After thousands of deaths, first responders are still navigating health effects 25 years post-9/11
More than 9,400 people have died from 9/11-related illnesses.
When Michael O'Connell found out he had been accepted into the New York City Fire Department, he was elated. O'Connell had started his career as a police officer, but he always had more of an interest in becoming a firefighter.
"It was more my speed," O'Connell told ABC News. "It was like camaraderie, team, unity. It's where I wanted to be."
O'Connell was sworn into the FDNY as a probationary firefighter. Just four months later, he was deployed to lower Manhattan on Sept. 11, 2001, following the terrorist attack at the World Trade Center.
For several weeks, O'Connell said he didn't go home. He went back-and-forth between his firehouse and ground zero, extinguishing fires amid the rubble and engaging in search-and-rescue operations.
O'Connell started hearing about fellow firefighters who worked at the site being diagnosed with asthma or cancer but didn't experience any health problems himself until New Year's Day 2007, when he says he woke up in severe pain.
"My body inflamed two times the size of what it was," O'Connell said. "I didn't know what was going on ... and I had like bruises and blisters all over my body."
O'Connell said he was eventually diagnosed with sarcoidosis, a multi-system inflammatory disease that typically affects the lungs, skin and lymph nodes, and his doctors believe is linked to his exposure to toxins at ground zero.
It's estimated that 400,000 people were exposed to toxic dust, smoke and debris; risk of physical injury; and physically and emotionally stressful conditions from 9/11 and the aftermath, according to the World Trade Center Health Program.
At least 69 cancers -- including breast, prostate, skin and head and neck -- have been certified as being linked to 9/11 as have airway and digestive disorders, musculoskeletal disorders and mental health conditions, according to the WTC Health Program.
More than 9,400 people have died from 9/11-related illnesses -- according to recently published data from the WTC Health Program -- which is three times higher than the 2,977 who died in the attacks in New York, at the Pentagon and in Shanksville, Pennsylvania. Data from the WTC Health Program shows about 50,000 cancer diagnoses have been certified.
Many of these people are members of the FDNY and NYPD who responded to the attacks or assisted in cleanup operations, but they also include civilians -- those who lived, worked, went to school or passed through the area.
"The truth is, 9/11 didn't end on 9/11," Michael Barasch, managing partner at Barasch & McGarry, a law firm that specializes in helping 9/11 responders and survivors get compensation and health benefits, told ABC News. "I personally lost dozens of clients, mostly firefighters and police officers, on 9/11, but I have lost thousands of clients since."
"9/11 Tribute in Light: Live from Lower Manhattan," a one-hour ABC News multiplatform live special, premieres on Friday, Sept. 11, at 8:00 p.m. EDT across ABC, Disney+, Hulu, National Geographic, ABC Owned Television Stations livestreams and ABC News Live.
Responding to ground zero
On the morning of 9/11, Thomas Wilson, an NYPD sergeant, was investigating a burglary of an elderly couple in Brooklyn when calls came in over his radio that an object had hit the World Trade Center. Wilson replied that he was heading to the Williamsburg Bridge.
"I said goodbye to that couple, 'I'll come see you later on to take that report,'" Wilson told ABC News. "Never did see them again."
Wilson said he shut down the Williamsburg Bridge on the Manhattan side while his colleague shut down the Brooklyn side. The assignment went from facilitating the movement of vehicles over the bridge to securing it as people fled from Manhattan over the bridge on foot.
"I don't know how many thousands upon thousands of people crossed the bridge that day," Wilson said. "I'm still haunted. Covered in dust. ... That mass exodus out of Manhattan still sticks with me."
When O'Connell, the firefighter, got down to the site, he said he was instructed to help shut down the water mains, and then he climbed on the rubble to assist in search and rescue.
Throughout the day, O'Connell remembers hearing alarms. He said that attached to the Scott Air-Pak, a self-contained breathing apparatus that firefighters wear, is a Personal Alert Safety System (PASS) Alarm, which sits on the chest and tracks movement.
