What are the images you remember most vividly from that September morning six years ago today? The planes slicing into concrete and glass, perhaps, or the tiny, desperate figures at the high windows of the wounded buildings waving for help – and a few eventually jumping into the void. Or is that billowing cloud of dust, advancing like the fury of Armageddon down the streets of Manhattan when the first tower fell?
I escaped the cloud by just feet and seconds. When I had composed myself sufficiently to turn on my heels and start to run northwards, I stumbled and fell but managed to pick myself just quickly enough to stay ahead of the cloud. It never quite enveloped me.
As clear in my memory is the snow that blanketed downtown Manhattan when I returned to the area on foot before dawn on 12 September. I kicked through it as I picked my way to the very edge of what they were later to call the pile. Here, in a drawer of my desk, I still have the flimsy face-mask that someone thrust at me that morning. Holding it now, it looks suspiciously clean, almost unused.
It wasn't so important for me – my time at the pile (and never in the midst of it) was a matter of a few hours, nothing more. I do remember shoving the mask in my pocket very fast because I didn't like wearing it. How could you worry about some putative future risk to your health when right before you were the remains of thousands already pulverised?
This anniversary of the September 11 attacks on New York will be a little different from those before. Today's memorial service, in which specially chosen rescue workers will read the names of those killed that morning, will take place in a small park to the south-east of Ground Zero rather than in the pit itself, where construction on replacement towers and a memorial centre makes such a gathering impossible. It is also the first anniversary to fall on a Tuesday, the same day of the week when the terrorists struck.
But there is something else. Of course, today's focus will be once more on the 2,749 souls who perished in the twin towers, as well as on their relatives, many of whom will be at the memorial service. But, this year, minds are also on two other groups of victims whose names are not on those death rolls: those who inhaled the toxic brew released into New York's air that day, and those who are still suffering from the horrors they witnessed.
This is the secondary catastrophe of September 11, one that is only now beginning to get full and proper attention. It is the scandal that haunts those in charge at the time, who failed to realise what dangers lurked in those vapours or were too distracted to warn enough of us about them – the city itself and its then mayor, Rudolph Giuliani; the former Governor of New York, George Pataki; and the then head of the federal Environmental Protection Agency, Christine Todd Whitman.
This new canvas of suffering has come into focus only very slowly. This much is clear, however; the hazards within the dust on that day, and the fumes that rose from the mangled pile during the weeks that followed September 11, were egregiously underestimated by the authorities. Study after study is now firmly linking the illnesses of countless New Yorkers, especially so-called "first responders" who rushed to the scene of destruction, to the particles that penetrated their airways and lungs.
How many were made ill this way? We don't know yet, but the number could be as high as 300,000. For some, the first symptoms of trouble may still not yet be apparent. Nor might they be simply lung-related. One study warns that types of cancer associated with the dust and fumes may eventually surface. As of now, 70,000 people have joined the World Trade Centre Health Registry database. An estimated 410,000 people had some contact with the dust (myself included). First responders who worked at the site numbered 40,000.
For these people, this morning is a signal moment because of the expected presence in the crowd of victims' relatives of one man who has not previously attended. He is Joseph Jones. More important will be the reading of his wife's name, Felicia Dunn-Jones, in the roster of victims' names, also for the first time.
It was in May this year that New York's Medical Examiner, Charles Hirsch, said he was adding Felicia Dunn-Jones to the list of those killed on September 11 even though she was not in the towers. Indeed, she did not die on that day, but rather on a February afternoon in 2002. Hers was the first case with evidence sufficiently compelling for him to link her death directly to the events of that Tuesday.
Dunn-Jones, a civil rights lawyer, had run from her office close to the towers just after the first tumbled down. She tried to protect her lungs with a piece of clothing held to her mouth as she ran north, but the dust-filled air caused her to choke and retch. The symptoms of respiratory distress began a few weeks later.
She developed "this crazy, persistent cough", mostly at night, Jones recalled this week. His wife was to die of cardiac arrest, brought on, the autopsy concluded, by sarcoidosis. "The Office of the Chief Medical Examiner has thus concluded that Mrs Dunn-Jones' exposure to World Trade Center dust on 9/11/01 contributed to her death and it has been ruled a homicide," a statement read. When the memorial is completed with etched names of all the victims, Dunn-Jones will be among them.
