Eleven years after the 9/11 terrorist attacks, research is still emerging on the health problems experienced by first responders, nearby residents, and others exposed to the debris field surrounding the World Trade Center towers.
On Monday, 50 types of cancers were added to the growing list of health conditions linked to the 9/11 attacks that are eligible for treatment and compensation through a special government fund. Prior to the announcement, people who attributed a cancer diagnosis to toxic exposure from the debris did not qualify for government compensation because of doubts about the association between the attacks and cancer cases.
This is a long-awaited decision that will add significantly to the number of people seeking compensation for their illnesses.
The World Trade Center attack "is among the most highly studied disasters in history," according to a special issue of The Lancet, published last year on the event's 10-year anniversary.
But the health ramifications for survivors, first responders, and others are still developing, notes John Feal, founder and president of the FealGood Foundation, a Nesconset, N.Y.-based nonprofit organization aimed at assisting first responders or anyone who has been injured as a result of the rescue, recovery, or cleanup.
A demolition expert, Feal was summoned to the World Trade Center towers site one day after the attacks to aid in cleanup and recovery. While he was working there, steel came loose from a debris pile and crushed his left foot, which was later amputated.
"Most of the conditions related to the attacks have been identified," Feal tells TakePart. "But we continue to see people get sicker and die. We haven't seen the first of the asbestos-related cancers yet because those cancers take so much longer to develop. There will be more illnesses."
In a report on the website 9/11 Health, Dr. Thomas Farley, commissioner of the New York City Department of Health and Mental Hygiene, said a wide range of health problems among rescue and recovery workers, residents, children, city employees, and others are associated with the attacks.
The most common problem is post-traumatic stress disorder, which affects 19 percent of the adults enrolled in the city's World Trade Center Health Registry, a list of people who were exposed to the disaster that’s headed by the New York City Department of Health and the Agency for Toxic Substances and Disease Registry. That rate is four times higher than in the general population.
Many conditions are surprisingly chronic. A 2011 study, published in the journal Disaster Medicine and Public Health Preparedness, found that post-traumatic stress symptoms were found in firefighters nine years after the attacks. Mental-health issues are particularly problematic because many people may be reluctant to seek treatment due to stigma or fear of discrimination, experts note.
Respiratory symptoms have also shown a stubborn persistence. People exposed to dust from the debris field are much more likely to have respiratory problems, including asthma, chronic bronchitis, and other lung function problems. New cases of respiratory problems were highest in the first year or two following the attacks. But even seven years after the attacks, studies showed that below-normal lung function persisted in many emergency medical service workers and firefighters.
"Some illnesses are treatable with medication and follow-up," says Feal. "But a lot of these illnesses and injuries are permanent."
A 2010 study in the New England Journal of Medicine suggested that the high rate of lung ailments found in first responders had not improved six years after exposure and were potentially permanent. The authors of the study called the World Trade Center dust—a brew of particulate matter, chemicals and jet fuel—"the most dense, intense particulate matter [humans were] ever exposed to in an urban environment."
The complexity of the health issues is still coming into focus. A study published earlier this year in the American Journal of Public Health found that some survivors of the attacks have multiple health problems linked to the event. Among more than 16,000 survivors studied, about one in four who had been diagnosed with either lower respiratory symptoms or post-traumatic stress disorder had both disorders five to six years after the attacks.
"Not being able to work due to disability has caused people even more stress," Feal says.
But the most perplexing and controversial health impact relates to health conditions that take many years to develop or produce symptoms, such as cancer. After years of debate, the National Institute on Occupational Safety and Health earlier this year proposed adding a long list of cancers to the list of conditions likely caused by toxic exposure from the debris.
The James Zadroga 9/11 Health and Compensation Act was signed into law last year to continue monitoring and treatment for those affected by 9/11 health problems and to compensate those injured by the attacks from a $4.3 billion federal fund.
Monday's announcement from the National Institute for Occupational Safety and Health is supported by a study published last year in The Lancet that found a "modest" increase in cancer cases in firefighters who were part of the 9/11 response compared to non-exposed firefighters.
Research on the health effects will need to continue for the lifetimes of the survivors and first responders, Feal argues.
"Nine-eleven was unprecedented, so the medical monitoring and treatment has to be unprecedented," he says. After all, "All those people who risked their lives for others—that was unprecedented."
Do you think more needs to be done for first responders who have lasting health effects from 9/11? Let us know in the comments.
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Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.