NEW YORK, Sept. 9 (UPI) — A new World Trade Center stands in lower Manhattan 20 years after Sept. 11, 2001, but thousands of people who were there that day — from first responders hoping to save lives to people who were just on their daily commute — continue to feel health effects linked to the terrorist attack.
More than 80,000 first responders are enrolled in the World Trade Center Health Program, a National Institute for Occupational Safety and Health initiative created under the Zadroga 9/11 Health Act of 2010, which provides care at no cost to those with health conditions related to the attacks.
In addition, it oversees the care of more than 30,000 civilians who survived the events of that day, including those who lived and worked in the neighborhood and students at schools nearby.
Both numbers have increased over the past decade, with the number of first-responder enrollees rising by about 40% since 2011 and the population of survivors under care growing three-fold since 2016. Many have cancer.
These trends are likely to continue, as new cancer cases among survivors of the attacks are expected to emerge due to disease “latency,” according to environmental and occupational medicine specialist Dr. Iris G. Udasin.
Solid tumor cancers related to toxic exposures take at least four years to develop, with most remaining latent for 15 to 20 years, Udasin said.
“Because of cancer latency and other health problems, such as diabetes and heart disease, developing with age, we’re seeing survivors who had been healthy for years only now entering the program,” Udasin, director of the WTC Center of Excellence at Rutgers University, told UPI in a phone interview.
As part of a WTC Center of Excellence, a designation awarded to several hospitals in the New York area, Udasin and her colleagues care for nearly 5,000 survivors.
“Only now are they getting sick,” she said.
Although the number of first responders and survivors in the WTC Health Program continues to rise, its “outreach” efforts for the latter group have not been as effective, Udasin said.
More than 10% of patients treated at Rutgers said they lacked access to at least one needed healthcare service under the WTC program, Udasin and her colleagues found in a study published earlier this year.
More than cancer
Cancer may be the health problem most commonly associated with the attacks, given the dust and debris that rained down on lower Manhattan and the cloud that hung over the area for weeks afterward.
However, first responders and survivors suffer from myriad issues, many of which continue to affect their quality of life 20 years later, said Mark Farfel, director of the New York City Department of Health’s WTC Health Registry.
The registry includes data on roughly 71,000 first responders and survivors, but estimates that as many as 400,000 people were exposed to toxic dust particles generated by the attacks in the five boroughs alone.
“The 9/11 disaster has had a long-lasting effect on the physical and mental health of thousands of survivors,” Farfel told UPI in a phone interview.
In an analysis he and his colleagues published in 2019, among those in the registry, 15% reported asthma diagnosed after 9/11, while 22% had gastroesophageal reflux disease, or acid reflux, 14% had post-traumatic stress disorder and 15% reported depression.
Nearly half of those who reported these conditions suffered from more than one of them, and many indicated that their quality of life has been affected as a result, the data showed.
Hearing loss also is common among survivors, Farfel said.
Lila Nordstrom, who was a senior at Stuyvesant High School, just north of the World Trade Center at the time of the attacks, has had chronic asthma and acid reflux, as well as rhinosinusitis — sinus inflammation — and PTSD in the years since.
These, along with various cancers, are among the most common conditions experienced by WTC Health Program enrollees, according to its data, which is available online.
Nordstrom now works with others who were students at Stuyvesant on Sept. 11 to help connect them with healthcare.
“The World Trade Center Health Program has helped so many people, but many others find that they can’t access its benefits because they suffer from conditions not covered under the program,” she told UPI.
This includes autoimmune disorders that have been linked with PTSD, particularly in women, said Nordstrom, who has written a book about their experiences called Some Kids Left Behind.
Many of her schoolmates continue to experience problems ranging from migraines to blood and thyroid cancers, Nordstrom said.
“There are hundreds, if not thousands, of people — survivors — who are essentially left on their own,” she said.
Helaina Hovitz Regal, who was in middle school in lower Manhattan 20 years ago and lived in the neighborhood, has had PTSD and still suffers from chronic migraine headaches.
