Eight years after the terrorist attacks at the World Trade Center (WTC), the so-called “9/11 fatigue” has supposedly set in, e.g. where people are simply tired of hearing, talking, and remembering the incident. However, for some people, the WTC incident wasn’t just a flash-in-the-pan moment especially when they have to live with the health effects each day.

The total number of people who died at the attacks was 2,819. Millions of people were affected physically and psychologically, and eight years later, thousands may be still be suffering from the aftermath. 9/11 responders (police officers, paramedics, fire fighters, rescue and clean up workers), by passers and those who lost loved ones are suffering from chronic and even life-threatening health problems.

Toxic dust in the air

A lot of health problems were caused by the fire and the collapse of the twin towers. Air quality was monitored after the attacks and what were found are:

• Smoke, dust, and debris
• High concentration of particulate matter
• Carcinogens , e.g. polycyclic aromatic hydrocarbons (PAHs), combustion-related carcinogens
• Building material debris, including asbestos

According to the researchers who monitored the area

The general population would have been exposed to particles and gases when on or near the site on days when the air was polluted by the fires or cleanup activities or when returning to contaminated buildings. Many survivors of collapsed or damaged buildings reported new or more severe respiratory symptoms several years after the disaster. One survey, started 8 months after the disaster, found greater respiratory morbidity and more symptoms among people living within 1.5 km of the site than among those in a control area.

Respiratory problems

In another study, researchers reported increases in respiratory symptoms and pulmonary function test abnormalities in WTC responders. The abnormalities were significantly associated to time of arrival at site, indicating them to exposure-related. The abnormalities persisted up to 2.5 years after the attacks. Another study focusing on firefighters only also found a dose-response relationship between arrival time and symptoms which include asthma, breathing problems, wheezing, rhinosinusitis, and gastro-esophageal reflux disease. Many firefighters developed the so-called “World Trade Center cough”. According to NY Mag, 300 firefihters were on leave for respiratory problems by January 2002.

Asthma has especially become a problem even for those without prior history of the disease. According to reports, post WTC asthma incidence is:

• General – 10.2%
• Rescue recovery workers – 12.2%
• Passers by – 8.6%

Cancer

It is not only respiratory problems but also cancer that is implicated. Years later, a small number of 9/11 responders have been reported to have developed immune system cancers which are normally rare. Researchers at the Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York followed up 28,252 responders for 6 years and found 8 cases of the blood cancer multiple myeloma. Of these, 4 were under the age of 45. This may seem like a small number, but this incidence is actually higher that what occurs in the general population especially in this age group.  The median age for this kind of cancer is 71 and takes 10 to 20 years to develop after exposure to carcinogen. It is not clear why the cancer just 2 to 3 years after the WTC attacks and why younger people are susceptible. The study concluded that the finding “underscores the importance of maintaining surveillance for cancer and other emerging diseases in this highly exposed population.”

Posttraumatic stress

No less serious is the posttraumatic stress disorder (PTSD) that many people experienced right after and years later after the attack. Even those who did not lose a loved one suffered from PTSD which may not have been long-lasting. An estimate of New Yorkers who suffered from PSTD after the attack is 422,000.

A breakdown of PTSD incidence after the WTC attacks is as follows:

• 13.6% of those without PSTD reported symptoms after the attacks.
• 14% were diagnosed with depression.
• 7.4% had PTSD and depression.
• Highest incidence of chronic PTS symptoms was observed among passers by.
• Resolved symptoms were highest among office workers.
• Late-onset PTS symptoms were observed among rescue/recovery workers.

Serious, long-lasting PTSD was associated with a loss of a loved one or job. More than 3,000 children lost a parent, more 1,600 lost a spouse or partner, and more 140,000 lost their jobs. Children who lost a parent during the attacks even though they weren’t directly exposure to dust were also found to suffer from psychiatric disorders, such as:

• Anxiety disorder – about 50%
• PSTD – about 30%
• Separation anxiety – 27%
• Depression- 14%

It has been eight years since the WTC attacks, but the problems are persisting and some are only just emerging. With continuing monitoring, more information and insights on the health effects of the WTC attacks  will come up.