dr. Prezant noted the medications that are being given ease symptoms but are not a cure. Dr. Byron Thomashow, medical director of the Center for Chest Disease and Respiratory Failure at New York–Presbyterian/Columbia hospital said that “The drop-off in lung function initially is really quite significant and doesn’t get better. That’s not what we’ve generally come to expect in people with fire and smoke exposure. They usually recover.”

Ongoing monitoring of first responders’ and residents’ health

There is scientific speculation that exposure to various toxic products and the pollutants in the air surrounding the Towers after the WTC collapse may have negative effects on fetal development. Due to this potential hazard, a notable children’s environmental health center (Columbia University Center for Children’s Health) is currently analyzing the children whose mothers were pregnant during the WTC collapse, and were living or working near the World Trade Center towers. The staff of this study assesses the children using psychological testing every year and interviews the mothers every six months. The purpose of the study is to determine whether there is significant difference in development and health progression of children whose mothers were exposed, versus those who were not exposed after the WTC collapse.

Mount Sinai Medical Center is conducting an ongoing monitoring program, World Trade Center Worker and Volunteer Medical Screening Program. A leader of Mt. Sinai monitoring efforts is Stephen M. Levin, Medical Director of the Mount Sinai – Irving J. Selikoff Center for Occupational and Environmental Medicine. First responders met in a conference, November 11, 2006, in an effort to monitor responders’ health. The event was organized by the World Trade Center Monitoring Program.

An ongoing Pennsylvania State University/Monmouth University study reported that respiratory illnesses grew by more than two hundred percent in the year and a half after the September 11 attacks. (This was the first study that monitored police officers at the Ground Zero site. It was published in the “Journal of Occupational and Environmental Medicine.”) In this study of 471 police officers, 19 percent of the officers in October 2001 experienced shortness of breath; 44 percent of the officers experienced shortness of breath in April 2003. The percentage of the 471 officers coughing up phlegm increased from 14 percent in October 2001 to 31 percent in 2003.

A 2006 medical study of fire fighters reported that those personnel who inhaled Ground Zero air essentially lost 12 years of lung function. Additionally, a Mount Sinai report found that 70 percent of recovery and rescue workers reported an increase in debilitated respiratory function between 2002 and 2004.

A 2008 report by New York City’s Department of Health indicated that up to 70,000 people might have stress disorder due to the attack. The findings were the result of the city’s health registry of September 11 first responders, residents, and others.

On September 18, 2001, EPA administrator Christine Todd Whitman told the public, via a press release, “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” and that “Given the scope of the tragedy from last week, I am glad to reassure the people of New York … that their air is safe to breathe and the water is safe to drink.”

An August 2003 report by the Office of the Inspector General of the EPA said the Bush administration pressured the EPA to remove cautionary information about the air quality at Ground Zero.

Numerous key differences between the draft versions and final versions of EPA statements were found. A recommendation that homes and businesses near ground zero be cleaned by professionals was replaced by a request that citizens follow orders from NYC officials. Another statement that showed concerns about “sensitive populations” was deleted altogether. Language used to describe excessive amounts of asbestos in the area was altered drastically to minimize the dangers it posed.

In September 2006, the U.S. House Committee on Homeland Security held a two-day hearing on illnesses caused by post-9/11 air quality. Former EPA head Christine Todd Whitman was a frequent target of criticism.

EPA scientist Dr. Cate Jenkins said on CBS television on September 8, 2006, that agency officials lied about the air quality in the weeks following September 11, 2001. She said that in her opinion the EPA knew about the toxicity of the air, and that WTC dust included asbestos and disturbingly high PH levels. She said that some of the dust was “as caustic and alkaline as Drano.” Dr. Marjorie Clarke also warned of the consequences of breathing toxic dust and fumes. Yet, agencies did not heed her warnings.

The New York State Department of Environmental Conservation conducted a study of the World Trade Center site, but refused to release the results of its study, saying they were part of a criminal investigation.

On September 13, 2006, Congressmen Jerrold Nadler (NY), Anthony Weiner (NY), Bill Pascrell Jr. (NJ) filed a request with US Attorney General Alberto Gonzales to investigate whether criminal charges may be brought against Whitman for lying about air safety in the Ground Zero area.

Critics assert that government officials – notably Bush, Christine Todd Whitman (former head of the US EPA), and New York City mayor Rudy Giuliani – downplayed the health risks of the area and rushed to reopen the area around Ground Zero, although this posed a grave and immediate health risk to first responders. Many corporations were eager to hear the news of the New York Stock Exchange being reopened only a few days after the collapse. On June 25, 2007, Whitman testified before a House of Representatives committee chaired by Jerrold Nadler. She said that a White House official informed her that President Bush expected that the Financial District would reopen within three days, that is, by September 14. She said that she replied that this would be cumbersome, since the EPA was still judging the health situation in the area. Investigations after the attacks suggest that the Bush administration pressured Whitman and Giuliani to provide health reassurances in order to keep Wall Street operating.