“When we think about 9/11 survivors, we often think of those who are suffering from physical health issues, but alongside them are people who are also living with incredibly painful mental health issues,” Hovitz Regal told UPI by email.
“Mental health and physical health are very strongly connected, and what can occur alongside the stress and anxiety of living with PTSD are physical issues … that can have a serious impact on their quality of life,” she said.
Hovitz Regal, who wrote a memoir called After 9/11: One Girl’s Journey Through Darkness to a New Beginning, also works as an advocate for people struggling with their mental health after surviving the attacks. She does not, however, compare her health problems to those suffering from a life-threatening illnesses.
However, “we are all dealing with [the] aftermath [and] we are all worthy of recovery,” she said.
Ongoing health challenges
Like Hovitz Regal, most of those enrolled in the WTC Health Program live in New York, New Jersey and Connecticut, though all 50 states and Washington, D.C., are represented.
About 2% of the first responders covered under the WTC Health Program worked at the Pentagon and in Shanksville, Pa., where other planes hijacked by the terrorists were crashed, killing all onboard.
However, data is not available on how many of the survivors receiving treatment under the program were at these locations at the time of the attacks.
The program covers various cancers and airway and respiratory diseases linked with exposure to toxins at the site, as well as mental health problems and, for first responders, musculoskeletal problems such as low back pain.
As of June 30, survivors age 35 and younger account for 1% of the program enrollees, while those age 35 to 44 make up 2%.
More than half of the enrollees are current or former first responders age 45 to 64, meaning they were 25 to 44 years old at the time of the attacks.
Nearly one-third of the survivors enrolled in the program have digestive disorders related to the attacks, while one-fourth of them have been diagnosed with linked cancers.
Up to 30% of the program enrollees suffer from multiple health conditions related to the attacks.
The most common forms of cancer among the survivors include prostate, breast, skin, thyroid and lung, based on program data.
Combined, more than 3,000 of the first responders and survivors with these cancers and lung and digestive diseases enrolled in the program have died.
“The health effects of the 9/11 attacks are still very real for many, many people,” Farfel, of New York City’s WTC Health Registry, said.
“And, as the years pass, these health effects continue to have a great impact on their lives and their healthcare needs,” he said.
Rays of light burst off a building at 1 Liberty Plaza to silhouette two firefighters surveying Ground Zero at dawn on September 15, 2001. Photo by Chris Corder/UPI | License Photo
People watch the World Trade Center burn as they listen to the radio of a stopped taxi following a terrorist attack involving two airplanes flying into the twin towers in New York City on September 11, 2001. Photo by Monika Graff/UPI | License Photo
President George W. Bush watches television coverage of the attacks on the World Trade Center on September 11, 2001, as he is briefed in a classroom at Emma E. Booker Elementary School in Sarasota, Fla. Bush was visiting the children when he got news of the attacks. Photo by Eric Draper/George W. Bush Presidential Library
The twin towers of the World Trade Center billow smoke after two airplanes crashed into the buildings on September 11, 2001. Photo by Laura Cavanaugh/UPI | License Photo
A paramedic consoles a injured woman near the site of the collapse of the World Trade Center. Photo by Ezio Petersen/UPI | License Photo
A volunteer wipes dust from his face as he carries an oxygen tank for firefighters in New York City. Photo by Monika Graff/UPI | License Photo
A New York City Police Emergency Services truck quickly drives away as the World Trade Center’s South Tower burns uncontrollably on September 11, 2001. Photo by Steven E. Frischling/UPI | License Photo
A massive smoke plume rising from the World Trade Center towers in lower Manhattan is seen from the International Space Station’s Expedition 3 crew on September 11, 2001. Photo courtesy of NASA | License Photo
A firefighter emerges from the smoke and debris of the World Trade Center. Photo by Jim Watson/U.S. Navy | License Photo
