Within seconds of the collapse of the World Trade Center in the September 11 attacks, building materials, electronic equipment, and furniture were pulverized and spread over the area of the Financial District of Lower Manhattan. In the five months following the attacks, dust from the destroyed buildings continued to fill the air of the World Trade Center site. Many New York residents have reported symptoms of Ground Zero–related 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 9/11 Health and Compensation Act became law in January 2011. More people have died from illnesses caused by 9/11 than during the attack itself. As of 2023, it is estimated that over 5,000 people have died from medical complications related to the attacks, specifically those enrolled in the World Trade Center Health Program by the CDC.
Exposures and conditions
As of December 2017, the most common conditions certified by the World Trade Center Health Program were rhinosinusitis, gastroesophageal reflux disease (GERD), asthma, sleep apnea, cancer, post-traumatic stress disorder, respiratory disease, chronic obstructive pulmonary disease, depression, and anxiety disorder. The most common cancers were skin cancer and prostate cancer. The World Trade Center Health Program regularly publishes the most commonly certified condition on its website.
Toxic dust
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 polycyclic aromatic hydrocarbons (PAHs) from the fires which burned for three months. Many of the dispersed substances (asbestos, crystalline silica, lead, cadmium, and 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 case report funded by the National Institute for Occupational Safety and Health (NIOSH) and performed by Mount Sinai School of Medicine observed carbon nanotubes in dust samples and in the lungs of several 9/11 responders. The dust was not only said to be wildly toxic but also contained more than 2,500 contaminants that included asbestos, lead, mercury, dioxins, and polycyclic aromatic hydrocarbons, which was present in the dust. This reports that the fires consumed three months and that most of these substances are carcinogens which have been proven to damage kidney, heart liver, nervous system and liver. The composition of the smoke and dust in the air was not fully understood at the time; the World Trade Center Health Program's Dr. Michael Crane touched upon this issue in an interview with Newsweek stating:
We will never know the composition of that cloud, because the wind carried it away, but people were breathing and eating it...What we do know is that it had all kinds of god-awful things in it. Burning jet fuel. Plastics, metal, fiberglass, asbestos. It was thick, terrible stuff. A witch’s brew. These toxic exposures have led to debilitating illnesses among rescue, recovery, and cleanup 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. Dr. Edwin M. Kilbourne, a high level federal scientist, issued a memo on September 12, 2001, to the Centers for Disease Control and Prevention advising against the speedy return to buildings in the area because of possible hazards from various toxic materials. On October 6, 2001, Associate City Health Commissioner Kelly McKinney said that proper safety protocol for WTC site workers was not being enforced. 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 that firefighters who arrived on the Sept. 11 morning had the worst impairments, which presented themselves within the first year after the attack, with little or no improvements in the ensuing six years. 30% to 40% of workers were reporting persistent symptoms and 1000 of the group studied were on "permanent respiratory disability".A test involving 5,000 rescue workers also indicated that not one of the rescue workers was found to have possessed a normal lung system but an average of 10 percent had been measured but it was the firefighters that were there in the mornings of the 9/11 day that had given the lowest mark. A 2006 study has discovered that first responders were losing 12 years of lung capacity. The World Trade Center Health Program rhinosinusitis, asthma, GERD, COPD, and cancer certified such conditions . Dr. Prezant noted that medication given to the victims can ease but not cure the symptoms. 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."
Cancer risk
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