When terrorists hijacked two planes and brought down the World Trade Center buildings, John Feal, now 54, was a supervisor for a demolition business.
20 years ago, two additional planes slammed into the Pentagon and a field outside Shanksville, Pennsylvania, respectively. Feal,
who is from Long Island, New York, arrived the day after the great buildings of New York City were demolished.
He had been working at Ground Zero for five days when his left foot was crushed by 8,000 pounds of steel.
Feal was in the hospital for 11 weeks, finally contracting gangrene, losing half of his foot, and having to relearn how to walk.
He’s had 42 surgeries since then, and he’s developed arthritis in around 80% of his body, as well as severe hip, knee, and lower back pain.
Feal founded a nonprofit that has been essential in ensuring that 9/11 responders and survivors receive the medical attention they need in exchange for their sacrifices.
“Most Americans simply believe that two buildings fell that day, and that innocent lives were lost as a result of mindless violence, and that is exactly what happened,” Feal argues.
“However, many people are unaware that tens of thousands of people became ill, and many have died as a result of illnesses obtained at Ground Zero since then.”
During the deadliest terrorist attack in world history, nearly 3,000 people were killed.
However, in the two decades since then, the frequency of deaths among survivors and first responders has increased dramatically.
who inhaled the poisonous dust, chemicals, gases, and fibers from the wreckage for months—has continued to rise.
More than 60 types of cancer and roughly two dozen additional diseases have been linked to Ground Zero exposures, according to researchers.
At least 4,627 responders and survivors who were registered in the WTC Health Program have perished as of today.
Not all individuals who died in the 20 years since the attacks may be attributed to conditions associated with Ground Zero exposures: the WTC Health Program keeps track of members who died for any reason, including accidents and conditions unrelated to 9/11.
However, the program, which was created to provide health care to 9/11 responders and survivors, has only a little more than 112,000 members.
only a small percentage of the estimated 410,000 first responders, cleanup crew personnel, and survivors who were exposed to polluted air.
Others who died as a result of 9/11-related illnesses were undoubtedly not enrolled in the program.
“As the 20th anniversary of the World Trade Center attacks approaches, it is impossible not to reflect on how the assaults continue to exact a heartbreaking human toll,” says Moshe Shapiro, a researcher at Mount Sinai’s Icahn School of Medicine who has published research on the disaster’s health impacts.
“I’ve talked to a lot of World Trade Center rescuers, and one thing stands out: despite the physical and other repercussions of the exposure, they say they’d do it all over again in a heartbeat.”
Many of these hundreds of thousands of Americans live with the memories of 9/11 every day, rather than simply once a year on September 11th.
The health consequences of environmental exposures in the days and months following the attack linger—or worsen as cancers emerge.
Around 74 percent of WTC Health Program respondents have been diagnosed with at least one physical or mental health issue associated with 9/11 exposure, with 20 percent having cancer and 28% having a mental health condition.
Chronic rhinosinusitis, or nasal inflammation, and gastroesophageal reflux disease (GERD) are the two most common conditions among enrolled responders, followed by cancer—particularly prostate cancer because 87 percent of living responders are men—asthma, sleep apnea, and post-traumatic stress disorder (PTSD).
Feal adds, “We worked there, we slept there, we went to bed there, we ate there, we sobbed there.”
“Those chemicals made us sick because they were absorbed by the nose, mouth, and skin.”
He and other rescuers, researchers, and supporters had to struggle for a decade after the assault to prove those health effects were genuine, he says.
Feal explains, “We said we were sick from 9/11.” “They [Congress members] said we were making it up, that it was all in our heads, that we were insane.”
But we’re a finite population, and with these life-altering disorders, we were dying off faster than we should have been.”
Epidemiologists like Christine Ekenga, an assistant professor of public health at Washington University in St. Louis who studies the health effects of disasters and has authored multiple papers on the repercussions of 9/11, were not surprised by the long-term health consequences.
“During those early years, long-term physical and mental health repercussions were always a concern among doctors and health researchers, and we did expect 9/11-related deaths long after the disaster,” she says.
The link between 9/11 and a slew of chronic health issues is now undeniable.
The WTC Health Program contains a list of ailments that it will address, all of which have been definitively connected to 9/11 exposures, according to the study.
And, because of the federal James Zadroga 9/11 Health and Compensation Act,
which was signed into law in 2011 and reauthorized in 2015, money for those diseases will be available until 2090.
Nearly half of living 9/11 responders have a respiratory or digestive illness, and 16% have gotten cancer as a result of the attacks.
Another 16 percent suffer from a mental illness such as post-traumatic stress disorder (PTSD), depression, or substance misuse.
All of these maladies, as well as musculoskeletal disorders that occurred on or after 9/11, are covered by the WTC Health Program.
Members of the New York City Fire Department (FDNY), a cohort of over 15,000 firefighters, emergency medical service personnel,
and civilians registered in the WTC Health Program were among the hardest hit.
According to Rachel Zeig-Owens, director of epidemiology for the FDNY’s WTC Health Program, 343 people perished on 9/11, but more than 200 have died since then.
Even two decades after the attacks, 9% of FDNY 9/11 veterans suffer from PTSD, and 18% suffer from depression.
“Most of the fire department was exposed to the high dust right from the start,
and they were committed to helping find everyone and doing the rescue and recovery work,” says Zeig-Owens, who is also an assistant professor of epidemiology at Albert Einstein College of Medicine.
In the early weeks, few of them wore respirators or other critical personal protective equipment.