If a firefighter stays still for 20 to 30 seconds, it emits a loud beep to help colleagues locate them.
"That's all you heard were those alarms when we first got there. Nothing but PASS Alarms," O'Connell said. "As a fireman, when you hear it, you're meant to act and try your best to get to that person. You couldn't. They were underneath that pile."
John Feal, a demolition supervisor at ground zero who arrived on site on Sept. 12, also remembers the PASS Alarms going off.
"I don't care who you are, you're not programed ... to see that kind of devastation of that magnitude," he told ABC News. "I've never witnessed anything like that in my life, nor do I wish I ever see anything like that again."
Cleanup efforts
Wilson said he contributed to recovery efforts at ground zero, where he says he spent about 350 hours, and later as a sifter at Fresh Kills Landfill on Staten Island, which was temporarily reopened as a sorting ground for some of the ground zero rubble.
Wilson said he almost never thought about the dust and toxins he was inhaling.
"My mindset was just get the job done," Wilson said. "... Got to do what you got to do to keep things moving along."
At the landfill, Wilson said he was issued a disposable suit with boots, a hood, gloves and a respirator, but said the shifts were 12 hours, and that some respirator filters have an eight-hour limit.
Ivonne Sanchez, former FDNY emergency medical technician, arrived at ground zero after the towers fell and said she spent about 20 straight hours at the site. She said the dust was so thick that she couldn't get her bearings.
For the next several months, Sanchez worked on body identification and recovery efforts. She said she was motivated to continue responding at ground zero with the hope that she would find her friend, who died in the attacks.
Sanchez said she didn't receive a mask until October, when the site was visited by Occupational Safety and Health Administration inspectors for mandatory mask fittings.
O'Connell, the firefighter, said he didn't have a mask for the first few days until he received a painter's mask.
"You'd put them on but, quite honestly, you can't work with a painter's mask on for 24 hours straight and be a part of Bucket Brigade and talk to your guys and drink water," he said. "You're always pulling it on and off. Nobody was thinking, 'What's coming of this? Are we gonna get sick because we're breathing this stuff in?' That wasn't in anybody's head."
First responders begin falling ill
New York City Mayor Zohran Mamdani said this week that more than 170,000 pages related to the attacks were being made public, including about air quality.
Among the documents revealed is the "Harding Memo," an October 2001 memo from then-Deputy Mayor Robert Harding that indicated the city knew of the air quality dangers and the legal liability, even though the city publicly declared the air was safe.
The Environmental Protection Agency (EPA) also told the public at the time that the air around ground zero was safe to breathe. In an interview with The Guardian in 2016, Christine Todd Whitman, who was EPA administrator during 9/11, apologized for "whatever we got wrong" but denied that she knowingly lied about the air quality or knew at the time it was dangerous.
In Lower Manhattan, the collapse of the Twin Towers led to a massive dust cloud that filled the air and blanketed city blocks with ash, debris, metal, glass, asbestos, benzene and other harmful particles, according to the WTC Health program. Fires within the debris pile burned through the end of December 2001 with flare-ups in 2002.
The city did not immediately respond to ABC News' request on potential toxins first responders were exposed to in the aftermath or allegations by agencies at the time that the air was safe.
Medical research is ongoing about the potential links between 9/11-related toxic exposure and certain cancers and illnesses. Dozens of cancers and conditions have a certified link, but scientists are still learning about the cumulative effects of breathing in a "toxic cocktail," how long it may take for certain cancers to develop -- if they do at all -- and how chemical exposure and trauma can accelerate physical decline and life expectancy.
Sanchez, the EMT, said she would often go home after a day at ground zero coughing, bleeding from her nose or vomiting. Sanchez retired in 2002 after recovery efforts ended due to an injury at the site, which she said caused lower back pain and nerve damage that she said she manages to this day.
In the years after 9/11, Sanchez said she developed chronic sinusitis and asthma. In 2014, in her early 40s, she said she began experiencing severe hot flashes. Sanchez said she went to the doctor four weeks later and was diagnosed with breast cancer that spread to her lymph nodes.
