Health effects arising from the September 11 attacks

World Trade Center Health Program
Company type	Government program
Industry	Health care
Founded	2011; 15 years ago
Founder	United States Congress
Headquarters	New York City, United States
Area served	United States
Key people	Stephen M. Levin (program leader at Mount Sinai Medical Center)
Products	Health monitoring and treatment for 9/11 survivors and responders
Parent	United States federal government

Within moments following the collapse of the World Trade Center during the September 11 attacks, debris including building materials, electronic devices, and furnishings was pulverized and scattered throughout the Financial District in Lower Manhattan. For a duration of five months afterward, airborne dust from the wreckage persisted at the World Trade Center site, prompting numerous New Yorkers to experience symptoms associated with Ground Zero respiratory illnesses.

In response to these ongoing health challenges, several specialized programs were established. The World Trade Center Health Program, created under the authority of the James Zadroga 9/11 Health and Compensation Act (2011), unified testing and treatment efforts for both survivors and responders affected by 9/11.

Significantly, fatalities attributed to illnesses caused by exposure related to 9/11 have surpassed the number of deaths occurring during the attacks themselves.

Exposures and conditions

By December 2017, the conditions most frequently certified through the World Trade Center Health Program encompassed rhinosinusitis, gastroesophageal reflux disease (GERD), asthma, sleep apnea, a range of cancers, post-traumatic stress disorder, respiratory ailments such as chronic obstructive pulmonary disease, along with mental health disorders including depression and anxiety disorder. Among cancers, skin cancer and prostate cancer were predominant. The program consistently releases updated statistics on certified medical conditions.

Toxic dust

According to Thomas Cahill, an air pollution specialist and Professor Emeritus at the University of California Davis, the dust resulting from the towers' collapse was extremely toxic. The debris largely consisted of pulverized concrete—which is linked to silicosis—and contained over 2,500 hazardous substances such as asbestos, lead, mercury, dioxins, and polycyclic aromatic hydrocarbons (PAHs) generated by fires that burned for three months. Many of these compounds were carcinogenic or damaging to vital organs and nervous tissue. Research conducted by Mount Sinai School of Medicine detected carbon nanotubes within dust samples and in the lungs of responders. Although the complete makeup of the dust cloud remains undetermined, it included burning jet fuel, plastics, metals, fiberglass, and asbestos.

These toxic exposures have led to severe illnesses among rescue personnel, recovery teams, and cleanup workers—examples include deaths from pulmonary fibrosis like that of NYPD officer Cesar Borja. There has been a notable rise in respiratory conditions among first responders as well as some residents and employees in Lower Manhattan and Chinatown. Early federal warnings about these hazards were largely disregarded; safety measures at the site were reportedly not enforced. A 2010 study involving 5,000 rescue workers revealed universal lung function decline averaging 10%, with firefighters who arrived on the morning of September 11 experiencing the most severe impairments. Despite treatments that alleviate symptoms, many continue to live with permanent respiratory disabilities.

Cancer risk

A 2012 investigation published in The Journal of the American Medical Association found no overall increase in cancer rates among rescue and recovery personnel compared to the general population; however, incidences of prostate cancer, thyroid cancer, and multiple myeloma were notably higher within this group. By 2006, numerous responders had developed blood-related cancers likely linked to toxic exposure at Ground Zero. In 2018, a legal firm disclosed that at least 15 men had been diagnosed with male breast cancer associated with their proximity to Ground Zero following the events of 9/11.

The September 11th Victim Compensation Fund (VCF) offered financial restitution to individuals diagnosed with cancers connected to exposure occurring from September 2001 through May 2002. Legal assistance was available to clarify eligibility requirements before the application deadline in July 2021.

Psychological effects

Research conducted soon after the attacks identified widespread stress symptoms across the United States, with exposure to the events being a predictor for developing post-traumatic stress disorder (PTSD). Further studies highlighted psychological consequences for those who lost family members or witnessed the attacks via television broadcasts.

Reactions

Medical professionals such as Dr. Larry Norton from Memorial Sloan-Kettering Cancer Center emphasized that a 70% illness rate among first responders represents a significant public health concern. Epidemiologists affiliated with Boston University, Harvard, Johns Hopkins, and other institutions contend that the occurrence of cancers among exposed individuals is unlikely to be coincidental, attributing these illnesses to toxins present at Ground Zero. The American College of Preventive Medicine has voiced apprehension regarding malignant mesothelioma cases emerging in exposed populations.

Monitoring and compensation

Around 400,000 people affected by the attacks qualify for enrollment in the World Trade Center Health Registry and can receive complimentary health monitoring and treatment through the World Trade Center Health Program.

Ongoing scientific research is investigating potential impacts on fetal development due to maternal exposure near Ground Zero. Columbia University’s Center for Children’s Environmental Health conducts yearly psychological evaluations and interviews with children and mothers affected by these exposures.

Mount Sinai Medical Center manages a continuous World Trade Center Worker and Volunteer Medical Screening Program under the leadership of Stephen M. Levin. In November 2006, first responder groups assembled to coordinate efforts related to health surveillance.