Jones began fighting to have his wife formally listed as a victim three years ago. Though he had qualified for about $2m in federal aid, he was then rebuffed by Hirsch and city officials. "He thought Felicia's death didn't meet the criteria," Jones said. "Even though we had gotten the award and everything, he said it was a murder scene." That Hirsch changed his mind is an indication of the new credence being given to the claims of thousands of others finding it tough today to breathe.
Even before Hirsch's about-turn on Dunn-Jones, other deaths seemingly related to September 11 had surfaced. James Zadroga, a 34-year-old police detective, spent hundreds of hours at Ground Zero; he died last year of a lung ailment. A New Jersey medical examiner ruled quickly that the officer's death was "directly related to the 9/11 incident".
Publicity is gradually being granted to scores of people who have not died, but whose physical and mental health has been ravaged after September 11. They include Steve Centore, a government scientist deployed to conduct environmental tests at the pile in the days after the tragedy. He was soon afflicted with a cough. But his illness spread, eventually compromising organs in his body. "I started bleeding everywhere – out of my ears, mouth, penis and anus – and none of the doctors could figure out why," Centore told Discover Magazine. "I was in the hospital for four weeks, and I can't tell you how many colonoscopies I had in that time." Last year, he had a liver transplant. He remains in fragile health.
For the city, these and other cases are the keys to a legally troubling Pandora's box. It has only gradually woken up to the scope of the problem it faces, setting aside this year an additional $1.9bn (£940m) to treat those suffering respiratory and other illnesses that might be traced back to September 11. Many sufferers will go to the WTC Environmental Health Centre, launched in January at Bellevue Hospital and set to expand to treat about 6,000 people. "We get about 100 to 200 calls a week," says Dr Joan Reibman, the director. "We have a couple of hundred people waiting, so to get an appointment takes six weeks."
How was it not obvious to the authorities at the time that the dust presented massive health risks? And why were they not more vigilant in protecting workers and residents, many of whom were allowed back into their apartments within days, and were only vaguely counselled on how to clean up the grey residue coating their windows and furniture?
Targeted for particular criticism is Christie Todd Whitman, the former head of the Environmental Protection Agency, which actually issued reassuring statements after the attacks to the effect that Manhattan's air was safe. In a CBS interview broadcast at the weekend, she said she did not have the authority to force emergency workers to wear protective gear. It was the responsibility of the city, she insisted.
The controversy may spell political trouble for Giuliani, whose front-runner status in the race for the Republican presidential nomination in 2008 is almost entirely built on his reputation as the saviour of New York after the attacks. "You smell it, and you feel there must be something wrong," an astonishingly sanguine Giuliani said in the days after the attack. "But what I'm told is that it is not dangerous to your health." Days later, he encouraged New Yorkers to "go back to normal".
Waging war on the city and its current mayor, Michael Bloomberg (who may himself harbour presidential ambitions), on behalf of those sickened by the fallout from September 11, is the personal injury lawyer David Worby. He started out by filing suit for one ailing policeman. But his quest rapidly expanded, and by 2004 he had filed a class-action suit against the city. Today, he is pushing the suit through the courts on behalf of no fewer than 10,000 people, all of whom believe they were made ill by the dust and fumes of the World Trade Centre and blame the city and federal authorities for not protecting them.
"Nobody would touch the case because it was considered unpatriotic to say anything against the clean-up or the EPA," Worby explains. "We have come a long way. They once called the 9/11 cough a badge of honour. Now they know that the whole thing is a catastrophic government disaster."
Former policeman Forcier spent seven months at a site in Staten Island, sifting through often grisly debris of the World Trace Centre attacks.
Soon afterwards, he began suffering from stress, and quit the NYPD. The experience of serving after 9/11 had left him unable to sleep, and he spent almost five years in bed: "I would sleep half an hour here, one hour there, and wake up to drink half a bottle of vodka."
After undergoing treatment for post-traumatic stress disorder in June, Forcier now takes a cocktail of prescription drugs to get through the day. "I've turned into a drug addict because of all the pills I have to take," he says. "Speaking about this brings back what happened. But it's OK: I'll take an extra dose."
At times during our interview he barely makes sense. "While he was a cop, Al had pride," says a friend. "Now, without the wage, the badge, and the weapon, he has no self-esteem."
