Today, like the eerie pit marking the former site of the Twin Towers, the environmental imprint of the collapse still haunts the surrounding communities -- and, many say, continues to threaten their health.

Three years after the initial impact, advocates remain determined not to let the issue fade from public view under the second Bush administration. On Tuesday, a citywide coalition of health, environmental, community and labor organizations, including the New York Committee for Occupational Safety and Health and the New York State Public Employees Federation, will head to Washington, DC to attend the President’s State of the Union address and demand that the White House and Congress finally act on the public health needs of the "Ground Zero Community." The mission is the latest marker in a protracted struggle between government authorities and concerned residents and workers.

Rushing into the Aftermath

People were encouraged to return to the area before the contamination had been thoroughly cleaned or even assessed.

In the panic that enveloped the city after September 11, 2001, the Environmental Protection Agency (EPA) moved swiftly to reopen lower Manhattan’s financial district. But when a strange affliction began to sweep through the community, people questioned whether Washington’s eagerness to revive downtown Manhattan came at the expense of public safety.

Since then, official probes into the health dangers posed by the collapse, along with reports from local communities and the press, have revealed that people were encouraged to return to the area before the contamination had been thoroughly cleaned or even assessed.

Just after the disaster, even though only limited environmental testing had been conducted, the EPA issued public safety reassurances about air quality. On September 21, then-EPA Chair Christine Todd Whitman, with the backing of the city government, the Occupational Safety and Health Administration and the Federal Emergency and Management Agency, declared, "New Yorkers and New Jerseyans need not be concerned about environmental issues as they return to their homes and workplaces."

Two years later, an investigative report of the EPA Inspector General’s office charged that the White House Council on Environmental Quality intervened in the EPA’s outreach effort and edited the language of public safety statements to downplay the dangers of contamination.

Responding to the Inspector General’s comments, EPA Acting Administrator Marianne Horinko wrote that the EPA’s statements about the supposed safety of the air were necessitated by public pressure: "The public sometimes wants information that is not scientifically available, or is not available quickly."

Just one week after a national catastrophe of unprecedented scale, the New York Stock Exchange was back in businesses.

Critics observe that the government’s response to another urgent matter was evidently more rapid: just one week after a national catastrophe of unprecedented scale, the New York Stock Exchange was back in businesses.

Caught in the Smoke Screen

Mavis Gordon, who was on her way to class at the Borough of Manhattan Community College (BMCC) when the Towers crumbled to dust just a few blocks away, wishes the EPA had offered the truth rather than what critics say were deceptive reassurances.

Nowadays, the 49 year-old does not need to knock when she returns at night to her Brooklyn apartment. Her son, she said, knows when to open the door because he recognizes his mother’s footsteps: over the past two years, her once-easy ascent has acquired a pained, belabored rhythm.

Gordon said she often finds herself struggling to breathe and is easily exhausted: "Whenever I go outside, I cannot walk … half a block; I’m out of breath." She has trouble sleeping at night because she wakes up coughing and wheezing. "It’s really horrible," she said, "and it just continues."

Since Gordon was evacuated from the campus that morning, her transformation has been both physical and psychological. She abandoned her coursework in human services at the end of the semester because the trauma had left her too disoriented to concentrate on her studies. Over the next few months, she said, her respiratory health began to deteriorate steadily, and by the middle of 2002, she had developed a persistent, inexplicable cough.

Now, she relies every day on a rescue inhaler whenever her lungs start acting up. Her doctor has tried unsuccessfully to diagnose her for two years, suspecting allergies and then heart trouble. She alerted her doctor after watching a news report on World Trade Center-related sickness, and now awaits the results of a new set of tests.

The cause of her health problems, Gordon now believes, is simply that "I breathed in the air that day … and I breathed [it] when I went back to school." Though she noticed the change in air quality, she said, she believed the official safety messages. She recalled, "The government said that the air was clean. … If I knew that it wasn’t clean, I wouldn’t have gone back to school."

Robert Gulack, a 51-year-old attorney with the Securities and Exchange Commission (SEC), was one of the thousands of area employees who streamed into lower Manhattan shortly after it was deemed safe again. On October 17, 2001, he entered the new SEC regional office in the Woolworth Building, overlooking Ground Zero. Though Gulack had never experienced breathing problems, after two days in the new space, his lungs began seizing up.

Doctors have since diagnosed Gulack with Reactive Airway Disorder, for which he takes several asthma medications. He has repeatedly battled bronchitis and pneumonia and suffered permanent lung damage.

Studies on younger exposed populations suggest that the adverse health effects may extend well into the next generation.