A joint study by Pennsylvania State University and Monmouth University revealed that respiratory illnesses among police officers present at Ground Zero more than doubled within eighteen months following the attacks. Firefighters exposed to Ground Zero air experienced lung function losses equivalent to up to twelve years; Mount Sinai reported that between 2002 and 2004, approximately 70% of recovery workers showed declining respiratory health. The New York City Department of Health estimated that as many as 70,000 individuals may be affected by post-9/11 stress disorders.

Compensation

Although over 100,000 people were eligible for compensation programs by the mid-2000s, fewer than 14,000 had registered. Deadlines for filing workers’ compensation claims were extended multiple times by New York governors Eliot Spitzer and Andrew Cuomo, with extensions lasting through September 2022.

In April 2022, legislation was introduced in the New York State Legislature proposing coverage for illnesses or fatalities resulting from participation in rescue and cleanup operations under workers’ compensation law. This bill would use certification from the CDC’s World Trade Center Health Program as presumptive evidence for claims.

Vulnerable Populations

A study conducted by the New York State Department of Health reported at least 204 fatalities among rescue and recovery personnel related to 9/11 as of 2008. Documented causes of death included cancers (55 cases), traumatic injuries (21 cases), heart disease (12 cases), sarcoidosis (2 cases), as well as neurological disorders, pneumonia, alcoholism, amyloidosis, and kidney ailments.

First Responders

Personnel from the NYPD and FDNY who operated at Ground Zero have experienced illnesses attributed to exposure to hazardous substances. The death of NYPD Detective James Zadroga in 2006 marked the first officially linked fatality due to toxins at Ground Zero. By 2017-2018, numerous additional NYPD officers had succumbed to cancer connected to these exposures; by 2020-2022, the combined confirmed deaths from related illnesses among NYPD and FDNY members approached 550. The Port Authority Police Department reported four fatalities tied to such conditions but implemented early protective protocols that reduced their officers' exposure relative to NYPD and FDNY responders.

Illustrative Health Cases

Prominent examples include Cesar Borja, a veteran NYPD officer who passed away from lung disease following prolonged exposure at Ground Zero; Detective Robert Williamson, who died from pancreatic and lung cancers; Officer Kevin Hawkins, who suffered from kidney cancer; Officer Frank Macri, whose lung cancer was legally recognized as linked to toxic exposure; and Captain Douglas Greenwood, who died by suicide after a prolonged struggle with lung disease. Families frequently attribute these health conditions directly to inhalation of Ground Zero dust.

Comprehensive List of Deceased Personnel

An extensive roster comprises attorneys, detectives, officers, EMTs, and special agents from multiple agencies who died between 2002 and 2019 due to illnesses associated with exposure at Ground Zero.

Legal Actions

First responders still living have pursued official acknowledgment for illnesses caused by toxic exposure at Ground Zero. The Patrolmen's Benevolent Association filed a lawsuit seeking benefits on behalf of Officer Christopher Hynes after his sarcoidosis diagnosis was denied recognition as a line-of-duty injury despite his significant work at the site without appropriate respiratory protection.

Various Volunteers

Hundreds of volunteers—including firefighters, construction workers, medical professionals, and clergy—contributed to recovery efforts or provided subsequent care. Sister Cindy Mahoney’s death from respiratory complications after years of assisting first responders underscored the health dangers faced by non-professional volunteers. Senator Hillary Clinton publicly recognized these adverse health effects.

Communication Workers

Mark DeBiase died from an illness linked to Ground Zero after working on restoring communications equipment at the site without adequate protective gear.

Janitorial Staff

Janitors such as Manuel Checo involved in cleanup operations developed "World Trade Center cough," a condition worsened by many lacking health insurance coverage.

Financial District Employees

Attorney Felicia Dunn-Jones passed away from sarcoidosis attributed posthumously to inhalation of dust near her office one block from the collapse zone. Mayor Rudy Giuliani acted promptly to facilitate Wall Street’s reopening on September 17.

Educators and students

Despite ongoing fires, pupils and faculty from nearby institutions such as Stuyvesant High School returned to their premises; many have subsequently suffered from asthma and other respiratory ailments believed to stem from polluted air systems. Several students also developed trauma-induced disorders, including PTSD. Discussions persist regarding possible connections between certain cancers in former students and exposure at Ground Zero.

Allegations of EPA statement manipulation by President George W. Bush

President Bush was criticized for purportedly exerting pressure on the EPA to soften warnings about air quality dangers near Ground Zero in the immediate aftermath of the attacks.

Early assurances by Christine Todd Whitman

Less than two weeks following the attacks, EPA Administrator Whitman proclaimed the air safe despite evidence suggesting otherwise.

Claims of EPA misinformation about Ground Zero air conditions

An EPA Inspector General’s investigation revealed that the Bush administration influenced the removal of cautionary language concerning air quality hazards near Ground Zero; warnings about asbestos risks were edited or omitted prior to publication. Congressional inquiries scrutinized Whitman’s involvement; EPA whistleblower Dr. Cate Jenkins accused officials of misrepresenting toxicity levels, including asbestos presence and caustic dust composition.