Two days after the collapse of the World Trade Center, mayor 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.”

In November 2001, Giuliani wrote to the city’s Congressional delegation and urged that the city’s liability for Ground Zero illnesses be limited, in total, at $350 million. Two years after Mayor Giuliani finished his term, FEMA appropriated $1 billion to a special insurance fund to protect the city against 9/11 lawsuits.

In a September 18, 2006 New York Daily News article titled, “Rudy’s Black Cloud: WTC health risks may hurt Prez Bid”, Sally Regenhard, mother of firefighter Christian Regenhard who died on September 11, is quoted, “There’s a large and growing number of both FDNY families, FDNY members, former and current, and civilian families who want to expose the true failures of the Giuliani administration when it comes to 9/11.” She told the New York Daily News that she intends to “Swift Boat” Giuliani.

Then senator Hillary Clinton contemplated calling Giuliani to testify before a Senate committee on whether the government failed to protect recovery workers from the effects of polluted Ground Zero air.

Congressman Nadler was quoted in a March 1, 2007, “New York Sun” article, “Potential Clinton-Giuliani Battle Brews Over 9/11 Health Issues.” He said that he “absolutely” wishes to interview Giuliani administration officials regarding the environment in the aftermath of the September 11 attacks. He asked, “Who made decisions, if any, that resulted unnecessarily in a lot of people getting sick?”

Handling of cleanup procedure:

A May 14, 2007, New York Times article, “Ground Zero Illness Clouding Giuliani’s Legacy”, gave the interpretation that thousands of workers at Ground Zero have become sick and that “many regard Mr. Giuliani’s triumph of leadership as having come with a human cost.” The article reported that he seized control of the cleanup of Ground Zero, taking control away from established federal agencies, such as the Federal Emergency Management Agency, the Army Corps of Engineers and the Occupational Safety and Health Administration. He instead handed over responsibility to the “largely unknown” city Department of Design and Construction. Documents indicate that the Giuliani administration never enforced federal requirements requiring the wearing of respirators. Concurrently, the administration threatened companies with dismissal if cleanup work slowed.

Workers worked without proper respirators. They wore painters’ masks or no covering. Specialists claim that the only effective protection against toxins such as airborne asbestos, is a special respirator. New York Committee for Occupational Safety and Health industrial hygienist David Newman said, “I was down there watching people working without respirators.” He continued, “Others took off their respirators to eat. It was a surreal, ridiculous, unacceptable situation.”

The local EPA office sidelined the regional EPA office. Dr. Cate Jenkins, a whistle-blower EPA scientist, said that on September 12, 2001, a regional EPA office offered to dispatch 30 to 40 electron microscopes to the WTC pit to test bulk dust samples for the presence of asbestos fibers. Instead, the local office chose the less effective polarized light microscopy testing method. Dr. Jenkins alleged that the local office refused, saying, “We don’t want you f—ing cowboys here. The best thing they could do is reassign you to Alaska.”

Lawsuit, settlement, and treatment costs:

First responders and other individuals are suing the City of New York. Lawyers are criticizing the city for failing to provide proper facial ventilators to clean-up workers. On October 17, 2006, federal judge Alvin K. Hellerstein rejected New York City’s motion to dismiss lawsuits that requested health payments to the first responders.

On November 19, 2010, attorneys said that plaintiffs accepted a settlement which should lead to $625 million being paid to more than 10,000 workers experiencing problems as a result of inadequate preparation to work at Ground Zero. Not all affected participated, but those who did not would be eligible for a portion of $7.4 billion provided by the James Zadroga 9/11 Health and Compensation Act, which the U.S. House passed in September 2010. New York City Mayor Michael Bloomberg asked the Senate to do the same. The plaintiffs in the settlement would also be eligible for compensation under the Zadroga Act.

On December 22, 2010, the United States Senate passed a 9/11 Health Bill running against opposition of the Republican Party. The measure calls for providing $1.8 billion until 2015 to monitor and treat injuries stemming from exposure to toxic dust and debris at World Trade Center site. There are nearly 60,000 people enrolled in health-monitoring and treatment programs related to the 9/11 attack. The bill is formally known as the James Zadroga 9/11 Health and Compensation Act, named after a New York police detective who took part in the rescue efforts at ground zero and later developed breathing complications.

On October 28, 2007, Jim Riches reported that the City of New York and litigating first responders have shown interest in a legal settlement, to resolve lawsuits against the city. The settlement would yield a financial settlement apportioned in the following manner: forty percent to lawyers, and sixty percent to litigants.