"In my life, I have never had this kind of continuous asthmatic condition," said Gulack. He stressed that his symptoms worsened significantly when he was in the office. In 2003, the SEC administration allowed him to work at home three days a week, but when the arrangement was terminated later that year, he fell ill again upon returning to his office. He has stayed home on workers’ compensation benefits since early 2003.

Gulack is convinced it was not the collapse itself that caused these problems. On September 11, he noted, after being evacuated from his workplace in 7 World Trade Center, he says he avoided exposing himself to the smoke plume by walking opposite the direction of the wind. Gulack claimed he "wasn’t exposed to anything on September 11 or during the month that followed," when he worked from home in New Jersey.

The source of his asthma, he said, is dust from Ground Zero trapped inside the Woolworth Building -- circulating through the central ventilation system and open spaces, and settling in the offices. Scientists have determined that the extreme alkalinity of the dust -- in combination with other contaminants -- probably caused the airway burning and irritation Gulack and many of his co-workers experienced when they began working in the space.

In addition to the immediate effects of the dust, the threat of airborne asbestos has also surfaced. Tests commissioned by SEC management in 2001 and 2002 detected extremely high levels of asbestos, a long-term, carcinogenic contaminant, both inside and on the exterior of the building. The management eventually had the six floors it leased professionally cleaned. But since other floors were not treated, said Gulack, recontamination was inevitable as people circulated between floors and as asbestos caking the building’s exterior blew in through the windows.

Both the landlord and the SEC, said Gulack, have repeatedly ignored employees’ demands for a building-wide clean-up, even though in January 2003, independent testing on the elevators and air systems, specially sponsored by the employee union, uncovered asbestos concentrations of up to 850 times the laboratory-defined "clean" level.

Since then, Gulack, a union steward, has campaigned on behalf of employees for thorough testing and cleaning of not only his workplace, but of all potentially contaminated buildings in surrounding areas.

"We are not soldiers," he said. "We did not volunteer to risk our lives. … And we’re supposed to have -- according to the federal law -- a clean, safe worksite."

Science Breaks the Silence on Ground Zero Illnesses

The dimensions of the pollution’s long-term impact on community members are just beginning to take shape through public health investigations, which indicate that the worst effects may have yet to emerge.

In a survey of respiratory health patterns in residents living near Ground Zero, conducted by the New York University Medical Center in mid-2002, over half of 2,520 respondents reported experiencing at least one new respiratory symptom, such as coughing or wheezing, compared to only one-fifth of an unexposed control group. Over 25 percent said they were still experiencing "persistent" symptoms until the time of the survey -- three times the rate in the control group. High rates of post-9/11 respiratory and mental health symptoms were also found in the preliminary results from the World Trade Center Health Registry, a less formal, government-sponsored survey of over 70,000 people exposed to Ground Zero dust.

Three years on, both public and private resources for 9/11-related medical assistance are drying up faster than public concerns are dissipating.

Studies on younger exposed populations suggest that the adverse health effects may extend well into the next generation.

A study by the State University of New York at Stonybrook on pediatric asthma among Chinese American children in Chinatown, just blocks from Ground Zero, found that cases of asthma, along with asthma-related clinic visits and prescriptions, increased significantly in the year after September 11. The number of children with asthma in the area increased 66 percent, while the number in a control group actually decreased by 11 percent.

New York City’s Mount Sinai Medical Center examined the effects of contamination on pregnant women and discovered that while there was no significant discrepancy in birth weights, mothers who were at or near Ground Zero on September 11 were twice as likely as unexposed mothers to have babies with low weight for their gestational age -- potential evidence of restricted growth due to exposure to carcinogenic chemicals called polycyclic aromatic hydrocarbons (PAHs). The collapse released an estimated 100 to 1,000 tons of PAHs. Follow-up studies on these mothers will determine what impact the contaminants might have on the physical and mental development of the babies.

Philip Alcabes, an epidemiologist at Hunter College who served on the Scientific Advisory Committee of the World Trade Center Health Registry, thinks the work of parsing the health issues emerging from Ground Zero has barely begun. "It’s impossible to say ten years down the road what’s going to turn out to be the most important health consequence," he said.  

Activists Say Politics and Money Hold Public Health Hostage

Activists contend that the EPA -- not private businesses, workers or community members -- must assume responsibility for dealing with Ground Zero contamination and consequent health issues.

The dilemma, said Robert Gulack, "is that individual landlords have a financial interest in minimizing the problem," and "employers have a vested interest in keeping everything quiet, so that employees will be productive and not frightened." A brewing public health crisis, he argued, must be resolved through public institutions.