The second tower of the World Trade Center collapses. Photo by Ezio Petersen/UPI | License Photo
A volunteer outside St. Vincent hospital in lower Manhattan directs people to the proper lines to donate blood for those injured in the collapse of the World Trade Center. Photo by Ezio Petersen/UPI | License Photo
Firefighters walk amid the rubble in front of the World Trade Center. Photo by Monika Graff/UPI | License Photo
Trans World Airlines planes sit idle on a runway at Lambert-St. Louis International Airport following a FAA grounding of all domestic flights for the first time in history after four planes were hijacked in the terrorist attacks. Photo by Bill Greenblatt/UPI | License Photo
People evacuate while the Pentagon billows smoke after an airliner crashed into the building in a terrorist attack, causing part of the building to collapse and catch fire in Arlington, Va., on September 11, 2001. Photo by Chris Corder/UPI | License Photo
Medical personnel and volunteers work the first medical triage area set up outside the Pentagon. Photo by Mark D. Faram/U.S. Navy | License Photo
A section of the Pentagon continues to smolder after an airliner was crashed into the building. Photo by Chris Corder/UPI | License Photo
One of the several investigators dressed in white and carrying yellow and red flags walk points to the crater caused by the crash of United Airlines flight 93, of which was hijacked and crashed near Shanksville Pa., on September 11, 2001, killing all 45 people on board. Photo by Archie Carpenter/UPI | License Photo
Parts of the American Airlines Boeing 757 were found in Shanksville, Pa., following the crash. UPI File Photo | License Photo
Members of Congress condemn terrorists at a press conference on the steps of the U.S. Capitol in Washington, D.C., on September 11, 2001. After remarks, they sang “God Bless America” together. Photo by Roger L. Wollenberg/UPI | License Photo
Jeanie Quest (L) and Phillip Jabour react to photographs of the terrorist attack on New York City and Washington, D.C., on September 11, 2001, in a special edition of the Dallas Morning News. Photo by Ian Halperin/UPI | License Photo
Emergency personnel stand before the collapsed 7 World Trade Center building on September 13, 2001 which was destroyed by fire following the terrorist attack. Photo by Monika Graff/UPI | License Photo
The World Trade Center, once a glittering symbol of the financial center of the world, stands blanketed in ash and soot on September 14, 2001. Photo by Jim Watson/U.S. Navy | License Photo
Three days after the attack, fires still burn amidst the rubble of the World Trade Center in New York City. Photo by Jim Watson/U.S. Navy | License Photo
Bush (C) tours the World Trade Center disaster site aboard Marine One with New York Mayor Rudolph Giuliani (L) and New York Gov. George Pataki on September 14, 2001. Photo by Eric Draper/The White House | License Photo
A small American flag stands among candles lit for a vigil in New York City on September 14, 2001 to remember those who died in the terrorist attack and destruction of the World Trade Center complex on September 11. Photo by Ezio Petersen/UPI | License Photo
Retired Fire Chief Joseph Curry directs orders to rescue teams as they clear through debris from the collapse of the World Trade Center on September 14, 2001. Photo by Preston Keres/U.S. Navy | License Photo
A firefighter from Engine Company 24, where New York City Fire Department Chaplin Michael Judge served, is overcome with grief at his funeral in New York City on September 15, 2001. Judge was killed while treating the injured during the World Trade Center destruction on September 11. Photo by Ezio Petersen/UPI | License Photo
The casket of Chaplin Michael Judge is carried past Engine Company 24. Photo by Ezio Petersen/UPI | License Photo
Smoke continues to rise from the destroyed World Trade Center on September 15, 2001. Pool Photo by Keith Myers/UPI | License Photo
People on their way to work walk down a smoke-filled Wall Street as business resumes at the New York Stock Exchange for the first time on September 17, 2001 since closing after the terrorist attack on the World Trade Center in New York City. Photo by Monika Graff/UPI | License Photo
Several women become emotional at a Union Square Park memorial site for victims of the September 11 terrorist destruction of the World Trade Center complex in New York City on September 18, 2001. Photo by Ezio Petersen/UPI | License Photo