The National Institute for Occupational Safety and Health issued a study on July 17, 2007, indicating that the estimates for monthly costs of treating Ground Zero workers had increased from around $6 million per month to $20 million per month by the end of 2007. The causes of the increased expense lie in the increasing numbers of workers getting sick and the worsening illnesses of workers. This indicated that the planned U.S. House appropriation legislation (of $50 million) for the sick workers, for the coming year, would be inadequate. The number of workers that have registered with area hospitals’ Ground Zero programs has reached 37,000. With about 500 new workers registering each month, the institute estimated that the number of registrants could reach 65,000 in two years. (The institute is overseen by the Department of Health and Human Services.) 40 percent of the World Trade Center workers being monitored by a Mount Sinai Hospital study lack health insurance.

In June 2008, New York City argued in federal court that 30 percent of the September 11 plaintiffs did not have serious injuries. This is part of a larger debate over the number of people sickened by the collapse of the Twin Towers.

First responders:

In particular, first responders, New York Police Department and Fire Department of New York members that reported to Ground Zero, have asserted that they are victims of diseases associated with the toxic cloud from the pulverized buildings and equipment. (See article: Rescue and recovery effort after the September 11 attacks.) NYPD Detective James Zadroga, 34, was the first 9/11 responder whose 2006 death was directly linked with toxic Ground Zero substances. Gerard Breton, a pathologist of the Ocean County, New Jersey medical examiner’s office (which conducted an autopsy), reported that “It is felt with a reasonable degree of medical certainty that the cause of death in this case was directly related to the 9/11 incident.”

Cesar Borja, a veteran of the NYPD, died, falling ill from lung disease. He had spent 16-hour days at the smoldering wreckage of Ground Zero. Detective Robert Williamson, 46, died from pancreatic and lung cancer on May 13, 2007. He worked for 16-hour days, without taking days off, in performing recovery work at the Ground Zero site. After the clean up effort, he was among individuals that lobbied Governor George Pataki to sign a bill permitting retirees suffering from Ground Zero illnesses to have their illnesses reclassified and to receive additional pension benefits. His family and union believe that his cancers were directly caused by exposure to Ground Zero dust at the World Trade Center site.

Twenty year veteran of the NYPD, Officer Kevin Hawkins, 41, died in May 2007 from kidney cancer, soon after filing for a Ground Zero disability pension. He had worked two months at the Ground Zero site.

On September 3, 2007, NYPD Officer Frank Macri died of lung cancer that spread throughout his body, including to his spine. Macri’s lungs were filled with dust when the towers collapsed and he later spent two months working on the site. The long hours on the site gave him vomiting spells and he was diagnosed with an already rapidly progressing stage four cancer only one year after the attack, despite being a non-smoker and cancer free before the attacks. In 2011, a lower court ruled that 9/11 toxins were the likely cause of Macri’s death. In 2012, the New York Supreme Court ruled that Macri’s widow is entitled to line-of-duty death benefits of his full salary.

Surviving first responders and their advocates are asserting that their illnesses have resulted from exposure to toxins at Ground Zero. The Patrolmen’s Benevolent Association of the City of New York (PBA) filed a lawsuit to secure benefits for Officer Christopher Hynes, 36. In March 2004 he was diagnosed as having sarcoidosis. However, the NYPD has refused to bestow line-of-duty injury status to him. Hynes had worked for 111 hours at Ground Zero and its vicinity. He claims that he was never given a proper respirator for his work at Ground Zero. He has had difficulty in paying medical bills because of the denial of line-of-duty status. One medical provider sued him for $3,094 for medical bills. The provider eventually settled out of court for $1,625. The PBA noted that firefighters, by contrast, have been given line-of-duty status for their injuries.

Hundreds of volunteer firefighters, construction workers, health professionals, clergy, and other individuals descended upon the scene in the days immediately following the attacks. These individuals volunteered directly at the Ground Zero site or cared for traumatized responders. Among individuals in the latter group, newspaper accounts have cited South Carolinian Episcopal nun, Sister Cindy Mahoney’s death as a fatality of Ground Zero illness. Mahoney spent several months attending to first responders’ spiritual needs. Two weeks prior to her death, she was cut off from her insurance. She choked to death on November 1, 2006, following five years of lung troubles.

Sen. Hillary Clinton on Sister Mahoney and Ground Zero illness: “We know that so many are now suffering health effects from breathing the toxic air at Ground Zero … Yet there are still some who doubt the link. By raising attention to her own devastating illness, Sister Mahoney will continue as she did in life, to help those affected by 9/11.”

9/11 Air Toxins.
9/11 Air Toxins.
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