While mounting scientific evidence has shed light on the magnitude of the quandary, it has not-yet stimulated policy solutions. An investigative report by the national environmental group Sierra Club noted that despite the federal government’s "compelling duty to respond to the adverse health effects of the WTC pollution," no special health treatment resources exist for local residents and employees, or for clean-up workers and volunteers who did not meet the rigid criteria for a federal Victim Compensation Fund award.

Labor representatives like Jimmy Willis of the Transport Workers Union, who advocates on 9/11-related health issues, argue that the government’s economic priorities have consistently trumped public health concerns.

"Everything that has gone wrong with this process from day one … all comes down to one thing: money," said Willis, specifically citing rejection of pension claims for emergency responders, conflicts over workers’ compensation, and medical care burdens as the bureaucratic hazards stemming from Ground Zero’s ecological fallout. "Follow the money, and you’ll find out where the problem is."

Community and labor advocates claim that since conventional health institutions like private insurance and workers’ compensation have proven inadequate for addressing the health effects of the September 11 attacks, the government must launch special public programs to provide compensation and redress. But three years on, both public and private resources for 9/11-related medical assistance are drying up faster than public concerns are dissipating.

Some members of Congress are working to move money out of federal coffers into the hands of workers and residents. Last March, Representatives Carolyn B. Maloney (D-New York) and Christopher Shays (R-Connecticut) proposed the Remember 9/11 Bill, which would fund medical monitoring and treatment of all residents and workers affected by the disaster, coordinated by a special federal authority.

The bill was stalled in Congress last year, but Maloney has moved to reintroduce it in 2005. She told TNS, "The shockingly high levels of respiratory illness and other emerging sickness" among people made ill by Ground Zero "constitutes a national health emergency, but so far the federal response has been tragically inadequate."

Still, past experiences campaigning for federal assistance have left activists pessimistic. In 2002, the White House used a line-item veto to block Senator Hillary Clinton’s (D-New York) $90 million proposal to support the health monitoring of rescue and recovery workers. In approving the budget bill, the president refused to include the health initiative in a "national emergency" funding package.

Though current federal funding for the major health monitoring programs -- mostly through the National Institute for Occupational Safety and Health -- will last until 2009, the work will probably require more sustained support. At a 2004 congressional hearing on 9/11-related health issues, Dr. Steven Levin, co-director of Mount Sinai’s WTC Worker and Volunteer Medical Screening Program, testified, "This group of responders has to be followed for at least another 20-plus years, since [related] cancers most often occur 20 or more years after the onset of exposure."

The American Red Cross, through a private donation pool known as the Liberty Fund, has supported a number of community-based programs for Ground Zero-related health issues, including limited medical insurance subsidies and a $1.5 million grant to Mount Sinai for a treatment program serving about 1,300 workers screened by the hospital.

Nevertheless, Dr. Robin Herbert, co-director of the screening program, told members of Congress, "philanthropic funding simply cannot provide all the resources necessary to provide care to all who need it," noting that patients seeking treatment must wait two to three months just to see a doctor. She added that 40 percent of the first 350 patients treated were uninsured, and one-third unemployed. Current funds for the treatment program, which receives no federal support, will run out in the middle of this year.

There are signs that the severely ill are so burdened with medical costs that they have difficulty covering basic living expenses. This winter, the nonprofit New York Disaster Interfaith Services established a program to provide food and clothing vouchers to recovery workers struggling with health care costs.

Labor and community advocates have also criticized the distribution of federal funds, arguing that the $20 million WTC Health Registry project, basically a large-scale phone questionnaire, merely saps funds that could be spent on more in-depth scientific studies or treatment programs.

Israel Miranda, health and safety coordinator for the local EMT and paramedics union, expressed impatience with programs that treat workers as research subjects but not people in need: "We were monitored after 9/11, and they want to continue monitoring us for years and years to come. … But what are they doing aggressively to treat the people and get these toxins out of these people’s bodies? They’re not doing much."

"The public just hasn’t grasped onto it yet," reflected Willis of the Transport Workers Union. The Bush administration, he fears, will continue burying the issue of Ground Zero contamination until it develops into a full-blown crisis.

The people who will be most deeply affected, Willis predicts, are not organized workers like those in his union, but ordinary people in communities with fewer legal and political resources: "Maybe it’ll start resonating with the rest of the country when … the first- or second-graders that were down there start getting sick with long-term illness in a few years. I don’t think I’m painting a bleak picture; I think it’s going to happen."

Part One of this series: Ground Zero: The Most Dangerous Workplace was published on January 24, 2005.