A brief review of the overall event and its major public and mental issues; what were the most significant health-related consequences and who was most affected; what do you feel were the most important recommendations or lessons learned of those mentioned in the report; and what are the major long-term issues.

Author: Jonathan B. Smith

Michigan State University 's School of Criminal Justice
Foundations of Homeland Security
Professor Phillip D. Schertzing, Ph.D.
Module 6: Public Health and Environmental Protection in Homeland Security
Case Study 9: Health Effects in the Aftermath of the World Trade Center Attack

Overview

The impact of the World Trade Center (WTC) bombing will have a potential lingering latent health effect upon as many as 400,000 people (more than 13 times the number of people who died from direct injuries suffered at the site) who were in and around the WTC at the time of the attacks (Heinrich, p. 1). These people were all exposed to a combination of airborne toxins including: pulverized concrete, fibrous glass, asbestos, other potentially harmful or carcinogenic particulate matter (Heinrich, p. 1). In reviewing the list of contaminants above, it becomes clear that the WTC attack was more than just an explosives attack it was also had a WMD chemical weapon component.

In addition to the physical effects, there are millions of people across the country that are facing serious mental health issues as a result of 9/11. The health related externalities from the WTC attack are not fully comprehended today; this is because diseases resulting from the attack may not fully present themselves for years to come. It is important that the health effects are understood, investigated and properly treated. The vast and unprecedented population affected by the attack has made it difficult to identify victims and distinguish attack related diseases from general health issues in the population.

Significant Health-Related Consequences and Parties Effected

There were two primary conditions that affected the largest portion of the population following the WTC attack:

The respiratory issues were characterized by "wheezing, shortness of breath, sinusitis, asthma and a new syndrome called WTC cough, which consists of a persistent cough accompanied by severe respiratory problems (Heinrich, p. 1)." Almost all of the firefighters who responded to the WTC attack complained of respiratory related issues and hundreds of them were eventually forced to retire from the department (Heinrich, p. 2). In addition to the firefighters, there were many other populations affected by the air quality issues including:

Similar to the mesothelioma related deaths caused by asbestos exposure during the 20th Century, it is almost certain that the attacks of 9/11 will result in thousands of additional casualties resulting in premature deaths.

The mental health effect of the attacks impacted a far larger portion of the population, unlimited by physical geography. The most common diagnosis was Post Traumatic Stress Disorder (PTSD). PTSD is caused by exposure to trauma that includes symptoms such as "difficulty sleeping, irritability or anger, detachment or estrangement, poor concentration, distressing dreams, intrusive memories and images, and avoidance of reminders of trauma (Heinrich, p. 12)." The incidence of PTSD were higher in the vicinity of the site, but the effects of the event had a ripple effect on the mental health across the entire nation. Symptoms of anxiety, stress and depression were commonly diagnosed mental health issues. People reported difficulty focusing on their daily routines and responsibilities and often resorted to the escapes of alcohol, tobacco and illicit substances. The whole nation was in mourning and the lingering mental health effect can even be seen today. Many New Yorkers believe that the city has never truly regained its pre-attack level of energy, sadly it may never again.

Recommendations, Lessons & Long-Term Issues

The long term health issues are difficult to fully predict. The chemical attack suffered by those exposed to the dust in the aftermath will very likely affect their health for the remainder of their lives. There are significant public health and policy issues relating to this "ticking time bomb." The attack may eventually result in more workers' compensation and disability related liability than any single event in history. The initial insurance estimate of $50 billion in loses (Hillman, p. 8) could potentially double or even triple, as a result of future worker's compensation and disability claims. The insurance industry and the government are actively working to try and limit the scope of the class of victims entitled to benefits. In the future these benefit and compensation issues will prove to be the thorniest and most persistent reminders of the attack.

Works Sited

Heinrich, Janet. (2004). "Health Effects in the Aftermath of the World Trade Center Attack." GAO.
Retrieved November 9, 2004, from
http://ww.gao.gov/new.items/d041068t.pdf

Hillman, Richard J. (2002). "Terrorism Insurance: Rising Uninsured Exposure to Attacks Heightens Potential Economic Vulnerabilities." GAO.
Retrieved November 9, 2004 from
http://www.gao.gov/new.items/d02472t.pdf

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