It took a week for the proper respirators to arrive after the cleanup began. They were large and unpleasant to wear even back then, and they hampered communication.
The average time spent on site by FDNY employees and retirees was three to four months,
while some stayed for the entire ten months until the cleanup was completed in July 2002.
The dose-response effect was one of Zeig-Owens’ important discoveries that supported the link between long-term effects and 9/11 exposures.
The most frequent illnesses, GERD and upper and lower respiratory disease affect more than 40% of FDNY employees,
with the highest incidence of respiratory disease among those who arrived on-site first.
After a little more than five years after 9/11, prostate cancer rates in FDNY personnel began to rise much sooner than the 10- to 20-year increase reported in studies of populations not exposed to Ground Zero.
Researchers also discovered that higher levels of exposure were linked to higher rates of prostate cancer.
Heart illness, some autoimmune diseases (particularly lupus), hearing issues, and neurological and cognitive impairments are among the conditions that are not yet covered by the WTC Health Program.
Workers who arrived on 9/11 morning, for example, were 38 percent more likely than those who came later that day or later that week to have a stroke, heart attack, or another cardiac incident in the years that followed.
However, research on the FDNY cohort demonstrates the difficulties in separating how 9/11 exposures have and have not led to various diseases.
For one thing, at the time of the attacks, FDNY members had higher baseline health and a healthier lifestyle than their peers.
Only 4% of them smoked, which is far lower than the general population of New York City (although about a third were former smokers).
Being healthier, to begin with, could explain why FDNY members and other responders involved in the WTC Health Program were 34 percent less likely than projected to die of cancer over the last two decades, with lower mortality rates for colon and prostate cancer in particular.
They do, however, have improved access to health tests and high-quality care as members of the WTC Health Program. As a result of these advantages, malignancies are detected and treated more quickly than in the general population.
The increasing rate of at least one of the malignancies could be explained by increased screening.
FDNY members who were 911 responders, for example, have a higher risk of thyroid cancer than the general population,
but Zeig-Owens’ research discovered that asymptomatic cases accounted for the additional risk, implying that rates were higher in this demographic due to superior health monitoring.
More accidental instances were detected by routine computed tomography (CT) imaging and chest x-rays for malignancy before symptoms arose.
Because they were part of a program that looked for cancer more frequently, FDNY members had a higher rate of thyroid cancer.
Other questions have still to be answered. Barrett’s esophagus, which can progress to esophageal cancer, is one of the most common long-term complications of Ground Zero exposure.
According to Zeig-Owens, her team isn’t observing greater incidences of this cancer in the FDNY group right now, but “it could just be a waiting game.”
It can take 10, 20, or even 30 years for cells to grow into cancer following the initial encounter.
On 9/11, the average age of FDNY responders was 40, and the majority of them are now in their 50s and 60s when cancer risk begins to rise with age.
Researchers are still trying to figure out which malignancies arise as a consequence of natural aging and which grow as a result of 9/11 exposure.
For example, a study published in the JNCI Cancer Spectrum in February 2020 evaluated the frequency of several malignancies among 9/11 responders and discovered an unexpected decreased rate of lung cancer but a higher risk of leukemia.
According to Shapiro, the study’s lead author, “the intricate link between exposure and cancer development is not entirely understood.”
His team, on the other hand, has some theories. “Exposure to benzene, which is found in [high] quantities from burning jet fuel at the World Trade Center site, is linked to leukemia,” he says.
Despite the rising list of post-9/11 health issues, the research has shown some positive results, such as a lower chance of cancer death.
A recent study revealed the characteristics that have the greatest impact on 9/11 responders’ risk of lung illness,
as well as measures to lessen that risk, such as losing weight and lowering cholesterol.
Now that scientists have a better understanding of the tragedy’s impacts, “we’re largely focused on how to help individuals improve,” says Anna Nolan, an environmental medicine professor at NYU School of Medicine who co-authored the lung disease risk study with Zeig-Owens and colleagues.
“BMI and lipids are significantly riskier for these people than smoking history, and I think that’s incredibly important,” she says, because those risk factors can be altered.
The study of the aftermath of the tragedy can aid public health experts and policymakers in better understanding the health effects of other man-made and natural disasters.
“The more you grasp the similarities to other ambient and urban exposures,” including wildfires,
the more you realize the processes by which particulate matter during the 9/11 cleaning contributed to inflammation and numerous health conditions,” Nolan adds.
Feal, for one, has remained steadfast in his quest to locate people who have fallen between the gaps and assist them in enrolling in the WTC Health Program.
And he has continued to pay tribute to those who have passed away by erecting a memorial to them at the Long Island park that the FealGood Foundation helped to create.
The COVID-19 pandemic has made that goal more difficult, and it has taken a toll on 9/11 survivors.
Feal, who claims to have “never been afraid of anything in my life,” had a terrifying encounter with COVID.
He says, “I felt I was going to die.” Around 100 9/11 survivors have died of the disease, many of them alone in hospitals, according to Feal.
Even after the pandemic’s immediate danger has passed, the effects of 9/11 will linger.
“The further we go away from 9/11, the more these men and women suffer, and we want to console them because the next 20 years are going to be a lot worse,” Feal says. His prediction is backed up by research.
“We’ve seen a lot of manmade and natural tragedies since that terrorist assault 20 years ago, and it takes a certain breed of individuals to go toward [them] when others are fleeing away,” Feal says.
“These individuals were the best of the best. They were our country’s most valuable assets.
They brought optimism to a desolate city and a desolate country. Furthermore, we must do a better job of assisting these men and women.”