The American flag s reflected in a convex mirror with thousands of glass plates while on display outside the Louisville Science Center in Louisville, Ky., on September 18, 2001. The reflections symbolize the loss of thousands of Americans in the September 11 attack on the World Trade Center. Photo by Tom Chiat/UPI | License Photo
A woman waits at a bus stop blanked with missing persons posters near Bellvue Hospital in New York City on September 20, 2001. More than a week after the terrorist attack, thousands of posters bearing photos of the missing continue to blanket the city. Photo by Roger L. Wollenberg/UPI | License Photo
A collection of photographs of those killed on September 11. UPI File Photo | License Photo
Bush holds a police shield given to him by the mother of Officer George Howard, who was killed trying to help others following the attacks on the World Trade Center, while addressing a Joint Session of Congress in Washington, D.C., on September 20, 2001. Pool Photo by Win McNamee/UPI | License Photo
A woman visits a small shrine that stands on a hill overlooking part of the Pentagon. Photo by Chris Corder/UPI | License Photo
Charles Frank Burlingame III, the American Airlines pilot whose plane was crashed into the Pentagon, was buried with full Navy honors, including a military band and a rifle salute, at Arlington National Cemetery in Arlington, Va., on December 12, 2001. Photo by Ricardo Watson/UPI | License Photo
Kathy Trant holds her son Alex during the calling of the names of victims during New York City’s September 11 Commemoration at Ground Zero on Septemeber 11, 2002. Her husband, Daniel Trant, died during the terrorist attack. Photo by J.Conrad Williams Jr./UPI | License Photo
From left to right, Lacey Gerle, Caralene Wise, Paige McCoy and Amanda Barshowski of Sewickley, Pa., hold each other in front of the temporary memorial overlooking the crash site of Flight 93 on September 11, 2002, in Shanksville, Pa., on the one year anniversary of the terrorist attacks on the United States. Photo by Stephen Gross/UPI | License Photo
A 20-ton cornerstone for the 1,776-foot Freedom Tower is unveiled during ceremonies held on July 4, 2004 at the former site of the World Trade Center, which was destroyed on September 11, 2001. Photo by Ezio Petersen/UPI | License Photo
A U.S. military honor guard stands at attention during a 9/11 Memorial ground-breaking ceremony, commemorating the 184 lives lost in the Pentagon and on American Airlines Flight 77 on September 11, 2001, outside of the Pentagon in Arlington, Va., on June 15, 2006. Photo by Yuri Gripas/UPI | License Photo
A man wears a jacket honoring rescue workers at a ceremony marking the sixth anniversary of the September 11, 2001 terrorist attacks in New York City on September 11, 2007. Pool Photo by Stan Honda/UPI | License Photo
A woman cries on the shoulder of a New York City firefighter during the ceremony near the site of the World Trade Center. Pool Photo by Justin Lane/UPI | License Photo
A visitor passes a wall displaying the front pages of newspapers from September 11, 2001, and a communications tower from one of the World Trade Center, at the nearly-finished Newseum in Washington, D.C., on April 8, 2008. The Newseum closed in 2019. Photo by Roger L. Wollenberg/UPI | License Photo
A woman writes a message to the victims of United Flight 93 after a service of remembrance in Shanksville, Pa., on September 11, 2010. Photo by Kevin Dietsch/UPI | License Photo
A single rose and the reflections of an officer are seen in the reflecting pool at Ground Zero during a ceremony in memory of victims of the attacks on September 11, 2010. Pool Photo by Don Emmert/UPI | License Photo
St. Louis Fire Chief Dennis Jenkerson puts a stitch in the National 9/11 Flag at the Soliders Memorial in St. Louis on October 11, 2010. The 30-foot American flag, destroyed when the World Trade Center buildings collapsed, was traveling around the country as part of a restoration effort. It was to become part of the permanent collection of the National September 11 Memorial Museum being built at the World Trade Center site. Photo by Bill Greenblatt/UPI | License Photo
Vice President Joe Biden (L) and President Barack Obama, along with with members of the national security team, receive an update on the mission against Osama bin Laden, the mastermind behind the terrorist attacks, in the Situation Room of the White House on May 1, 2011. (A classified document seen in this photograph has been obscured.) Photo by Pete Souza/White House | License Photo