Of 23 colleagues in Klein's Hercules Squadron – a sort of Swat team for the Emergency Service Unit in New York – 14 died in the September 11 attacks.
Klein spent eight months removing debris at Ground Zero. On top of post-traumatic stress syndrome, he now suffers from gastric and intestinal problems.
After being diagnosed by a doctor, Klein applied for workers' compensation and social security. He was denied three times, but he believes that he has a small chance of success because New Yorkers still view the firefighters, police and volunteers of September 11 as "true heroes".
For those who spent months alongside Klein cleaning the streets and buildings of the surrounding area, there is perhaps less hope. Workers' compensation for cleaners is still rare, and Klein has now devoted himself to campaigning for their rights.
Wellington Da Silva Canova
When the second tower fell, Canova had to dive underneath a van to protect himself. As the dust had settled, he discovered a 68-year-old woman who couldn't breathe. With two years' experience as a paramedic, he managed to save her.
Canova spent five more days looking for survivors and finding only parts of mutilated bodies – "a foot in high heels, a head attached to an arm, half of a leg". Three months later, he began to have nightmares. Before long, the 31-year-old Brazilian was on unemployment benefits and Prozac prescribed by his doctor. The diagnosis: post-traumatic stress disorder. He lost his job, car, apartment and mental health. His wife filed for divorce and took their two children.
Today, Canova works as a bounty hunter for the US Recovery Bureau. He says that he's feeling better and – "Thank God" – that he had used an oxygen mask at Ground Zero: "At least I didn't catch any respiratory illnesses."
Alex Sanchez worked 14 hours a day, seven days a week, for six months, cleaning the ventilation and air conditioning ducts of 12 buildings close to Ground Zero. "There was dust from decades before the towers fell. The dust was so thick you wouldn't believe it," he says. "But nobody talked about contamination. We just used a bandanna. Who knows what we breathed in."
In May 2002, Alex could not work any more. "Everybody kept telling me that I had to go back to work, but my body said the opposite. There were so many chemicals involved in cleaning that I got sick and spent a week in bed. My relationship at home got ugly. I could not make myself get up, it was very frustrating."
Since he did not have health insurance, Sanchez was forced into near bankruptcy by having to pay for his treatment. "I lost my apartment and I had to live for two years sharing a room with my son, my mother, and my aunt."
Seventeen days after 9/11, Feal was supervising the demolition of a pile of rubble when an eight-ton steel beam fell on his left foot. In hospital doctors set his toes with bolts, but days later the foot became gangrenous. "It was a medical error," he says. "You shouldn't place a bolt in broken bone if there's no blood flow. But I was so doped that I didn't understand a thing."
After nine weeks and dozens of operations, part of his foot was amputated. The doctors had said that he could leave the hospital once he could walk. After two weeks practising alone at dawn, John was cleared to go home.
Months later, he developed a infection in his right heel and had to have more surgery. "It was a horrible year. My mother died of cancer and my dog almost died of Lyme disease. I sold my Jeep, my Corvette and my Harley-Davidson to pay medical bills. Today, I have almost nothing. But I am alive."
Cleaner Manuel Checo worked close to Ground Zero for several months. Environmental Protection Agency tests later proved there were thousands of tons of particles of cement, glass fibre, asbestos, lead, pesticides and other toxic substances in the air.
"I take seven pills a day, I have asthma, sinus, depression, skin problems," Checo says. "I live alone in a room and hardly have money to eat."
Although he had worked since 1999 for one of the contracted companies to clean buildings near Ground Zero, Checo covered vacations of other cleaners so was not classed as a full-time employee or entitled to any benefits. After losing his job in December 2002, he lived in his car for six months.
"When the towers fell, I was caught in a smoke cloud with a policeman," says Valenti, a teacher who worked nearby. "He asked me if we were in the sky."
Even though he spent just two days helping at Ground Zero, Valenti developed pulmonary asthma, fibrosis, restricted airways, heart enlargement and circulatory problems. He now takes up to 26 pills a day and has slept seated in an armchair for the last five years because he can't breathe if he lies down. Valenti's pulmonary capacity is so low that, in May, he collapsed while walking up the 14 steps leading to his front door in Long Island, where he lives with his father and son Joseph.
He rolled down the stairs and broke 10 bones including both hips, and some vertebrae and ribs. "My doctor said that I was very lucky. If I had perforated my lung or broken my neck, I would have died."
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