25 Years After 9/11, the Health Toll Is Still Unfolding

New York City Mayor Zohran Mamdani released a trove of documents this week that shed new light on the air quality around the World Trade Center after the September 11 terrorist attacks.

Some of these documents suggest, contrary to statements by former mayors Michael Bloomberg and Rudy Giuliani, that harmful levels of asbestos remained in the area—possibly for months after the towers fell.

Today marks the 25th anniversary of the 9/11 attacks, which killed nearly 3,000 people and brought the Twin Towers in lower Manhattan crashing down. Across New York City, officials have organized commemorations to honor the victims, as well as the first responders who dug through the rubble in the hope of saving those who could still be found alive and later recovering the remains of the dead.

Inside Climate News spoke with Dr. Michael Crane, the medical director of the World Trade Center Health Program Clinical Center of Excellence at Mount Sinai Hospital in New York City. Established under the federal James Zadroga 9/11 Health and Compensation Act of 2010, the World Trade Center Health Program is administered by federal health agencies. It serves over 145,000 9/11 responders and survivors.

For two decades, Crane has treated the first responders—including firefighters, emergency physicians and police officers—who were at the scene in the aftermath of the attacks. 

This interview has been edited for length and clarity.

LAUREN DALBAN: I wanted to hear about what we know about the impacts from the clouds of dust that emanated from the buildings as they collapsed.

MICHAEL CRANE: When the buildings collapsed, the upper floors basically smashed down on the lower floors, and they created dust.

It was a thick, choking dust, mostly concrete dust, which by itself can be rather irritating. But then there were all the other building components as well—and it was on fire. 

Just by analogy, you saw the [Los Angeles] fires … Just imagine similar materials, plus probably more plastics, plus the asbestos insulation, plus metals—all in this cauldron that was turning it into fumes and gases and small particles that people could inhale.

It was really hellish. In terms of being able to inform patients and staff about what they breathe, it was very unsatisfactory, and it still is, actually.

DALBAN: And what do we understand about how inhaling that dust has led to a decline in lung function in a lot of the responders that you treat?

CRANE:  These are tremendous irritants. So when they go in [the body], they will attract the body’s cells that try to protect the organism, and so you get inflammation. You get inflammation all up and down the tubes that carry the oxygen and air into the base of our lungs where the air exchange takes place with the bloodstream.

Inhaling something like it alone is enough to have you coughing. These big, healthy firemen were getting all kinds of irritants in their lungs, and they had this really loud, thunderous cough. It was a real marker of the really terrible irritation that was happening. 

The same thing happened in the esophagus. What we always forget is that when you breathe stuff in over time—it’s got solid particles—so you’re going to swallow some of it. The same compounds that were irritating the breathing tubes irritated the eating tubes. 

The whole upper airway was at risk, including the stuff that went up into people’s noses and caused sinus conditions. So lots and lots of inflamed tissue, particularly if people were there for a long time without any kind of respiratory protection and masks, and there were lots of them who had none. 

DALBAN: That’s something that you guys are able to treat at this point. 

CRANE: Early on, when they came in, I was a company medical director for a company called Con Edison, which is the electrical utility in New York. When our workers came back, the first people we called to help us were these lung specialists, who just miraculously were in the hospital about halfway down the block.

They came running up to help us, and they gave the usual medicines that they would give to an asthmatic patient and that would kind of tamp down the irritation for a while.

These guys, they refused to go home. They went back to work. We tell them ‘you gotta go home and rest,’ and they would go back to the same conditions again and again and again, because they’re heroes for one thing, and because they were so angry, some of them, at what had happened to their city.

DALBAN: You said a few years ago, in a radio interview, that you might expect to see the rates of cancer in those responders go up after the 20-year mark. Do we know any more about that? 

CRANE: This is the one that I want to be wrong about. We have it set up so they can have annual exams, so they’ll come once every 12 months or every 15 months, and we’ll track how they’re doing and get their data. 

So if they have cancer, we can refer them for treatment. But still, in addition to the respiratory stuff and the stomach stuff, they’ve had terrible problems with mental health issues—terrible bouts of depression, awful thoughts about suicide, and post-traumatic stress disorder. They have nightmares. 

It’s debilitating, long-lasting, and really takes very careful therapy to help start to straighten these things out. We’ve been able to make pretty significant inroads there, but that’s a constant struggle.

DALBAN: The city now has released documents that suggest that the asbestos problem in the aftermath of the towers actually may have lasted much longer than city officials initially let on. How should we understand the difference between community members who might have been exposed by living in that area or working in that area, and what has happened to the first responders? 

CRANE: I mean, asbestos—It’s a very serious toxic material. Typically, it affects the lungs. It can cause fibrosis of the lung. It can cause lung cancer and cancer in other organs as well.

If you smoke and you are exposed to asbestos, your odds of cancer are going way up because the two are like additive or multiplicative, some people say, in terms of increasing the risk. So it is truly serious. 

Now that we hear that this stuff was kind of scattered all over Manhattan and it remained there, and nobody cleaned it up—that’s a very long-term threat to the people who live there. It’s very, very serious, and if you were living down there and kept encountering that dust, the odds are you had a fairly significant exposure. 

DALBAN: Do you think that there are still any gaps in the medical research about the impact of the dust cloud on the people who were working out there? 

CRANE: We know a bit now about the people who did the work. The survivor program has unfortunately been kind of undersubscribed, but they also have some good information. In this situation, it’s just like with the workers. The more you see of them … the greater the number of things you see has happened to them, likely because of the exposure. 

We don’t really know about what the impact of these toxins has been on those people who were children. We didn’t really have a children’s program. Now, people who are interested in science need to be saying, “Given this information—that there was long-term toxin exposure—we’ve really got to get an eye on these folks and do it quickly.”