Michael Henry II, 6, holds a flag as he visits the Pentagon’s 9/11 memorial in Arlington, Va., on May 2, 2011. Photo by Roger L. Wollenberg/UPI | License Photo
Families wait to visit the Memorial Pools on the 10th anniversary of the terrorist attacks on the World Trade Center at Ground Zero in New York City on September 11, 2011. Photo by John Angelillo/UPI | License Photo
The final section of spire is raised by crane to the top of One World Trade Center skyscraper, also known as the Freedom Tower, in New York City on May 2, 2013. Once the pieces are installed, at a later date, the spire will make One World Trade Center the tallest building in the Western Hemisphere. Photo by John Angelillo/UPI | License Photo
Members of the media and others look out at 1 World Trade Center from an observation deck after the opening of the new 4 World Trade Center building in New York City on November 13, 2013. 4 World Trade Center is the first office tower to be completed on the original 16-acre World Trade Center site since 9/11. Photo by John Angelillo/UPI | License Photo
Mija Quigley of Princeton Junction, N.J., caresses the name of her son Patrick Quigley, who died aboard one of the planes in the terrorist attacks at the 9/11 Memorial during ceremonies marking the 12th anniversary in New York City on September 11, 2013. Pool Photo by Chris Pedota/UPI | License Photo
Katya Busoolo pauses to remember her mom, Irina Kolpakova, at the 9/11 Memorial during ceremonies marking the 12th anniversary. Pool Photo by Alejandra Villa/UPI | License Photo
Ester DiNardo, mother of Marisa DiNardo, clutches her image while attending the 9/11 Memorial ceremonies marking the 12th anniversary. Photo by Adrees Latif/UPI | License Photo
Ruth Lamagne remembers her son, Port Authority police officer David Lamagne, at the 9/11 Memorial during ceremonies marking the 12th anniversary. Pool Photo by Alejandra Villa/UPI | License Photo
The “Twin Towers in Tribeca” art installation created by British street artist Banksy are seen in Tribeca in New York City on October 15, 2013. Photo by Dennis Van Tine/UPI | License Photo
Honor guards composed of members of the New York and Port Authority fire and police departments present the colors during the national anthem during the dedication of the national September 11th Memorial Museum in New York City on May 15, 2014. The museum, commemorating the September 11, 2001 attacks on New York and Washington, opened to the public on May 21. Pool Photo by Chang W. Lee/UPI | License Photo
Belinda Adams (L) wipes her face as she remembers her father, Patrick Adams, who died in the attacks, during memorial observances held at the site of the World Trade Center in New York City on September 11, 2014. With her is her niece, Deeanne Cush (C), and her mother, Belinda Adams. Pool Photo by Mark Lennihan/UPI | License Photo
Pope Francis visits the 9/11 Memorial & Museum in New York City on September 25, 2015 and prays at “Trying to Remember the Color of the Sky on That September Morning” by Spencer Finch. Reposed behind this blue wall are the remains of many who perished at the World Trade Center site on September 11, 2001. Pool Photo by Susan Watts/UPI | License Photo
Mounted National Park Service police patrol behind bells to be rung during a ceremony marking the anniversary of 9/11 at the Flight 93 National Memorial in Shanksville, Pa., on September 11, 2018. Photo by Pat Benic/UPI | License Photo
Flowers are laid on a bench at the National 9/11 Pentagon Memorial in Arlington, Va., on September 11, 2018. Photo by Kevin Dietsch/UPI | License Photo
Two men take photos in the center of one of the Twin Towers Tribute In Light art installations on the 17th anniversary of the terrorist attacks on the World Trade Center at Ground Zero in New York City on September 11, 2018. Photo by John Angelillo/UPI | License Photo
Jon Stewart (C), comedian and 9/11 rights activist, embraces 9/11 survivors as they speak at a press conference on the passage of the 9/11 Victim Compensation Fund extension at the U.S. Capitol in Washington, D.C., on July 23, 2019. Photo by Kevin Dietsch/UPI | License Photo
The Twin Towers Tribute In Light art installation shines on the 19th anniversary of the 9/11 terrorist attacks on the World Trade Center at Ground Zero in New York City on September 11, 2020. Photo by John Angelillo/UPI | License Photo