The New York State Department of Environmental Conservation withheld study findings due to ongoing criminal probes. Lawmakers requested an investigation into Whitman’s public statements about post-attack air safety.

Alleged governmental minimization of health dangers

Critics contend that officials such as Bush, Whitman, and Mayor Giuliani downplayed health risks to hasten Lower Manhattan’s reopening despite significant hazards—leading to lawsuits alleging negligence in safeguarding first responders. Giuliani publicly assured safety shortly after the attacks while advocating for limits on municipal liability related to illnesses; FEMA later allocated $1 billion for legal defense insurance.

Families of firefighters have actively campaigned to expose administrative shortcomings in protecting health during cleanup efforts.

Management of cleanup operations

The Giuliani administration assumed control over cleanup activities from federal agencies but failed to mandate respirator use among workers exposed to hazardous dust; contractors faced termination threats if progress slowed. Workers frequently wore inadequate masks or none at all, despite expert advice that only specialized respirators could prevent asbestos inhalation.

EPA regional offices offering advanced monitoring were reportedly marginalized by local offices resistant to outside involvement according to whistleblower accounts.

Litigation, settlements, and healthcare expenses

First responders filed suit against New York City claiming inadequate provision of protective gear; courts permitted lawsuits seeking medical compensation to move forward despite city immunity claims.

In November 2010, plaintiffs agreed to a $625 million settlement addressing insufficient preparedness at Ground Zero; numerous individuals also qualified for benefits under the James Zadroga 9/11 Health and Compensation Act enacted later that year, which allocated $1.8 billion through 2015 for monitoring and treatment programs serving almost 60,000 participants.

Treatment costs escalated sharply as more individuals fell ill; monthly expenditures rose from $6 million in early assessments to $20 million by late 2007, with registrants expected to reach 65,000 within two years. A substantial share lacked health insurance during this time.

In June 2008 federal court proceedings, New York City challenged claims alleging severe injuries among some plaintiffs amid ongoing debate over illness prevalence linked to exposure during the collapse.

World Trade Center health program leadership

In mid-2007, Mayor Bloomberg designated Jeffrey Hon as the coordinator for the World Trade Center health initiative, aiming to consolidate health-related data, although his responsibilities concerning pension matters remained ambiguous.

At the federal level, Dr. John Howard directed the World Trade Center Health Program established under the Zadroga Act. His 2011 assessment concluded that there was insufficient proof connecting particulate matter exposure to cancer, which restricted access to certain treatment funds. This conclusion faced opposition from New York congressional members who expected future findings to confirm a causal relationship.

Legal action by local inhabitants

Residents of Lower Manhattan initiated legal proceedings against the Environmental Protection Agency (EPA), accusing it of misleading the public about air quality hazards. Courts permitted lawsuits targeting former EPA administrator Whitman, alleging she provided false reassurances following the collapse, while dismissing immunity defenses based on public interest claims.

Subsequently, arbitration panels approved settlements amounting to $500 million, covering most plaintiffs not included in earlier congressional compensation programs.

Protests by Ground Zero workers and local residents

In January 2007, demonstrators—including members of the Sierra Club—appealed to President Bush to increase funding beyond the $25 million allocated for ill workers, highlighting governmental delays in response. Residents affected by illnesses after cleaning debris from their homes also demanded access to medical treatment.

Ground Zero workers’ litigation

By mid-2007, more than 10,000 claims had been submitted against New York City concerning toxic exposures at Ground Zero. Prominent legal representatives headed class-action suits on behalf of thousands, alleging negligence by authorities despite initial hesitations due to political sensitivities surrounding cleanup operations.

Documentary films

Fallout: The Health Impact of 9/11
Dust to Dust: The Health Effects of 9/11
The Toxic Clouds of 9/11: A Looming Disaster
Toxic Legacy
Sicko (Michael Moore)
No Responders Left Behind

Additional resources

"9/11 responders who became ill from toxic exposure now have a monument to their heroism". Los Angeles Times, September 10, 2017

Books

Wayne Barrett and Dan Collins, Grand Illusion: The Untold Story of Rudy Giuliani and 9/11 (2006), ISBN 0-06-053661-6
Steve Centore, One of Them: A First Responder's Story (2008), ISBN 0-9801274-0-8
Juan Gonzalez, Fallout: The Environmental Consequences of the World Trade Center Collapse (2002), ISBN 1-56584-754-7

External links

Environmental advocacy groups related to Ground Zero

Natural Resources Defense Council provides information on the environmental consequences of the World Trade Center attacks
9/11 Environmental Action initiative
World Trade Center Environmental Organization
"Beyond Ground Zero", an organization dedicated to assisting low-income workers and residents

Organizations supporting workers

Feal Good Foundation, a nonprofit focused on disseminating health-related information for September 11 responders
9/11 Health Now