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.