"It was Stage II and ... it was very aggressive," Sanchez said.
Sanchez said she had a lumpectomy in August 2014 and a mastectomy in December 2014. While Sanchez says her cancer is currently in remission, she said she has also developed seven or eight stomach ulcers that have caused gastrointestinal problems from her time at ground zero.
Wilson, the police officer, said he also developed cancer. Wilson was diagnosed with an aggressive neck cancer that had spread to his tongue and skeletal muscle after going to the doctor for sinus issues and tongue pain, he said.
Wilson said he underwent a procedure called a hemiglossectomy, which involved removing part of his tongue, along with a neck dissection to remove the neck tumor and 39 lymph nodes.
Doctors used a skin graft from the wrist to replace part of Wilson's tongue as well as an artery from his arm to implant in his neck, he said.
To this day, Wilson said he continues to take medication for his thyroid, experiences fibrosis in his neck, attends swallow therapy and sleeps with an oxygen machine due to severe asthma. He said he also suffers from osteoradionecrosis in his jaw, a serious condition in which bone dies after being exposed to radiation therapy.
Wilson said he also started seeing a mental health specialist two years ago.
"I had a lot to unpack," he said. "It eases me and it helps me get back, and I know I had a lot of anxiety; I still do."
O'Connell, the firefighter, learned he had developed sarcoidosis when his wife was pregnant with the couple's first child, he said.
"I just [thought], this is the first child I'm gonna have. Maybe the only. I just want to get to that day. Get me to the day so I can see this baby and see you and her together, and then I'm good," O'Connell said.
O'Connell said he received drugs, including cancer medications and steroids as treatment. He said he was told there was never a case of sarcoidosis in the history of the FDNY until he was diagnosed but, since then, there have been many more cases, according to O'Connell.
O'Connell returned to work but said he had to retire as a lieutenant in 2010 after experiencing flare-ups while he was in the line of duty.
"That's your family. ... It's a house of 50 guys, and we do everything together," he said. "It's a family and leaving that is one of the worst things that's ever happened in my life."
Many first responders have died from their illnesses, including William Gormley, a firefighter with the New York City Fire Department.
His daughter, Bridget Gormley, said from 9/11 until his death, he had a persistent cough. She said her father was also riddled with skin cancer following his time at ground zero and was going to the doctor two or three times a year to remove cancerous tissue from several areas including his back, arms and nose.
In Christmas 2016, William Gormley was diagnosed with bladder cancer. The cancer spread to his lungs, and he died in June 2017.
"I think my father was well aware that it was caused from being downtown, ground zero, in the pit, in a pile," Bridget Gormley told ABC News. "He and his friends would joke, 'This is all going to kill us one day.' Very gallows humor, but I think they knew."
"I couldn't wrap my head around it': Civilians develop illnesses as well
9/11-related illnesses didn't just affect the first responders but also civilians, including people who were working in the area at the time.
Barbara Mohan, office administrator and paralegal at Barasch & McGarry, said she first realized something was wrong in 2016, when she tripped on an uneven sidewalk walking across City Hall Park on her way to the office and fell on her knee.
Mohan said she went to a hospital, where doctors determined she hadn't broken or fractured any bones. Within a week or two, Mohan said she started to get pain in her hip.
She said she went to an orthopedist, who diagnosed her with bursitis -- inflammation of a small fluid-filled sac that cushions the bones, tendons and muscles near joints -- and recommended physical therapy.
"The more I went to physical therapy, the more it hurts," Mohan told ABC News. "Another X-ray, and then [the orthopedist] sent me for an MRI, and it showed a lesion on my hip bone, kind of the top of the femur."
The doctor referred Mohan to Memorial Sloan Kettering Cancer Center, she said, where she was diagnosed with large B-cell lymphoma, a subtype of non-Hodgkin's lymphoma that affects the lymphatic system.
Mohan, who had been working in an office just blocks away from the World Trade Center since 1996 -- and returned to work three weeks later -- was told by colleagues at the firm that they believed her cancer was linked to her 9/11 exposure.
