As the nation commemorates the 25th anniversary of the Sept. 11, 2001, attack on the World Trade Center’s twin towers, the health fallout from the attack still affects thousands of individuals — and the numbers are increasing.
Nearly 3,000 people died that day in the wreckage of two airplanes and burning buildings. Clouds of toxic dust and chemicals also shrouded thousands of first responders, office workers and pedestrians, and anyone near Ground Zero breathed in the smoke and noxious fumes. But thousands of others are still being treated for lingering medical and mental health conditions stemming from that day.
Decades of Continuing Care
The World Trade Center Health Registry was created in 2002 to track and investigate illness connected to 9/11, such as long-term physical and mental health issues and emerging and rare health conditions, and to connect enrollees to resources. While the registry monitored the health of people directly exposed to the WTC disaster, it didn’t provide treatment. In 2003, it began enrolling people who lived, worked or went to school near the WTC site, or who were involved in rescue and recovery. Roughly 71,000 individuals, including 2,869 children, were added to the registry,- making it the largest post-disaster health registry in U.S. history. Enrollees included 2,869 children whose parents or guardians completed the enrollment process for them.
In 2011, the WTC Health Program opened and now serves 145,000 responders and survivors, as well as responders from the Pentagon and Shanksville, Pennsylvania, sites where Flight 77 and Flight 93, respectively, struck and were downed. Several clinical centers in metropolitan New York and a nationwide provider network offer no-cost treatment only for certified WTC-related health conditions. The program is administered by the National Institute for Occupational Safety and Health, which is part of the Centers for Disease Control and Prevention and authorized until 2090.
Before the federal program launched, 9/11 survivors were treated via a patchwork of city, philanthropic and federal healthcare providers that didn’t operate as one unified system.
Since 2003, the World Trade Center Health Program Clinical Center of Excellence at Rutgers University has provided care to survivors from the New York and New Jersey areas, with more than 6,500 people relying on the center.
Jodi Streich, director of the center’s mental health services, said their conditions range from respiratory, neuromuscular and gastrointestinal disorders to cancers, PTSD, depression and anxiety.
“One might think that 25 years is enough time to grieve,” Streich said. “In reality, many who responded that day held in their grief for 25 years and only now are they ready to talk about it.”
Frank Geffre, 61, a firefighter from Piscataway, N.J., spent time at Ground Zero supporting recovery efforts. Since then, he has had cancerous nodes on his sinus canal, colon cancer and nearly lost his left kidney to radiation treatment. Many of the people he worked alongside at that time have since died.
The WTC Health Program at Rutgers gave him a community of support and clinical and mental health services that he said saved — and extended — his life. That sense of community matters most in August, when anniversary-related symptoms often intensify, according to Streich.
The Cancer Numbers Keep Climbing
One of the starkest examples of how 9/11’s health effects have grown worse with time is an escalation in the number of people diagnosed with cancer. A Rutgers study published in 2019 found a 40% increase in head and neck cancer diagnoses among WTC responders between 2009 and 2012, compared with the overall population. Cancers of the throat and voice box showed the sharpest rise. The increase was most pronounced among responders over age 55. Because some cancers take 20 to 30 years to develop, doctors say the full impact on health of 9/11 is still coming into focus. Every cancer linked to WTC exposure is now covered by the health program, including uterine cancer, which federal officials added to the official list of WTC-related conditions in 2023.
Other ongoing conditions tracked by the program include asthma, chronic lung disease, sleep apnea, gastrointestinal disorders, PTSD, depression and anxiety. Data from the Rutgers clinic feeds into broader research at the university and in other government-approved WTC health studies, helping scientists track how these illnesses evolve decades after exposure.
Health Effects Reached Beyond Manhattan
While the twin towers were located in Lower Manhattan, the attack’s health effects were not contained to one borough. The federally recognized exposure zone stretches below Houston Street in Manhattan to include parts of Brooklyn Heights and DUMBO in Brooklyn, reflecting how far the dust cloud traveled.
The WTC Health Registry also has documented lasting harm beyond solely first responders. Of the more than 43,000 office workers and passersby enrolled in health tracking, about 8% developed asthma within five to six years, according to officials. Nearly 8,500 people who were evacuated from the towers enrolled; roughly 40 % were injured while escaping, and about 15% later showed signs of probable PTSD. Residents near the site, including children, older adults and people with existing medical conditions, also faced long-term respiratory symptoms, asthma and PTSD.
On Wednesday, the CDC announced it will begin studying the health issues of people who were under age 21 when the attacks occurred.
New Research on Racial Disparities
Newer studies also have begun to examine how 9/11-related illness has affected Black responders differently. A study that tracked more than 61,000 WTC rescue and recovery workers from 2001 to 2015 found Black responders had nearly double the rate of prostate cancer and more than triple the rate of multiple myeloma, a blood cancer, compared with white responders. The same study found Black responders had lower rates of thyroid and colorectal cancers.
Fortunately, Black members of the WTC Health Program have been getting equal access to care, according to a study that found Black responders and survivors completed their initial health evaluations required to enter the program at higher rates than white members. Researchers suggested that lower access to the overall health care system, as well as a lack of insurance among Black Americans, may have made the no-cost WTC Health Program a more viable option.
City Releases Long-Sought Records
Decades of effort to uncover the full scope of 9/11’s health impacts reached a turning point this week when Mayor Zohran Mamdani announced the release of more than 170,000 pages of city records on the government’s response to the attacks and their aftermath. The release also settled two lawsuits brought by 9/11 Health Watch, ending a multi-year fight over records on air quality and health.
Across several mayoral administrations, first responders, elected officials and families of victims of 9/11-related illnesses have pushed for the records to be made public. In 2023, t then-Mayor Eric Adams denied the organization’s request to release the records.
“We commend the fresh commitment to transparency …,” Andrew Carboy, counsel to 9/11 Health Watch, said in a statement. “But the City’s reversal is no reason for celebration. The September 11th community expects the government to obey the law and not willfully defy it for a quarter century.”
The new online portal containing the records includes the frequently cited “Harding Memo” that assessed legal risk and ways to protect the city from lawsuits. The portal also contains previously “lost” records known as the “68 boxes” that officials could not locate until last year. More documents and information are scheduled for release in the near future.
“The very least our city owes the families, survivors and first responders whose lives were forever changed by the September 11th attacks is transparency and accountability,” Mamdani said.
The city also plans to add staff to help New Yorkers document their presence in the exposure zone so they can access the WTC Health Program and the federally-funded September 11th Victim Compensation Fund.
Marking the Anniversary, in Different Ways
For many, reflecting on the past 25 years brings a sense of relief. The WTC Health Program Clinical Center of Excellence at Rutgers marked the anniversary with a ceremony honoring those who died and the first responders who answered the call.
“For many of our members, taking part in the commemoration itself — whether performing, speaking or simply standing together — is its own form of catharsis,” Streich said. “They’re not just honoring that day. They’re also paying tribute to who is standing alongside of them.”
Not everyone marks the day the same way. Geffre, the firefighter from Piscataway, N.J., plans to attend a Yankees-Mets game with his son instead.
“As a first responder, ‘Never forget’ brings up things that I don’t always want to remember,” he said. “Sometimes, I do want to forget.”
