Rescuing the Rescuers: The Effort to Cover and Monitor 9/11 Responders for Lung Disease and Cancer

When terrorists attacked the World Trade Center on September 11, 2001, killing nearly 3,000 people and injuring almost 9,000 more, it wasn’t the end of the tragedy. In the days and weeks to come, thousands of emergency workers — firefighters, police officers, construction workers and private citizens — descended on Lower Manhattan to aid in rescue and recovery efforts. Some are still paying a heavy price for their service.

Unknown to them, the Twin Towers were built using a toxic mix of asbestos-laden building products that pulverized into a fine dust when they came down.

Like some veterans of the U.S. military, many 9/11 responders have experienced illnesses they believe to have stemmed from the contaminants they inhaled during their service that day, and in the days that followed. And like military veterans, some of them are receiving health care for those conditions that is provided by the government.

Two days after the attacks, the U.S. Environmental Protection Agency issued a statement that the air was safe to breathe — an assertion that turned out to be incorrect. Of the more than 40,000 people who responded that day and in the weeks to come, some 70 percent have experienced lung problems.

“We have seen a few cases of mesothelioma, but mostly what I’m seeing is lung cancer,” says Raja M. Flores, professor and chief of thoracic surgery at Mount Sinai Medical Center in New York. Flores notes that it can take several years for symptoms to manifest. “I think in the next 10 or 15 years, we’ll be learning a lot more about the kinds of diseases you can get from pulverized concrete and steel,” he says.

Brian G.M. Durie, an attending physician at Cedars-Sinai and chairman of the International Myeloma Foundation, explains that a statistical approach, comparing cancers that would be expected in the general population versus those that emerge in first responders, can make a strong case. “With 9/11,” he says, “there were many more cases of myeloma than you would expect in people who weren’t exposed.”

Demolition expert John Feal was working at Ground Zero on September 17 when a 3,000-pound piece of steel crushed his left foot, which was later amputated. At first, he was denied benefits because his injury occurred outside the timeframe of the initial Sept. 11 Victim Compensation Fund, which was created by an act of Congress and active from 2001 through 2004. Feal filed a lawsuit and won, and then began helping other responders to seek restitution for their health problems or economic losses. One issue they faced was that health care and financial compensation programs for those affected by 9/11 did not automatically recognize that some cancers could have arisen from exposure at crash sites.

“Right now, there are more than 6,000 people with 9/11-related cancer,” Feal says. “We know of about 1,800 people who have passed away since the attack from cancer and other lung diseases. I’ve walked the halls of Congress for more than six years, fighting for first responders’ benefits.”

Former Daily Show host Jon Stewart was one New Yorker who took notice and joined Feal in the fight. In a statement for this article, Stewart said: “These folks got sick because of their selflessness…they remain in the shadows and in need of help because of our selfishness.”

Feal was there when, in December 2010, Congress finally passed the James Zadroga Act, allocating $4.2 billion for first responder health care and financial losses due to an inability to work. In 2012, cancer was added to the bill; covered types can be found at cdc.gov/wtc/coveredcancers.html.

The Zadroga Act established the WTC Health Program, which consists of a Responder Program for first responders and a Survivor Program for those caught in the aftermath of the disaster; this replaced two earlier health care programs established by the government and the Red Cross. The act also reinstituted the Victim Compensation Fund to help those who experienced economic losses because of 9/11-related illnesses.

To be considered for coverage, responders or their relatives need to prove they were present at a “9/11 crash site” and suffered “physical harm or death as a result of” their presence, while survivors must have been within 1.5 miles of the attack. A review process is available, however. For certain cancers to be considered related to 9/11, they must be shown to have developed a certain amount of time after the tragedy — .4 years for leukemia, for instance, versus 14 years for mesothelioma.

In December 2015, the Zadroga Act was extended for 75 years, reauthorizing both the health program and the Victim Compensation Fund at a price of $8.1 billion. Prospective claimants now have until December 18, 2020 to file for benefits. Applicants can call 1-855-885-1555 to learn more. To contact the WTC Health Program, visit nyc.gov/html/doh/wtc/html/contact/contact.shtml or call 888-982-4748.

With the battle for coverage won, Durie would like to go one step further, establishing a monitoring program for responders not yet diagnosed; only limited screening has been available under past health care programs for this population.

“We strongly advocate a screening and prevention program that would catch these cancers early,” he says. “It would not only help prevent some cases, but also reduce the cost of treatment.”