"I just couldn't wrap my head around it," she said. "I just got cancer. I guess I never associated it to [9/11] ever, not once. And I work here, two blocks away."
Barasch, the attorney, said he also developed cancer. In 2018, he was diagnosed with prostate cancer, which is the second most common cancer in the 9/11 community, and then years later, he was diagnosed with squamous cell carcinoma, a skin cancer, when doctors noticed irregular coloring under his thumb.
"Of course, I knew right away it was caused by my exposure," Barasch said. "I was here on 9/11, caught in the dust cloud, moved back three weeks later. ... So, I knew, because this is what I do for a living, I suspect the average civilian has no idea."
The fight for benefits
Feal, the demolition supervisor, said he was injured at ground zero on Sept. 17, 2001, when a falling piece of steel landed on his left foot. He said he developed gangrene, then sepsis, and eventually required a partial amputation.
He said he was denied compensation from the first 9/11 Victims' Compensation Fund (VCF) created by Congress because his injury occurred outside of a 96-hour window of eligibility for rescue workers. Feal was injured about 123 hours after the attack.
A spokesperson for the VCF told ABC News that questions about denied compensation under the first VCF "should be directed to those who implemented the program and formulated the regulations," and pointed to remarks VCF Special Master Allison Turkel provided during a press briefing last week.
The denial spurred Feal to become an advocate for 9/11 first responders. Feal founded the FealGood Foundation to help ground zero workers receive assistance, spread awareness and advocate, including lobbying members of Congress.
"I had nothing to prove. I had a documented injury," Feal said. "All of those men and women, uniform and non-uniform, and those people that [went] to work, that went to school in lower Manhattan, they had to prove they got sick from 9/11."
Feal and several first responders suffering from 9/11-related illnesses lobbied Congress in the late 2000s to help pass the James Zadroga 9/11 Health and Compensation Act of 2010, which provides health monitoring and aid to the first responders, volunteers and survivors of the attacks. This also led to the establishment of the WTC Health Program.
James Zadroga was an NYPD officer who responded to recovery efforts at ground zero and died in 2006 of a respiratory disease. Two separate autopsies reportedly linked his death to inhaling toxic substances at ground zero and he was the first NYPD officer whose death was attributed to exposure at the site.
Turkel said during the press briefing last week that the VCF has received more than 112,000 claims and has awarded more than $18.56 billion to over 77,000 claimants since reopening in 2011.
The Zadroga Act expired in 2015, and Feal and first responders went down again to Washington, D.C. O'Connell, the firefighter, testified before Congress, as did late night host Jon Stewart in a clip that went viral.
"What Jon did in those eight-and-a-half, nine minutes in front of Congress that America saw really moved the needle," Feal said.
In December 2015, the James Zadroga 9/11 Health and Compensation Reauthorization Act passed, which extended medical benefits to affected individuals until 2090.
25 years later
The first responders -- O'Connell, Wilson and Sanchez -- often conduct outreach, including speaking at schools, sharing with students their experiences at Ground Zero and their work to ensure first responders receive health care and compensation.
"I think [9/11 is] an historical event, but also, we're still living with ... many of the repercussions that happened that day," Wilson said. "So, I would like to see more schools make sure they're teaching about it."
The 9/11 Memorial & Museum announced earlier this year it will add a seventh moment of silence and a bell toll at this year's 25th commemoration ceremony to honor those who have died of illnesses related to their time at or near the World Trade Center site.
For the past 24 years, there have been six moments of silence followed by bell tolls: two to mark the times when the planes struck the World Trade Center towers; one to mark when a plane struck the Pentagon; one to mark when a plane crashed in Shanksville, Pennsylvania; and two to mark the collapses of the Twin Towers.
Knowing what they know now, and having suffered their various illnesses, O'Connell, Wilson and Sanchez all said they would respond to ground zero the way they did a quarter-century ago.
"I wouldn't change a thing," O'Connell said. "I can't say anything else but that. Nothing, not a thing."
