Denise Harrison was working at Bellevue Hospital in New York City on September 11, 2001. The hospital had cleared the emergency room, anticipating a massive influx of patients after the terrorist attack at the World Trade Center, she says. “But it never really happened.”
“We had more doctors there than patients,” Harrison says. “We knew why. That was saddening.” Thousands died on September 11, when fires burned and buildings fell.
But for hundreds of thousands more who responded to the disasters, worked in the recovery or cleanup, or lived near ground zero, that day and its toxic aftermath continue to reverberate.
In New York City, when the twin towers collapsed, spewing dust and debris and polluting the air, the massive destruction and toxic exposures fueled respiratory diseases, cancers and mental health disorders.
It’s now 25 years later, and new health challenges are arising. Responders to the disasters are aging, developing health issues that can complicate their Sept. 11–related conditions. Retirement can deepen mental health struggles. Anniversaries can be triggering. The news reports and images dominating the airwaves and social media for this latest milestone “will definitely reactivate the emotions, the memories. And it doesn’t all go away on September 12,” says Jodi Streich, the mental health director at the World Trade Center Health Program at Rutgers University in Piscataway, N.J. “It stays.”
The paths of people harmed by the terrorist attacks have or may eventually intersect with the WTC Health Program, created to screen, monitor, treat and research the related health conditions. The program cares for people who worked in rescue, response, recovery and cleanup at the disaster sites in New York City, the Pentagon in Arlington, Va. and the plane crash site near Shanksville, Pa. It also covers people in New York City who lived, worked or attended school near the World Trade Center. As of summer 2026, more than 154,000 people are enrolled in the program, which is funded through 2090.
“Most disasters don’t end when the event ends,” says Harrison, medical director of the WTC Health Program at New York University. The WTC Health Program is “like a safety net” for her patients, Harrison says, where medical providers know their stories and their struggles. “They come where they are understood.”
Ongoing conditions, ongoing care
The WTC Health Program includes clinical centers in New York and New Jersey and a national network of participating doctors. People who qualify have an initial evaluation and yearly check-ups along with necessary specialized care at no cost to them. The program officially began in 2011, after Congress dedicated long-term funding to Sept. 11 health care.
The dust from the collapse of buildings at ground zero — the 110-story twin towers and a neighboring 47-story office building — clung to the air for nearly two weeks until it finally rained. Although crews continued to douse the debris pile with water, the work to recover bodies and clean the area stirred up the toxic dust again and again. Samples taken in the days after the disaster revealed metals, asbestos, carcinogens, lead, pesticides and many more toxic components in the dust.
On September 8, New York City released around 170,000 documents that discuss air quality and health risks just after the terrorist attack and suggest leaders at the time may not have fully revealed what they knew.
Iris Udasin, director of the Rutgers WTC Health Program, has been caring for people who responded to the Sept. 11 disasters since the beginning. “Initially everybody was coughing, a lot of them had asthma, a lot of them had sinus problems,” she says. Considering the toxic dust and fumes people were breathing, these health issues were expected.
Later, gastroesophageal reflux disease, or GERD, afflicted many people who responded to the disasters. In a cohort of more than 27,000 World Trade Center rescue and recovery workers, the incidence of GERD rose from close to 6 percent before the disaster to 39 percent nine years after the disaster.
Rescue and recovery workers from the New York City Fire Department suffered from a number of respiratory diseases, including obstructive airway disease, researchers reported just after the 20th anniversary of the attacks.
Notably, many people who responded to the World Trade Center disaster developed sleep apnea, despite lacking usual risk factors such as age and obesity. Through WTC Health Program research, “we discovered that sinus problems, especially related to environmental exposures, are a major risk factor for sleep apnea,” Udasin says.
Dozens of cancers are tied to Sept. 11 exposures, including prostate, skin and thyroid cancers. Mental health disorders including post-traumatic stress disorder, depression and anxiety are also elevated among people who responded to the disasters.
Many firefighters, police officers and other disaster site workers in the WTC Health Program are now in their 50s and 60s. With age, some are getting sicker, Udasin says, developing cardiovascular disease or diabetes, for example, which makes it more difficult to treat Sept. 11–related conditions.
And retirement “has brought on a whole different host of mental health setbacks,” Streich says. For some of her patients, work was a kind of therapy — a way to suppress what happened to them. Losing that structure can set people adrift.
Research has found that people who responded to the World Trade Center disaster report stigma associated with seeking mental health care. Streich says that some don’t come in for care until they’re at their lowest point. People who survived the disasters can also feel a tremendous amount of guilt that they made it through while friends and colleagues didn’t.
Streich also sees some of her patients struggling with memory and attention. Recent research has found a growing risk of cognitive dysfunction resembling dementia in people who responded to the disaster at ground zero or were survivors. The evidence suggests that the risk is associated with exposure to air pollutants and chronic post-traumatic stress disorder.
Responding to a new milestone
Even though it’s been 25 years, there are still people coming in to be screened for the first time, says Keisha Bennett, a nurse practitioner at NYU’s WTC Health Program. The initial visit includes a detailed questionnaire focused on the patient’s experiences related to September 11. “There are a lot of emotions that are involved,” Bennett says. She reminds her patients, “you’re not doing this alone.”
This is a big anniversary. But grief “is not a one size fits all,” Streich says. And trauma can surface on its own timeline: It “could be a year, it could be five and sometimes 25.” Some responders are grappling with the years lost “due to the mourning, due to the PTSD.”
During Streich’s tenure, the Rutgers program has started numerous mental health groups that have video meetings. One group has been together since the 20th anniversary of the disasters. Other groups focus on firefighters, police officers, retirees, cancer support or chronic pain issues. These spaces provide a sense of community, Streich says, and another source of support along with program check-ins and counseling appointments.
In her day-to-day providing care, Udasin sees the personal milestones her patients reach. She recounts one man, a disaster responder, who was left with a bad wound after having a severe mouth cancer removed. He realized he needed to see a psychiatrist because he was taking his unhappiness and anger out on his family. Since then, he told her he’s living a much better life.
“When I can get these big, tough policemen and firemen to go and get their mental health taken care of, that’s a really big deal to me,” she says. “We feel like we’ve been able to get these great people better care then they would have obtained if they had not come through program.”
