In the days after Sept. 11, 2001, Tom Mazzola dug through the heap of burning detritus that was the World Trade Center, looking for survivors. Finding safety gear seemed less important and he did not consider the potential threat from the mixture of asbestos, lead, mercury, pulverized concrete, powdered glass and compounds from burning jet fuel.
But now Mazzola, a volunteer emergency worker, is plagued by shortness of breath, headaches, joint pain, and the chronic "World Trade Center cough".
Last week he visited a clinic in upper Manhattan that screens 9/11 workers for health problems -- motivated in part by the knowledge that some of those who breathed the hot black gravelly air alongside him have since died.
Timothy Keller, an emergency medical technician, died in June of heart disease complicated by bronchitis and emphysema. Another emergency worker, Felix Hernandez, died in October of respiratory ailments. And at the beginning of January a police detective, James Zadroga, died of what his family reported as black lung disease, with high levels of mercury in his blood and powdered glass in his body.
Their deaths and the illnesses of thousands of others suggest a broader health problem, according to medical and environmental experts. New York legislators have called on the federal government to appoint a health tsar to oversee testing and treatment.
"Our grave concern right now is what we're seeing now is just the tip of the iceberg," Donald Faeth said, an emergency medical technician and a union representative for other sick workers.
"There are people who died that day and didn't realize they died that day," he said.
At the Mount Sinai Medical Center in upper Manhattan, doctors are monitoring the health of about 16,000 workers exposed to the dust and debris from the towers. About half have problems ranging from persistent respiratory disease to sinus problems to stomach ailments, and many have multiple problems, according to Jacqueline Moline, an investigator in the program.
"It's hard to know what to expect," Doctor Moline said, adding that diseases could take years to develop. Her concerns start with cancer, but extend to potential effects on the heart and a variety of lung and respiratory problems. She advises screening exposed workers every 18 months for at least 20 years, but her program is only funded until 2009.
She is also concerned that many of her sick patients have been denied compensation. Often workers cannot prove they were at Ground Zero or that their ailments are a direct result of exposure to contaminants there.
If health problems cause them to stop working they lose their salaries and health insurance, and some can no longer afford medication and treatment.
In the days that followed the September 11 attack, many of the estimated 50,000 workers at the site went without masks or wore flimsy ones, and used little other protective gear. A further 50,000 residents of lower Manhattan, along with 400,000 people working within two kilometers of the site, were also unprotected from billowing toxins rising from the rubble.
The administrator of the Environmental Protection Agency at the time, Christie Whitman, assured New Yorkers their air was "safe to breathe." Several groups have since filed class action lawsuits against her and her agency, and last week a federal judge called her statements "conscience-shocking."
Even the EPA's own inspector general has criticized the agency's handling of the crisis. A 2003 report found that on the basis of early tests for asbestos, which had been reassuring, the EPA made misleading pronouncements about air quality. And the White House, the report said, removed cautionary language from the agency's press releases.
A further study by the US general accounting office in 2004 found that the federal government had taken no comprehensive actions to study the health effects of 9/11 pollution and "the full health impact of the attack is unknown."
David Worby, who has filed a lawsuit in Manhattan federal court on behalf of 6,000 workers, says he has identified 23 deaths among workers exposed to 9/11 contaminants. No official statistics exist to confirm his claims. But last month two New York senators and more than a dozen members of Congress signed a letter calling the deaths of at least three workers "an ominous sign" and demanding a plan for long-term monitoring and care.
A group of ailing emergency workers, Unsung Heroes Helping Heroes, held its first conference last month. One of those who attended was Bill Dahl, a former paramedic.
"I remember the wind kicking up that night," he said in a telephone interview punctuated by his coughing.
"It was like a little hurricane. Your eyes and your nose and your mouth would get caked with debris. Whenever you found water, you tried to wash your eyes out and rinse your mouth out. At one point the officer I was with had to be ordered home because his eyes started to bleed," he said.
In the days that followed he was assigned to a hazardous materials unit. He said he had worked 14 to 16-hour days to decontaminate other workers at the site, but he himself was not issued with an air-purifying respirator.
A week after Sept. 11 Dahl, who had prided himself on jogging 12km a day, began to cough up gray mucus. He would often wake in the night wheezing, unable to breathe. In January 2002 he had his first full-blown asthma attack. He has since developed an extremely rare form of cancer, synovial sarcoma, in his throat.
He said the workers' compensation board had so far denied him benefits, suggesting his pulmonary problems could result from his cancer, or from a recent car accident, not necessarily from exposure to the World Trade Center ruins. He plans to submit that his rare cancer itself resulted from 9/11.
These days he cannot walk or talk much without wheezing. And he can't help but wonder if the next death will be his own.
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